A ruptured ectopic pregnancy in a patient with an intrauterine device: A case report

Intrauterine devices (IUDs) are used worldwide. The 2 types that are used are the levonorgestrel IUD and a copper containing IUD. This is a case study of a 30-year-old female with a levonorgestrel IUD who was diagnosed with a ruptured ectopic pregnancy in the emergency department (ED). Point-of-care urine pregnancy test and point-of-care ultrasound (POCUS) were vital in making this diagnosis and should be utilized in patients assigned female at birth who present with abdominal pain.     

Comparison between inferior vena cava ultrasound,lung ultrasound,bioelectric impedance analysis,and natriuretic peptides in chronic heart failure

Background: Heart failure (HF) is an important healthcare problem. Knowing volume status in outpatients with chronic HF to adjust treatment and to avoid decompensations is a challenge. The aim of this study is comparing the usefulness of inferior vena cava (IVC) ultrasound, lung ultrasound, bioelectrical impedance analysis (BIA), and natriuretic peptides in the follow-up of outpatients with chronic HF.

Methods: This was a prospective cohort study. Ninety-nine patients with chronic HF were included consecutively as they attended scheduled medical visits. The different techniques were performed on the day of the clinic visit, and the result was hidden from the patients and the responsible medical team. Follow-up time was 1 year. Outcome events checked were a combination of death or hospitalization, due to HF.

Results: Thirty-six patients (36.4%) died or were hospitalized for HF. They had a significantly lower IVC collapse, and a greater number of lung B-lines and higher NTproBNP levels compared to patients who remained stable. There were no differences in the BIA parameters. After multivariable analysis, cut-off points of IVC collapse <30%, number of pulmonary B lines greater than 5, and NTproBNP levels greater than 2000?pg/ml were associated with increased risk of HF death or admission. NTproBNP had the best area under the curve.

Conclusion: Evaluation of congestion in outpatients with chronic HF may be based on NTproBNP, IVC ultrasound, or lung ultrasound; they are useful in identifying patients at high risk of hospitalization or death due to HF.     

Use of echocardiography in the neonatal intensive care unit

The role of echocardiography in the neonatal intensive care unit (NICU) has rapidly evolved over the last two decades and there are now guidelines to direct Neonatologist Performed Echocardiography (NPE). Expert consensus statements have provided a framework for echocardiography training, scope of practice, and clinical governance structure for neonatologists. Now NPE is routinely being used a standard of care in the NICUs across the world. It is referred to as NPE, targeted neonatal echocardiography, point of care echocardiography or functional echocardiography, depending upon the country's guidelines. The terms are used somewhat interchangeably, but functional echocardiography is aimed less at the identification of structural abnormalities and more at determining cardiac function. Clinical examination and the existing tools for the haemodynamic monitoring in the neonatal intensive care lack sensitivity and specificity, and they are indirect parameters of cardiovascular well-being. Functional echocardiography provides direct assessment of haemodynamics at bedside. It is now widely regarded as a useful extension to the clinical examination and other monitoring tools in the critically ill infant. This review article provides an overview of the five most common applications of NPE in the neonatal intensive care unit; diagnosis and haemodynamic evaluation of PDA, diagnosis and evaluation of pulmonary hypertension, diagnosis of pericardial effusion and guide pericardiocentesis, assessment of cardiac functions and fluid volume status (pre-load). It describes how PE can be used by the healthcare professionals to optimize care for sick neonates with haemodynamic instability.     

Point-of-care lung ultrasound in children with bronchiolitis in a pediatric emergency department

ObjectivesThis study assessed the association between findings of lung ultrasound (LUS) performed in the pediatric emergency department (PED) on infants with bronchiolitis and need for respiratory support.MethodsAn observational study was carried out in the PED during the epidemic seasons in two consecutive years. Infants diagnosed with bronchiolitis who fulfilled the inclusion criteria were evaluated. A group of six pediatricians performed LUS and classified lung findings into four groups: normal pattern (A), moderate interstitial pattern (B1), severe interstitial pattern (B2), and isolated consolidation (C). The relationship between LUS findings and need for respiratory support was explored. An expert sonographer, blinded to the results, reviewed the ultrasound studies to determine the interobserver reliability.ResultsA total of 200 infants were included (mean age 5.7 months ± 4.4 SD); 65 (32.5%) obtained moderate clinical scores, while 23 (11.5%) needed respiratory support at admission and 34 (17.0%) at 48 h. The ultrasound findings in the PED were the following: A = 89 (44.5%), B1 = 55 (27.5%), B2 = 34 (17%), and C = 22 (11%). Age less than 6 weeks and moderate bronchiolitis were correlated with abnormal LUS (P < 0.005). The severity of interstitial ultrasound pattern has some correlation with an increased need for respiratory support. The interobserver concordance was high (0.95, confidence interval: 0.92–0.98).ConclusionLUS is a feasible tool that may help to confirm the clinical impression and assess the need for respiratory support in children with bronchiolitis, but further multicenter studies are needed.