Test performance of point-of-care ultrasound for gastric content

Objective

We sought to determine test performance characteristics of emergency physician ultrasound for the identification of gastric contents.

The use of point-of-care ultrasound to guide clinical management in intra-abdominal hypertension

IntroductionThe Abdominal Compartment Society (WSACS) developed a medical management algorithm with a stepwise approach to keep intra-abdominal pressure (IAP) ≤ 15 mm Hg. The role of point-of-care ultrasound (POCUS) as a bedside modality in the critical care patients is not well studied in relation to the intra-abdominal hypertension (IAH) management algorithm.AimTo test the role of point-of-care ultrasound (POCUS) in the medical management of patients with intra-abdominal hypertension (IAH).MethodWe conducted a prospective observational study. Those who met the inclusion criteria were assigned to undergo POCUS and small bowel ultrasound as adjuvant tools in their IAH management.ResultsA total of 22 patients met the inclusion criteria and were included in the study. The mean age of the study participants was 65 ± 22.6 years, 61% were men, and the most frequent admission diagnoses were hepatic encephalopathy and massive ascites (five cases). Ultrasound and abdominal X-rays were comparable in confirming correct NGT position, but the ultrasound was superior in determining the gastric content (fluid vs. solid) and diagnoses of gastric paresis in two cases. Small bowel obstruction was present in four patients and confirmed with abdominal CT; two of the patients underwent surgical intervention for mesenteric vessel occlusion and transmesenteric internal hernia. Enema treatment was found to empty the bowel incompletely 72%, 56%, and 42% of the time on days 1, 2, and 3, respectively. Four patients with cirrhosis admitted with upper gastrointestinal bleeding and hepatic encephalopathy (out of a total of 8) were found to have large amounts of ascites, and US-guided paracentesis was performed.ConclusionPOCUS can be used in the nonoperative management of IAH. It is an important tool in the diagnosis and treatment of patients with IAH.Electronic supplementary materialThe online version of this article (10.1007/s40477-020-00546-8) contains supplementary material, which is available to authorized users.     

Severe massive pulmonary thromboembolism: a case reinforcing the crucial role of point-of-care ultrasound in emergency settings

Patients with high-risk pulmonary embolism (PE) have a significant mortality rate, and thus a timely diagnosis and early treatment are essential to improve outcomes. Since these groups of patients are often too ill to be transferred to the radiology department to perform a chest computed tomography angiography, offering a feasible, reliable and bedside diagnostic tool may be desirable in this setting. We report the case of a middle-aged woman presenting to the emergency department with shock who was diagnosed with massive pulmonary embolism based on point-of-care ultrasound (POCUS). We are hereby discussing the usefulness of POCUS in this subset of PE patients, highlighting the importance of considering ultrasound as a first-line diagnostic (and monitoring) tool for each patient with suspicion of massive PE.Electronic supplementary materialThe online version of this article (10.1007/s40477-019-00417-x) contains supplementary material, which is available to authorized users.     

Non-contacting ultrasound transducer system suitable for eye movement recording

A piezoelectric ultrasound transducer generates waves in air by means of the flexural motion of its piezoelectric element. Most materials reflect ultrasound air waves and this reflected energy can react with the source transducer to assist or damp its motion. Variation of source to reflector distance alters the phase of the reflected energy and produces a predictable electrical response. This response can form the basis of a non-contacting method for measuring small axial movements and is particularly suitable for recording such movements of the eye.     

Pancreatic ultrasound following blunt abdominal trauma

Ten patients with suspected pancreatic injury from blunt abdominal trauma were evaluated by ultrasound. One examination performed on the day of the trauma was nondiagnostic. Nine examinations were performed between 6 days and 9 months following the trauma and revealed a pseudocyst in 3, and pancreatic enlargement in 2 patients. The remaining 4 examinations were normal and helped to exclude pancreatic injury.     

Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology

BACKGROUND: To evaluate the utilization of point-of-care ultrasound (POCUS) for the assessment of emergency department (ED) patients with musculoskeletal symptoms and the impact of musculoskeletal POCUS on medical decision-making and patient management in the ED.METHODS: This was a retrospective review of ED patients presenting with musculoskeletal symptoms who received a POCUS over a 3.5-year period. An ED POCUS database was reviewed for musculoskeletal POCUS examinations used for medical decision-making. Electronic medical records were then reviewed for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and impact of musculoskeletal POCUS on patient management in ED.RESULTS: A total of 264 subjects (92 females, 172 males) and 292 musculoskeletal POCUS examinations were included in the final analysis. Most common symptomatic sites were knee (31.8%) and ankle (16.3%). Joint effusion was the most common finding on musculoskeletal POCUS, noted in 33.7% of the patients, and subcutaneous edema/cobblestoning was found in 10.2% of the patients. Muscle or tendon rupture was found in 2.3% of the patients, and 1.9% of the patients had joint dislocation. Bursitis or bursa fluid was found in 3.4% of patients, and tendonitis/tendinopathy was found in 2.3%. Twenty percent of them were ultrasound-guided musculoskeletal procedures, and most of them (73.3%) were arthrocentesis. Of the included studies, all except three either changed or helped guide patient management as documented in the patients’ medical records.CONCLUSION: Our study findings illustrate the utility of POCUS in the evaluation of a variety of musculoskeletal pathologies in the ED.     

Top-cited publications on point-of-care ultrasound: The evolution of research trends

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.

重症床旁即时超声检查的医生培训与教育

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。     

Bedside US imaging in multiple trauma patients. Part 1: US findings and techniques

Objectives

The aim of this review article is to present the current views and visions of the role of ultrasound (US) in the management of patients with multiple trauma. The article is divided into two parts. Part 1 (US findings and techniques) will mainly deal with the technical aspects of US imaging in trauma patients and is written also for educational purposes. Part 2 (pathophysiology and US imaging in trauma patients) will deal with integration of US in the clinical and pathophysiological management of multiple trauma patients.

Methods

A non-systematic review of the literature through PubMed search (restricted to the last 10 years) of original articles and review articles.

Results

80 publications were selected for Part 1. Of these 80 articles, the author selected 50 according to personal criteria on the basis of their innovative or original contents (48 original articles and 2 literature review articles); 19 articles were furthermore extracted from the references of the selected publications. The information extracted from these 69 publications was organized into sections dealing with different fields of applications of US imaging in multiple trauma patients.

Conclusions

US imaging in trauma has evolved from the initial use, i.e., early diagnosis of peritoneal effusion (focused abdominal sonography for trauma), to a wider use known as resuscitative ultrasonography, and is today considered as an extension of physical examination to implement a more effective approach to clinical problems and increase the timeliness and safety of interventions.     

Simplified point-of-care ultrasound protocol to confirm central venous catheter placement: A prospective study

BACKGROUND: The current standard for confirmation of correct supra-diaphragmatic central venous catheter (CVC) placement is with plain film chest radiography (CXR). We hypothesized that a simple point-of-care ultrasound (POCUS) protocol could effectively confirm placement and reduce time to confirmation.     

性激素水平可能是严重创伤患者预后性别差异的重要影响因素

目的 探究不同年龄段女性严重创伤患者与同龄男性病死率差异的特点,探索严重创伤患者预后性别差异的潜在机制.方法 回顾性分析上海交通大学附属上海市第六人民医院急性创伤急救中心EICU 2010年1月至2012年12月收治的成年严重钝性创伤患者,按年龄将其分为18岁≤年龄＜45岁、45岁≤年龄≤55岁及年龄＞55岁三个亚组,比较各组患者预后性别差异的特点,多元logistic回归模型分析性别因素与患者病死率的独立相关性.结果 女性创伤患者粗病死率明显低于男性(5.0％ vs.9.1％,P＜0.05).回归分析结果显示,女性严重创伤患者病死率比男性低79％(OR=0.21,95％ CI:0.07～0.64,P=0.006).而且这种性别差异只存在于18岁≤年龄≤45岁患者中(女性 vs.男性OR =0.15,95％ CI:0.04～0.67,P=0.012),在45岁≤年龄≤55岁(OR=1.10,95％CI:0.36 ～2.82,P=0.980)及年龄＞55岁(OR=0.67,95％ CI:0.21～2.15,P=0.504)的患者中,女性病死率与男性相比均差异无统计学意义.结论 女性严重创伤患者病死率明显低于男性患者,且这种性别差异是源于18岁≤年龄≤45女性创伤患者病死率明显低于同龄男性,该结果表明性激素水平可能是创伤患者预后性别差异的一个重要影响因素.     

Review of simulation model for education of point-of-care ultrasound using easy-to-make tools

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.     

Pediatrician performed point-of-care ultrasound for the detection of ingested foreign bodies: case series and review of the literature

PurposeForeign body (FB) ingestions represent a common problem in children. History and physical examination are commonly not enough to diagnose a foreign body ingestion; therefore, conventional radiography is routinely used to detect them. Point-of-care ultrasound is widely used in the emergency department for several diagnostic applications but there are few articles describing the possibility to use point-of-care ultrasound to detect ingested foreign bodies, and the necessary training to get competent in this application. The main objective of this paper is to illustrate the use of point-of-care ultrasound (POCUS) to detect ingested foreign bodies. The secondary objective is to describe a limited training, necessary for emergency pediatricians, to obtain this skill.MethodsThis is a case series of eight pediatric patients who presented to the pediatric Emergency Department (ED), with suspected ingestion of FB, and were assessed with POCUS. Physician sonographers were two pediatricians and three residents in pediatrics working in two Italian Pediatric EDs. All sonographers participated in a 2-day POCUS workshop which included the most common pediatric POCUS applications.ResultsPOCUS, performed by emergency pediatricians who participated to a limited training, allowed to always identify the foreign bodies ingested.ConclusionsWe demonstrate that an appropriate and limited training allows pediatric emergency physicians to correctly identify foreign body in the esophagus or stomach. Point-of-care ultrasound in foreign body ingestion in the Emergency Department may allow to prioritize the escalation of care in children and it can contribute to reduce the time to endoscopic management when needed.Electronic supplementary materialThe online version of this article (10.1007/s40477-020-00452-z) contains supplementary material, which is available to authorized users.     

Opthalmologic effect of ultrasound at diagnostic intensities

This study examined the possible harmful effects on the eye of prolonged exposure to ultrasound at diagnostic intensities. The left eyes of 20 rabbits were exposed to 9.5 mHz continuous wave ultrasound at 33.7 mW/cm² for one to four hours. The right eyes serves as controls. Careful gross and microscopic examination did not reveal any morphological effects caused by ultrasonic irradiation.     

眼外伤住院患者陪伴需求情况的调查与护理对策

目的：为了强化＂以患者为中心＂的护理服务理念,同时为临床护理管理工作提供客观依据。方法：分别对153例眼外伤致视力下降住院患者进行问卷调查。结果：陪伴护理纠纷的发生是由多因素相互作用所致,反映了患者不同的心理需求。结论：强化护理管理,提高护理工作质量,增强护士的主动服务意识,建立有效的医患沟通,重视满足患者的生活需要是解陪伴问题的关键。     

对比增强超声对猪肝轻度损伤的初步研究

目的应用对比增强超声来探索肝割裂伤口的位置、范围及图像特征。方法两只巴马小型猪,用手术刀经皮经肝作深20mm,宽10mm的切口。静脉注入超声造影剂(SonoVue)来显示伤口的位置、范围和图像特点。结果经皮经肝形成的割裂口,于裂口的位置用二维声像图(基波和谐波模式)上无法显示伤口的位置和范围。注入造影剂后,肝实质高回声消退后,呈线状强回声的割裂口显示十分清晰,此处的强回声一直持续时间较长。另外,紧贴裂口处的肝包膜下,可见线状强回声。肝实质内造影剂完全消除后,将造影模式转换成灰阶模式,仍见裂口处的强回声条索,并见其后方的弱声影。再反转成彩色血流成像模式,于裂口处彩色血流明显增强。结论由于造影剂的原因,割裂口在对比增强超声图上显示为强回声。因此,对比增强超声能反映肝脏损伤的程度和损伤区的部位、形态和范围。     

超声造影在肾脏外伤分级诊断中的应用价值

目的探讨超声造影(CEUS)评估肾脏外伤分级的临床价值。方法对45例肾脏外伤疑诊患者行CEUS检查,并对肾损伤分级诊断结果与CT或手术分级结果相对比分析。结果45例患者中肾脏外伤43例,CEUS检出40例。CEUS分级为Ⅰ级损伤12例,Ⅱ级损伤11例,Ⅲ级损伤7例,Ⅳ级损伤8例,Ⅴ级损伤2例。CEUS漏诊3例,均为Ⅰ级损伤,另有3例出现分级错误,其中1例将Ⅲ级高估为Ⅳ级,2例将Ⅳ级低估为Ⅲ级。超声造影评价肾损伤的分级与CT或手术分级的一致性指数为0.831(P=0.000),两者的一致性很好。CEUS检出肾脏外伤病灶的敏感性为93.0%,特异性100.0%,准确性93.3%。结论CEUS能较准确判断肾脏损伤的分级,正确指导临床减少对Ⅰ、Ⅱ、Ⅲ级肾损伤患者的不必要手术探查,避免对Ⅳ、Ⅴ级肾损伤患者盲目保守治疗,为保留肾单位的治疗赢得时间。