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1.
Shao-Feng Liao Pai-Jung Chen Chung-Hsien Chaou Ching-Hsing Lee 《The American journal of emergency medicine》2018,36(8):1429-1438
Study objectives
Point-of-care ultrasound (POCUS) has been a rapidly growing and broadly used modality in recent decades. The purpose of this study was to determine how POCUS is incorporated into clinical medicine by analyzing trends of use in the published literature.Methods
POCUS-related publications were retrieved from the Web of Science (WoS) database. The search results were ranked according to the number of times an article was cited during three time frames and average annual number of citations. Of the top 100 most cited publications in the four rankings, information regarding the publication journal, publication year, first author's nationality, field of POCUS application, and number of times the article was cited was recorded for trend analysis.Results
A total of 7860 POCUS-related publications were retrieved, and publications related to POCUS increased from 8 in 1990 to 754 in 2016. The top 148 cited publications from the four ranking groups were included in this study. Trauma was the leading application field in which POCUS was studied prior to 2001. After 2004, thorax, cardiovascular, and procedure-guidance were the leading fields in POCUS research. >79% (118/148) of the top-cited publications were conducted by authors in the United States, Italy, and France. The majority of publications were published in critical care medicine and emergency medicine journals.Conclusions
In recent years, publications relating to POCUS have increased. POCUS-related research has mainly been performed in thorax, cardiovascular, and procedure-guidance ultrasonography fields, replacing trauma as the major field in which POCUS was previously studied. 相似文献2.
Brit Long Stephen Alerhand Kurian Maliel Alex Koyfman 《The American journal of emergency medicine》2018,36(3):488-493
Introduction
Cardiac arrest management primarily focuses on optimal chest compressions and early defibrillation for shockable cardiac rhythms. Non-shockable rhythms such as pulseless electrical activity (PEA) and asystole present challenges in management. Point-of-care ultrasound (POCUS) in cardiac arrest is promising.Objectives
This review provides a focused assessment of POCUS in cardiac arrest, with an overview of transthoracic (TTE) and transesophageal echocardiogram (TEE), uses in arrest, and literature support.Discussion
Cardiac arrest can be distinguished between shockable and non-shockable rhythms, with management varying based on the rhythm. POCUS provides a diagnostic and prognostic tool in the emergency department (ED), which may improve accuracy in clinical decision-making. Several protocols incorporate POCUS based on different cardiac views. TTE includes parasternal long axis, parasternal short axis, apical 4-chamber, and subxiphoid views, which may be used in cardiac arrest for diagnosis of underlying cause and potential prognostication. TEE is conducted by inserting the probe into the esophagus of intubated patients, with several studies evaluating its use in cardiac arrest. It is associated with few adverse effects, while allowing continued compressions (and evaluation of those compressions) and not interrupting resuscitation efforts.Conclusions
POCUS is a valuable diagnostic and prognostic tool in cardiac arrest, with recent literature supporting its diagnostic ability. TTE can guide resuscitation efforts dependent on the rhythm, though TTE should not interrupt other resuscitation measures. TEE can be useful during arrest, but further studies based in the ED are needed. 相似文献3.
Margaret J. Lin Mark Neuman Rachel Rempell Michael Monuteaux Jason Levy 《The Journal of emergency medicine》2018,54(1):96-101
Background
Point-of-care ultrasound (POCUS) is increasingly being used to differentiate cellulitis from abscess in the pediatric emergency department (ED). POCUS has also been shown to decrease length of stay (LOS) for other applications among adult patients.Objective
We sought to determine if ED LOS differed for children presenting with skin and soft tissue infections who received POCUS versus radiology-performed ultrasound.Methods
We performed a retrospective cohort study of children presenting to an urban pediatric ED between January 2011 and June 2013 with a diagnosis of cellulitis or abscess who underwent soft tissue ultrasound. Patients who received a surgical consult, had significant medical comorbidities, or had a lesion located on the face, hands, feet, or groin were excluded. We compared ED LOS among children who received radiology-performed ultrasound to children who received POCUS, adjusting for relevant clinical variables.Results
Among 3094 children with a diagnosis of cellulitis or abscess, we identified 202 who underwent a POCUS and 118 who underwent radiology-performed ultrasound. The POCUS group had a shorter median LOS than the radiology-performed ultrasound group (adjusted median difference –73 min; 95% confidence interval –93.6 to –52.4 min). In the subset of patients discharged from the ED, this difference was more pronounced (adjusted median difference –89 min; 95% confidence interval –109.9 to –68.1 min).Conclusion
Among children presenting to a pediatric ED with superficial skin and soft tissue infections, children receiving POCUS experienced shorter LOS compared to children receiving radiology-performed ultrasound. 相似文献4.
David Kanon Paige Skinner William A. Kennedy Angela R. Cirilli 《The Journal of emergency medicine》2017,52(5):e175-e177
Background
Foreign body (FB) impaction in the oropharyngeal region—and specifically the tongue—is a common problem in the emergency department that often requires specialty consultation and admission for operative intervention. Over the years, the use of point of care ultrasound (POCUS) has increased ease and success of FB removal in other anatomic regions, but is only rarely reported for extraction of FB from the tongue outside of the operating room.Case Report
This case demonstrates a unique case of ultrasound-guided removal of a fishbone from the tongue in the emergency department after blind attempts failed. Operative intervention and admission were initially avoided; however, because of initial failed attempts and blind dissection before the use of POCUS, the patient presented a day later requiring admission for postprocedural tongue swelling and edema.Why Should an Emergency Physician Be Aware of This?
Emergency physicians should be aware that POCUS may assist in FB localization in the tongue. 相似文献5.
Lisa Mills Eric J. Morley Zachary Soucy Gary M. Vilke Samuel H.F. Lam 《The Journal of emergency medicine》2018,54(2):215-220
Background
This review provides practicing emergency physicians updated information regarding point-of-care ultrasound (POCUS) imaging of patients with suspected urolithiasis.Methods
A PubMed literature search was conducted for articles published between January 1, 1996 and May 31, 2017 and limited to human clinical trials written in English with relevant keywords. High-quality studies identified then underwent a structured review. Recommendations herein are made based on the literature review.Results
Two hundred seventy-two abstracts fulfilling the search criteria were screened and 10 appropriate articles were rigorously reviewed in detail. There were 8 prospective studies and 2 retrospective studies. Only 1 of them was a multi-institutional randomized trial. POCUS performed in the emergency department (ED) is moderately sensitive and specific in making the diagnosis of urolithiasis in symptomatic patients. Suspected urolithiasis patients evaluated initially with ED POCUS have complication rates compatible with those evaluated initially with computed tomography.Conclusions
POCUS has moderate accuracy in making the diagnosis of urolithiasis. Nevertheless, it may be safely used as a first line of imaging in ED patients with suspected symptomatic urolithiaisis. 相似文献6.
Background
Infant lumbar punctures (LPs) are common procedures performed in the emergency department. However, 10% to 35% of these LPs are unsuccessful or grossly bloody, which can lead to increased hospitalization, increased costs, and prolonged exposure to antibiotics or antivirals. Point of care ultrasound (POCUS) may help to surmount the intrinsic causes of LP failure by providing a visual guide of the vascular structures in the needle path before a LP is performed.Case Report
We report two cases where color flow Doppler POCUS was used to identify vascular structures around the spinal canal in infants before attempting a LP.Why Should An Emergency Physician Be Aware of This?
Color flow Doppler POCUS directly visualizes the spinal vascular structures in infants and may help guide the physician in the decision-making process of what intervertebral space and stylet placement to use for a LP. 相似文献7.
Background
A subluxation of the radial head (SRH) is a clinical condition that commonly occurs in children under 6 years of age. History and physical examination findings typically include a child who presents with an elbow held in extension and with forearm pronation, after having suffered significant longitudinal traction on the arm, or after a fall on an outstretched hand. The diagnosis is often clinically obvious. The injury responds dramatically to closed reduction, and usually no imaging is required. However, cases with atypical presentations and patients who do not respond favorably to a reduction maneuver present clinical challenges, because the initial diagnosis of SRH may seem to be questionable or erroneous. Point-of-care ultrasound (POCUS) can assist decision-making and clinical management for these patients.Case Reports
We report three cases of SRH that were diagnosed and managed with POCUS in the emergency department.Why Should an Emergency Physician Be Aware of This?
POCUS can assist in the diagnosis and management of patients with clinical suspicion of SRH, especially in cases of atypical presentations or cases in which the mechanism of injury is unknown. It is also an extremely valuable tool in determining postprocedure reduction success. 相似文献8.
Chelsea A. Tafoya Matthew J. Tafoya Maxwell Osei-Ampofo Rockefeller A. Oteng Torben K. Becker 《The Journal of emergency medicine》2017,52(5):723-730
Background
Point-of-care-ultrasound (POCUS) is an increasingly important tool for emergency physicians and has become a standard component of emergency medicine residency training in high-income countries. Cardiopulmonary ultrasound (CPUS) is emerging as an effective way to quickly and accurately assess patients who present to the emergency department with shock and dyspnea. Use of POCUS, including CPUS, is also becoming more prevalent in low- and middle-income countries (LMICs); however, formal ultrasound training for emergency medicine resident physicians in these settings is not widely available.Objectives
To evaluate the feasibility of integrating a high-intensity ultrasound training program into the formal curriculum for emergency medicine resident physicians in an LMIC.Methods
We conducted a pilot ultrasound training program focusing on CPUS for 20 emergency medicine resident physicians in Kumasi, Ghana, which consisted of didactic sessions and hands-on practice. Competency was assessed by comparing pretest and posttest scores and with an Objective Structured Clinical Examination (OSCE) performed after the final training session.Results
The mean score on the pretest was 61%, and after training, the posttest score was 96%. All residents obtained passing scores above 70% on the OSCE.Conclusion
A high-intensity ultrasound training program can be successfully integrated into an emergency medicine training curriculum in an LMIC. 相似文献9.
Tobias Kummer Laura Oh Mary Beth Phelan Robert D. Huang Jason T. Nomura Srikar Adhikari 《The American journal of emergency medicine》2018,36(7):1287-1294
Introduction
Contrast-enhanced ultrasound (CEUS) using intravascular microbubbles has potential to revolutionize point-of-care ultrasonography by expanding the use of ultrasonography into clinical scenarios previously reserved for computed tomography (CT), magnetic resonance imaging, or angiography.Methods
We performed a literature search and report clinical experience to provide an introduction to CEUS and describe its current applications for point-of-care indications.Results
The uses of CEUS include several applications highly relevant for emergency medicine, such as solid-organ injuries, actively bleeding hematomas, or abdominal aortic aneurysms. Compared with CT as the preeminent advanced imaging modality in the emergency department, CEUS is low cost, radiation sparing, repeatable, and readily available. It does not require sedation, preprocedural laboratory assessment, or transportation to the radiology suite.Conclusions
CEUS is a promising imaging technique for point-of-care applications in pediatric and adult patients and can be applied for patients with allergy to CT contrast medium or with impaired renal function. More high-quality CEUS research focusing on accuracy, patient safety, health care costs, and throughput times is needed to validate its use in emergency and critical care settings. 相似文献10.
Background
Acute proximal hamstring ruptures can be a diagnostic challenge in the emergency department. The revealing sign of large posterior thigh ecchymosis is typically not yet present; the physical examination is limited due to pain, radiographs can be unremarkable, and definitive testing with magnetic resonance imaging is not practical. These avulsions are often misdiagnosed as hamstring strains and treated conservatively. The diagnosis is made after failed treatment, often months after the injury. Surgical repair at that time can be technically challenging and higher risk due to tendon retraction and adhesion of the tendon stump to the sciatic nerve.Case Reports
The first case illustrates an example of how delay in diagnosis can occur in both emergency medicine and outpatient primary care settings. It also shows complications and morbidity potential for patients who warrant and do not receive timely surgical repair. The second case illustrates physical examination findings obtainable during the acute setting, and the use of point-of-care ultrasound (POCUS) in facilitating an expedited diagnosis and treatment plan.Why Should an Emergency Physician Be Aware of This?
Timely diagnosis of hamstring rupture is paramount to optimize patient outcomes for this serious injury. The best results are obtained with surgical repair within 3–6 weeks of injury. POCUS evaluation can aid significantly in the timely diagnosis of this injury. If the POCUS examination raises clinical concern for a proximal hamstring rupture, this may allow for earlier diagnosis and definitive treatment of proximal hamstring rupture. 相似文献11.
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12.
Joseph S. Colla Pavitra Kotini-Shah Savannah Soppet Yi-Fan Chen Robert Molokie Puja Prajapati Heather M. Prendergast 《The American journal of emergency medicine》2018,36(10):1855-1861
Background
Acute chest syndrome (ACS) is the leading cause of death for patients with sickle cell disease (SCD). Early recognition of ACS improves prognosis.Objective
Investigate the use of bedside lung ultrasound (BLU) in identification of early pulmonary findings associated with ACS in SCD patients.Methods
Prospective, observational study of a convenience sample of SCD patients presenting to the Emergency Department (ED) for a pain crisis. BLU interpretations were made by an emergency physician blinded to the diagnosis of ACS, and were validated by a second reviewer. The electronic medical record was reviewed at discharge and at 30?days.Results
Twenty SCD patients were enrolled. Median age was 31?years, median hemoglobin was 7.7?g/dL. Six patients developed ACS. Five patients in the ACS group had lung consolidations on BLU (83%) compared to 3 patients in the non-ACS group (21%), p?=?0.0181, (OR?=?12.05, 95% CI 1.24 to 116.73). The ACS group was also more likely to have a pleural effusion and B-lines on BLU than the non-ACS group, p?=?0.0175; 0.1657, respectively. In the ACS group, peripheral and frank consolidations on BLU was 83% and 50% sensitive, 79% and 100% specific for ACS, respectively; whereas an infiltrate on initial chest X-ray (CXR) was only 17% sensitive. BLU identified lung abnormalities sooner than CXR (median 3.6 vs. 31.8?h).Conclusions
Pulmonary abnormalities on BLU of an adult SCD patient presenting to the ED for a painful crisis appear before CXR, and highly suggest ACS. BLU is a promising predictive tool for ACS. 相似文献13.
James Siu Ki Lau Chi Kit Yuen Ka Leung Mok Wing Wa Yan Pui Gay Kan 《The American journal of emergency medicine》2018,36(7):1134-1138
Objectives
This study is to present the diagnostic values of the novel sonographic visualization of the inferoposterior thoracic wall (VIP) and boomerang signs in detecting right pleural effusion by sonologists with little to no experience in ultrasound.Methods
A prospective analysis of a convenience sample of patients who were assessed by junior intensive care physicians was performed. The patients all underwent computed tomography (CT) of the chest or abdomen with lung bases as part of their care regardless of indication; the results were interpreted by radiologists and were considered the gold standard. Sonography was performed to assess for the presence of the VIP and boomerang signs. Sonographic and chest radiographic findings were compared against CT results.Results
73 patients were enrolled. The sensitivity and specificity for the VIP sign were 0.85 (95% confidence interval [CI], 0.67–0.94) and 0.86 (95% CI, 0.70–0.95). The sensitivity and specificity for the boomerang sign were 0.78 (95% CI, 0.60–0.90) and 0.87 (95% CI, 0.71–0.95). However, the sensitivity and specificity for the traditional approach of detecting an anechoic collection above the diaphragm to indicate pleural effusion were only 0.54 (95% CI, 0.37–0.71) and 0.86 (95% CI, 0.80–0.99).Conclusions
Despite inexperience in sonography, the novel VIP and boomerang signs show high diagnostic values in detecting right pleural effusion compared to the traditional methods. 相似文献14.
Rasha E. Buhumaid Julie St-Cyr Bourque Hamid Shokoohi Irene W.Y. Ma Mckenna Longacre Andrew S. Liteplo 《The American journal of emergency medicine》2019,37(2):298-303
Objective
The differential diagnoses of patients presenting with chest pain (CP) and shortness of breath (SOB) are broad and non-specific. We aimed to 1) determine how use of point-of-care ultrasound (POCUS) impacted emergency physicians' differential diagnosis, and 2) evaluate the accuracy of POCUS when compared to chest radiograph (CXR) and composite final diagnosis.Methods
We conducted a prospective observational study in a convenience sample of patients presenting with CP and SOB to the Emergency Department (ED). Treating physicians selected possible diagnoses from a pre-indexed list of possible diagnoses of causes of CP and SOB. The final composite diagnosis from a chart review was determined as the reference standard for the diagnosis. The primary analysis involved calculations of sensitivity and specificity for POCUS identifiable diagnoses in detecting cause of CP and SOB. Additional comparative accuracy analysis with CXRs were conducted.Results
128 patients with a mean age of 64?±?17?years were included in the study. Using a reference standard of composite final diagnoses, POCUS had equal or higher specificity to CXR for all indications for which it was used, except for pneumonia. POCUS correctly identified all patients with pneumothorax, pleural effusion and pericardial effusion. In patients with a normal thoracic ultrasound, CXR never provided any actionable clinical information. Adding POCUS to the initial evaluation causes a significant narrowing of the differential diagnoses in which the median differential diagnosis from 5 (IQR 3–6) to 3 (IQR 2–4) p?<?0.001.Conclusion
In evaluation of patients with CP and SOB, POCUS is a highly feasible diagnostic test which can assist in narrowing down the differential diagnoses. In patients with a normal thoracic ultrasound, the added value of a CXR may be minimal. 相似文献15.
Brent A. Becker Eric Chin Eric Mervis Craig L. Anderson Masaru H. Oshita J. Christian Fox 《The Journal of emergency medicine》2014
Background
Measurement of the common bile duct (CBD) has traditionally been considered an integral part of gallbladder sonography, but accurate identification of the CBD can be difficult for novice sonographers.Objective
To determine the prevalence of isolated sonographic CBD dilation in emergency department (ED) patients with cholecystitis or choledocholithiasis without laboratory abnormalities or other pathologic findings on biliary ultrasound.Methods
We conducted a retrospective chart review on two separate ED patient cohorts between June 2000 and June 2010. The first cohort comprised all ED patients undergoing a biliary ultrasound and subsequent cholecystectomy for presumed cholecystitis. The second cohort consisted of all ED patients receiving a biliary ultrasound who were ultimately diagnosed with choledocholithiasis. Ultrasound data and contemporaneous laboratory values were collected. Postoperative gallbladder pathology reports and endoscopic retrograde cholangiopancreatography (ERCP) reports were used as the criterion standard for final diagnosis.Results
Of 666 cases of cholecystitis, there were 251 (37.7%) with a dilated CBD > 6 mm and only 2 cases (0.3%; 95% confidence interval [CI] 0.0–0.7%) of isolated CBD dilation with an otherwise negative ultrasound and normal laboratory values. Of 111 cases of choledocholithiasis, there were 80 (72.0%) with a dilated CBD and only 1 case (0.9%; 95% CI 0.0–2.7%) with an otherwise negative ultrasound and normal laboratory values.Conclusion
The prevalence of isolated sonographic CBD dilation in cholecystitis and choledocholithiasis is <1%. Omission of CBD measurement is unlikely to result in missed cholecystitis or choledocholithiasis in the setting of a routine ED evaluation with an otherwise normal ultrasound and normal laboratory values. 相似文献16.
Jesper Weile Christian B. Laursen Christian A. Frederiksen Ole Graumann Erik Sloth Hans Kirkegaard 《BMC emergency medicine》2018,18(1):60
Background
Point-of-care ultrasound (POCUS) can improve patient management in the emergency department (ED). However, previous studies have focused only on selected groups of patients, such as trauma, shock, dyspnea, or critically ill patients, or patients with an already known diagnosis. Most patients seen in the ED do not match these criteria. We aim to present total prevalence of positive findings when basic POCUS is applied to the broad population of patients seen in an emergency department.Methods
We conducted a single-center prospective explorative observational study of 405 unselected patients aged 18?years or over. A structured whole-body ultrasound examination was performed on all patients within 2?h of arrival to the ED. The ultrasound examination consisted of focused cardiac ultrasound, focused abdominal ultrasound, focused assessment with sonography for trauma (FAST), and focused lung ultrasound.Results
We managed to perform 94.5% of all planned examinations. The study revealed positive findings in 39.3% of all included patients. This study presents the prevalence of positive findings among subgroups of patients. Divided among the categories of chief complaint, we found 62 positive examinations in 58 (14.3%; 95% CI, 10.9–17.7) unique patients with orthopedic complaints, 77 positive examinations among 59 (14.6%; 95% CI, 11.1–18.0) unique patients with medical complaints, and 55 positive examinations among 42 (10.4%; 95% CI, 7.4–13.3) unique patients with abdominal surgical complaints.Conclusion
POCUS revealed positive findings in more than one third of unselected patients in the emergency department. The study presents the findings and distribution among categories of chief complaints. Future investigations are necessary to elucidate the implication of the findings.17.
Ali A. Rabaan Ali M. Bazzi Sana A. Alshaikh 《Diagnostic microbiology and infectious disease》2018,90(4):280-285
Objective
To compare two influenza polymerase chain reaction (PCR) methods.Methods
A total of 749 suspected MERS-CoV patients presenting at Johns Hopkins Aramco Healthcare, Saudi Arabia, each submitted a clinical sample for influenza A reflex testing using the on-site Cepheid® Xpert Flu assay and at the Ministry of Health laboratory by the Roche PCR assay.Results
There was 92.12% overall agreement between the two methods. Specificity of the Cepheid® Xpert Flu was 95.8% for H1N1 and 94.4% for total influenza A. Cepheid® Xpert Flu sensitivity for influenza A was 100% for younger patients (0–19-year age group) but significantly lower both for older patients (68.2% for 60–79-year and 50% for ≥80-year age groups) and overall for males compared to females (72.6% and 94.0%, respectively).Conclusions
Specificity of the Cepheid® Xpert Flu test was high; however, sensitivity for total influenza A was lower particularly in males and older patients. 相似文献18.
Edward Carlin Colleen Urban Jessica Sidle Angela Cirilli Jennifer Larson Mark Richman Daniel Dexeus 《The Journal of emergency medicine》2018,54(6):844-848
Background
Gonorrhea is the second most common sexually transmitted infection. Disseminated gonococcal infection (DGI) consists of gonococcal infection plus one or more of the triad of arthritis, tenosynovitis, and dermatitis. Diagnosis in the emergency department (ED) must be suspected clinically, as confirmatory tests are often not available. Point-of-care ultrasound (POCUS) can aid in diagnosis and appropriate management by identifying tenosynovitis and excluding arthritis.Case Report
A 26-year-old man with multiple recent sex partners presented to the ED with slowly progressing right wrist pain and swelling over 5 days. His dorsal right wrist was swollen, with slightly decreased range of motion owing to mild pain, and no warmth, tenderness, erythema, or drainage. Multiple hemorrhagic, gray-purple blisters were noted over both hands. Serum white blood cell count was 12 × 103/μL; C-reactive protein was 30.3 mg/L. POCUS of the dorsal right wrist found no joint effusion; the extensor tendon sheath contained a large anechoic space with clear separation of the extensor tendons, suggesting a tendon sheath effusion/tenosynovitis. DGI was suspected, without septic arthritis. The patient was admitted and treated with ceftriaxone and azithromycin. Gonococcus grew from blood cultures and pharyngeal swabs.Why Should an Emergency Physician Be Aware of This?
DGI must be suspected clinically, as confirmatory tests are often not available in the ED. Not all patients present with arthritis, tenosynovitis, and dermatitis. It is often difficult to differentiate tenosynovitis from arthritis. POCUS can aid in diagnosis by identifying tenosynovitis (vs. arthritis or simple soft-tissue swelling), allowing timely appropriate DGI diagnosis and management, and, importantly, averting unnecessary arthrocentesis. 相似文献19.
Background
Use of diagnostic thoracic ultrasound (TUS) in medical professions to examine the pleura, lung parenchyma and diaphragm is gaining in popularity, however the ways in which physiotherapists are using TUS is unclear.Objective
The aim of this scoping review is to gain an understanding of the emerging evidence base surrounding physiotherapy use of TUS to inform research and clinical practice.Data sources
A systematic search was conducted of the following databases: Cochrane, EPPI centre, PROSPERO, Medline, CINAHL, AMED, EMBASE, HMIC, and BNI.Study selection
Inclusion criteria: primary research reporting the use of diagnostic TUS; a physiotherapist as part of the study design or as the chief investigator; published in English.Synthesis methods
Data regarding demographics, design, type of conditions and anatomical structures investigated and profession leading the TUS of included papers were compiled in a tabular format.Results
Of the 26 included papers, nine studied healthy participants, four studied COPD and four studied critical care patients. Most papers (n = 23) involved scanning the diaphragm. In eight studies the physiotherapist operated the TUS.Limitations
The paper selection process was performed by one author; with no cross-checking by another individual.Conclusion
Use of TUS by physiotherapists is an emerging area in both diaphragm and lung diagnostics. A wide range of patient populations may benefit from physiotherapists using TUS. Papers in this review are heterogeneous making any generalisability difficult but does show its potential for varied uses. TUS is an innovative skill in the hands of physiotherapists, but more research is needed. 相似文献20.
Jennifer Singleton Jesse M. Schafer Jeremiah S. Hinson Erin M. Kane Sherieka Wright Beatrice Hoffmann 《The American journal of emergency medicine》2017,35(5):720-724