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1.
Jonathan D. Auten John H. Naheedy Nicole D. Hurst Andrew T. Pennock Kathryn A. Hollenbach John T. Kanegaye 《The American journal of emergency medicine》2019,37(5):832-838
Objective
Emergency department (ED) reduction of pediatric fractures occurs most commonly in the forearm and can be challenging if fluoroscopy is not available. We sought to assess the ability of point of-care ultrasonography (POCUS) to predict adequacy of reduction by fluoroscopy.Methods
We prospectively enrolled ED patients 0–17?years of age with radial and/or ulnar fractures requiring reduction under fluoroscopic guidance. Post-reduction POCUS (probe dorsal, volar, and coronal) and fluoroscopic (AP and lateral) fracture images were recorded. Fracture angles were compared between blinded POCUS and fluoroscopic measurements and between POCUS measurements by a blinded emergency physician and a blinded radiologist, reporting mean differences and 95% confidence intervals. We calculated sensitivity, specificity, and likelihood ratios of POCUS in the prediction of fluoroscopically detected post-reduction malalignment, as interpreted by a blinded pediatric orthopaedist.Results
The 58 patients were 7.9?±?3.5?years of age and had 21 radial (36%), 1 ulnar (2%), and 36 radioulnar (62%) fractures. Fluoroscopy and POCUS angles were within a mean of 0.1°–3.2°, depending on the site and surface measured. Radiologist- and emergency physician-interpreted POCUS measurements were within a mean of 1° in all dimensions. POCUS identified inadequate reductions with 100% sensitivity and 92–93% specificity.Conclusions
Blinded emergency medicine and radiology interpretations of post-reduction POCUS fracture images agree closely. Post-reduction POCUS measurements are comparable to those obtained by fluoroscopy and accurately predict adequacy of reduction. POCUS can be used to guide pediatric fracture reduction when bedside fluoroscopy is not available in the ED. 相似文献2.
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《The American journal of emergency medicine》2020,38(1):1-6
ObjectiveWe sought to assess interrater reliability (IRR) of lung point-of-care ultrasound (POCUS) findings among pediatric patients with suspected pneumonia.MethodsA convenience sample of patients between the ages of 6 months and 18 years with a clinical suspicion of pneumonia had a lung ultrasound performed by a POCUS-credentialed emergency medicine physician with subsequent expert review. Each lung zone was assessed as either normal or abnormal, and specific ultrasound findings were recorded. IRR was assessed by intraclass correlation coefficient (ICC) and kappa statistics.ResultsSeventy-one patients, with a total of 852 lung zones imaged, were included. The sonographer assessment of normal versus abnormal, across each of the zones, demonstrated moderate agreement with ICC 0.46 (95% CI: 0.41, 0.52) and kappa 0.56. Right-sided zones demonstrated moderate agreement [0.43 (CI 0.35, 0.51)] while left-sided zones, specifically left-sided anterior zones, showed only fair agreement [0.36 (0.28, 0.44)]. IRR varied between specific findings: ICC for B-lines 0.52 (95% CI: 0.46, 0.57), pleural effusion 0.40 (0.34, 0.45), consolidation 0.39 (0.33, 0.44), subpleural consolidation 0.31 (0.25, 0.37), and pleural line irregularity 0.16 (0.10, 0.23). A composite indicator of typical pneumonia findings (consolidation, B-lines, and pleural effusion) demonstrated moderate [ICC 0.52 (0.46, 0.57)] reliability.ConclusionsWe found moderate interrater reliability of lung POCUS findings for the assessment of pediatric patients with suspected pneumonia. B-lines had the highest reliability. Further assessment of lung POCUS is necessary to guide proper training and optimal scanning techniques to ensure adequate reliability of ultrasound findings in the assessment of pediatric pneumonia. 相似文献
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Po-Yang Tsou Yu-Hsun Wang Yu-Kun Ma Julia K. Deanehan Jason Gillon Eric H. Chou Tzu-Chun Hsu Yuan-Chun Huang Judy Lin Chien-Chang Lee 《The American journal of emergency medicine》2019,37(9):1760-1769
ObjectiveIt is unclear whether point-of-care ultrasound (POCUS) by emergency medicine physicians is as accurate as radiology-performed ultrasound (RADUS). We aim to summarize the diagnostic accuracy of ultrasonography for intussusception and to compare the performance between POCUS and RADUS.MethodsDatabases were searched from inception through February 2018 using pre-defined index terms. Peer-reviewed primary studies that investigated the diagnostic accuracy of ultrasound for intussusception in children were included. The study is reported using Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). Meta-analysis of the diagnostic accuracy of ultrasound for intussusception was conducted using the random-effects bivariate model. Subgroup analysis (POCUS vs RADUS) was also performed. Meta-regression was utilized to determine if the diagnostic accuracy between POCUS and RADUS was significantly different.ResultsThirty studies (n = 5249) were included in the meta-analysis. Ultrasonography for intussusception has a sensitivity: 0.98 (95% CI: 0.96–0.98), specificity: 0.98 (95% CI: 0.95–0.99), positive likelihood ratio: 43.8 (95% CI: 18.0–106.7) and negative likelihood ratio: 0.03 (95% CI: 0.02–0.04), with an area under ROC (AUROC) curve of 0.99 (95% CI: 0.98–1.00). Meta-regression suggested no significant difference in the diagnostic accuracy for intussusception between POCUS and RADUS (AUROC: 0.95 vs 1.00, p = 0.128).ConclusionsCurrent evidence suggested POCUS has a high diagnostic accuracy for intussusception not significantly different from that of RADUS. 相似文献
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Children with complaints of hip pain, a painful limp, or refusal to weight bear commonly present to the Emergency Department (ED). The ability to use point-of-care ultrasound in the ED to diagnose a hip joint effusion and to guide arthrocentesis can be helpful to facilitate diagnosis and management of these children. The capsular-synovial thickness of the hip is measured from the anterior bony cortical surface to the posterior surface of the iliopsoas muscle at the concavity of the femoral neck. A capsular-synovial thickness > 5 mm, or > 2 mm difference compared to the asymptomatic contralateral hip are the described sonographic criteria for hip joint effusion in children. We report on the use of point-of-care ultrasound to diagnose hip effusion and to guide arthrocentesis in a series of pediatric patients presenting with hip pain to the ED. 相似文献
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Volpicelli G Elbarbary M Blaivas M Lichtenstein DA Mathis G Kirkpatrick AW Melniker L Gargani L Noble VE Via G Dean A Tsung JW Soldati G Copetti R Bouhemad B Reissig A Agricola E Rouby JJ Arbelot C Liteplo A Sargsyan A Silva F Hoppmann R Breitkreutz R Seibel A Neri L Storti E Petrovic T;International Liaison Committee on Lung Ultrasound 《Intensive care medicine》2012,38(4):577-591
Background
The purpose of this study is to provide evidence-based and expert consensus recommendations for lung ultrasound with focus on emergency and critical care settings.Methods
A multidisciplinary panel of 28 experts from eight countries was involved. Literature was reviewed from January 1966 to June 2011. Consensus members searched multiple databases including Pubmed, Medline, OVID, Embase, and others. The process used to develop these evidence-based recommendations involved two phases: determining the level of quality of evidence and developing the recommendation. The quality of evidence is assessed by the grading of recommendation, assessment, development, and evaluation (GRADE) method. However, the GRADE system does not enforce a specific method on how the panel should reach decisions during the consensus process. Our methodology committee decided to utilize the RAND appropriateness method for panel judgment and decisions/consensus.Results
Seventy-three proposed statements were examined and discussed in three conferences held in Bologna, Pisa, and Rome. Each conference included two rounds of face-to-face modified Delphi technique. Anonymous panel voting followed each round. The panel did not reach an agreement and therefore did not adopt any recommendations for six statements. Weak/conditional recommendations were made for 2 statements, and strong recommendations were made for the remaining 65 statements. The statements were then recategorized and grouped to their current format. Internal and external peer-review processes took place before submission of the recommendations. Updates will occur at least every 4?years or whenever significant major changes in evidence appear.Conclusions
This document reflects the overall results of the first consensus conference on “point-of-care” lung ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20?years. Recommendations were produced to guide implementation, development, and standardization of lung ultrasound in all relevant settings. 相似文献8.
David C. Mackenzie Aftab M. Azad Vicki E. Noble Andrew S. Liteplo 《The American journal of emergency medicine》2019,37(1):123-126
Objective
We sought to determine test performance characteristics of emergency physician ultrasound for the identification of gastric contents.Methods
Subjects were randomized to fast for at least 10?h or to consume food and water. A sonologist blinded to the patient's status performed an ultrasound of the stomach 10?min after randomization and oral intake, if applicable. The sonologist recorded their interpretation of the study using three sonographic windows. Subsequently 2 emergency physicians reviewed images of each study and provided an interpretation of the examination. Test performance characteristics and inter-rater agreement were calculated.Results
45 gastric ultrasounds were performed. The sonologist had excellent sensitivity (92%; 95% CI 73%–99%) and specificity (85%; 95% CI 62%–92%). Expert review demonstrated excellent sensitivity but lower specificity. Inter-rater agreement was very good (κ?=?0.64, 95%CI 0.5–0.78).Conclusion
Emergency physician sonologists were sensitive but less specific at detecting stomach contents using gastric ultrasound. 相似文献9.
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We read with interest the review article in volume 9 issue 5 Journal of Acute Disease, entitled "Using point-of-care ultrasound in ocular emergencies: a mini review" by Builes et al. Ocular point-of-care ultrasound (POCUS) is gaining popularity under the COVID-19 pandemic, as physicians are of close proximity to patients under normal practice with slit lamp and direct ophthalmoscope. With the help of POCUS, patients with ocular emergencies could be evaluated at a distance, without even a need to share mydriatic eye drops across patients. Therefore, we would like to update the current evidence on ocular POCUS usage. 相似文献
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重症床旁即时超声凭借其简便实用、快速直观等优势在诊断和评估重症患者病情中得到了广泛的应用和普及,为了确保该技术安全、有效的运用,重症床旁即时超声需要良好的培训、教育和资格认证体系,并有必要将此培训纳入急诊、麻醉和重症医生的常规培训项目。其培训和教育应当把握重点,突出特色,分级、持续深入地培训,同时采用多样化的教学方法,培养医护人员良好的临床实践能力。当前,在培训和教育中仍存在一些困难,需要努力克服。 相似文献
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Mariko Nomura Daniel Mantuani Arun Nagdev 《The American journal of emergency medicine》2018,36(3):526.e5-526.e6
Vision loss in young adults is relatively rare. In patients with suspected HIV or syphilis, the risk of developing vision loss is increased, and should alert the emergency physician of specific retinal pathologies. We present a case of a 33-year-old man with recently identified syphilis and HIV, who was diagnosed with bilateral retinal detachments (RDs) with the help of point-of-care ultrasound (POCUS) in the setting of panuveitis (preventing visualization with direct fundoscopy). 相似文献
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Rui-ting Li Yue Zhao Xiao-jing Zou Hua-qing Shu Ting Zhou Shang-wen Pan Xue-hui Gao Hai-yan Huang Hong Liu You Shang 《世界急诊医学杂志(英文)》2022,13(2):135-140
Intestinal obstruction(IO),which refers to a partial or complete blockage of the intestine,is an emergency gastrointestinal disorder commonly seen in the intensive care unit(ICU)and emergency department and associated with high morbidity and mortality.[1,2]Common etiologies of IO include adhesions,hernias,intussusception,foreign bodies,ischemia,tumors,etc.Delay in the diagnosis and management of IO is associated with higher mortality due to complications such as bowel necrosis,perforation,sepsis,and septic shock.[3]IO can be divided into small bowel obstruction(SBO)and colonic obstruction(CO).In SBO,74%of cases are caused by adhesions,which may respond to conservative management.It is critical to identify which of those cases may progress and require emergent surgical intervention with the help of the diagnostic and assessment tools.In contrast to SBO,most cases of CO demand surgery.In this instance,appropriate assessment tools are required to define the location of the obstruction,which will assist in the proper surgical procedure.[4] 相似文献
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《The Journal of emergency medicine》1999,17(1):53-56
Hypnosis can diminish pain and anxiety for many emergency patients during examinations and procedures. While hypnosis has been used for millennia and was demonstrated to be of use in clinical medicine more than a century ago, modern physicians have been reluctant to adopt this technique in clinical practice. This article describes four children with angulated forearm fractures who had no possible access to other forms of analgesia during reduction, and in whom hypnosis was used successfully. A simple method for hypnotic induction is described. 相似文献
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Kyu Chul Shin Young Rock Ha Seong-Joon Lee Jung Hwan Ahn 《World Journal of Clinical Cases》2020,8(19):4286-4302
Point-of-care ultrasound (POCUS) is a powerful diagnostic tool and provides treatment guidelines in acute critical settings. However, the limitation of using POCUS is operator dependent. Appropriate and validated training for acquiring and using skills in practice must be conducted before using POCUS in clinical settings in order to keep patients safe. Simulation education models have been introduced as a way to solve and overcome these concerns. However, the commercial simulator with sufficiently secured fidelity is expensive and not always available. This review focused on the inexpensive and easily made simulators for education on POCUS in critical specific situations related to the airway, breathing, circulation, and disability. We introduced the simulators that used non-infectious materials, with easily transportable features, and that had a sonographic appearance reproducibility similar to human tissue. We also introduced the recipe of each simulator in two parts: Materials surrounding disease simulators (surrounding materials) and specific disease simulators themselves (target simulators). This review article covered the following: endotracheal or oesophageal intubation, lung (A-lines, B-lines, lung sliding, and pleural effusions such as hemothorax), central vein access, pericardial fluid (cardiac tamponade), the structure related to the eyes, soft tissue abscess, nerve (regional nerve block), and skull fracture simulators. 相似文献
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William Thomas MBBS GradDipSurgAnat GradCertClinUS Jonathan Henry MBChB MClinUS CCPU AFRACMA FACEM Jay Ee Chew MD Manuja Premaratne MBBS FRACP FSCCT FCSANZ Gabriel Blecher MBBS PGradDipMan MSc CCPU FACEM Darsim L Haji MBChB PhD PGradDipCritCareEcho FACEM 《Emergency medicine Australasia : EMA》2023,35(5):720-730
Point-of-care ultrasound (POCUS) is becoming ubiquitous in emergency medicine. POCUS for abdominal aortic aneurysm is well established in practice. The thoracic aorta can also be assessed by POCUS for dissection and aneurysm and transthoracic echocardiography is endorsed by international guidelines as an initial test for thoracic aortic pathologies. A systematic search of Ovid Medline, PubMed, EMBASE, SCOPUS and Web of Science from January 2000 to August 2022 identified four studies evaluating diagnostic accuracy of emergency physician POCUS for thoracic aortic dissection (TAD) and five studies for thoracic aortic aneurysm (TAA). Study designs were heterogeneous including differing diagnostic criteria for aortic pathology. Convenience recruitment was frequent in prospective studies. Sensitivity and specificity ranges for studies of TAD were 41–91% and 94–100%, respectively when an intimal flap was seen. Sensitivity and specificity ranges for studies of thoracic aorta dilation >40 mm were 50–100% and 93–100%, respectively; for >45 mm ranges were 64–65% and 95–99%. Literature review identified that POCUS is specific for TAD and TAA. POCUS reduces the time to diagnosis of thoracic aortic pathology; however, it remains insensitive and cannot be recommended as a stand-alone rule-out test. We suggest that detection of thoracic aorta dilation >40 mm by POCUS at any site increases the suspicion of serious aortic pathology. Studies incorporating algorithmic use of POCUS, Aortic Dissection Detection Risk Score and D-dimer as decision tools are promising and may improve current ED practices. Further research is warranted in this rapidly evolving field. 相似文献