Collaborative task-sharing to enhance the Point-Of-Care Ultrasound (POCUS) access among expectant women in Kenya: The role of midwife sonographers

Unrealized maternal and child health goals continue to challenge Kenya where adverse outcomes remain high and diagnostic services are limited. The acute shortage of doctors and radiographers requires alternate human resources for health (HRH) with the ability to identify risk factors in pregnancy through Point-Of-Care Ultrasound (POCUS). A specialist radiologist and ultrasonography team partnered with midwives to adopt interprofessional task sharing and capacity building. Faculty from the Radiology Department of our hospital designed and implemented the project which was carried out at three outreach health service centres. Designing and implementing a training model to skill midwife sonographers with the capacity to accurately identify risk factors in pregnancy is an effective model to increase POCUS access. A collaborative task sharing model focused on training quality, validation of results, tracking of errors and specialist level clinical supervision yielded a safe and scalable model of HRH capacity building. Programme evaluation, verification of outcomes and dissemination of results were all monitored. The project was a successful HRH task sharing and interprofessional learning initiative involving task sharing a clearly defined suite of sonographer competencies with participating midwives. The programme increased POCUS accessibility at the three outreach clinics with proven outcomes in the early detection and referral of risk factors in pregnancy.     

便携式超声在创伤急救中的应用

目前便携式超声已经广泛运用到急诊、重症监护、麻醉等相关领域并取得成就。随着超声技术的进步,便携式甚至口袋型超声机出现并得到应用,便携式超声在创伤急救中的应用也逐步得到发掘及认可。本文旨在阐述目前国内外便携式超声在院前急救、心肺复苏、紧急气道管理及其他创伤相关领域中的应用现状及前景。     

Point‐of‐care ultrasound in paediatric emergency medicine

Point‐of‐care ultrasound (POC US) is an adjunct to clinical paediatric emergency medicine practice that is rapidly evolving, improving the outcomes of procedural techniques such as vascular access, nerve blocks and fluid aspiration and showing the potential to fast‐track diagnostic streaming in a range of presenting complaints and conditions, from shock and respiratory distress to skeletal trauma. This article reviews the procedural and diagnostic uses, both established and emerging, and provides an overview of the necessary components of quality assurance during this introductory phase.     

CLUE: COVID‐19 lung ultrasound in emergency department

Lung ultrasound (LUS) plays a critical role in the SARS‐CoV‐2 pandemic. Evidence is mounting on its utility to diagnose, assess the severity and as a triage tool in the ED. Sonographic features correlate well to computed tomography (CT) chest findings and a bedside LUS performed by a trained clinician along with clinical examination, could be an alternative to chest X‐ray and CT chest in these highly infectious patients. In this article, we have described a step‐by‐step approach to LUS in COVID patients and the CLUE (COVID‐19 LUS in the ED) protocol, which involves an anatomical parameter, the severity of lung changes, objectively scored using the validated LUS scoring system and a physiological parameter, oxygen requirement. We believe this CLUE protocol can help risk‐stratify patients presenting to ED with suspected COVID‐19 and aid clinicians in making appropriate disposition decisions.     

Modelo Point-of-Care Ultrasound en Atención Primaria: ¿herramienta de alta resolución?

Point-of-Care Ultrasound is a method of performing a rapid clinical ultrasound, with the aim of responding to a clinical question immediately. This is not an ultrasound performed systematically as the radiologists do, nor does it pretend to replace it. It is useful in some kind of screening (abdominal aortic aneurysm) and is of special interest in ultrasound-guided procedures (joint infiltration by injection).It allows to adapt the derivations, minimising the uncertainty, ruling out certain pathologies due to its high diagnostic precision. It can also lead to overdiagnosis, if the examinations carried out are not limited to the organs on which our clinical suspicion is based.Ultrasound is one tool more in the diagnostic process, but its use must be limited to certain clinical situations. Its use in early detection of prevalent diseases in Primary Care should be properly evaluated. On the other hand with more evidence of a high diagnostic accuracy in a large list of pathological conditions.     

Point-Of-Care Ultrasound Diagnosis of Medial Plantar Artery Pseudoaneurysm Secondary to Penetrating Injury

BackgroundPseudoaneurysms of the foot are rare and can occur from a range of etiologies, including laceration from a foreign body. The majority of reported cases have been diagnosed by computed tomography, magnetic resonance imaging, or angiography. These tests require intravenous access and contrast, confer radiation, take time to perform and interpret, are expensive, and are not always readily available in the acute setting. No prior reported pseudoaneurysms of the foot have been diagnosed by point-of-care ultrasound (POCUS).Case ReportAn 8-year-old boy presented to the emergency department for evaluation of left foot pain and swelling 2 weeks after stepping on small pieces of broken glass. He had a 3 × 3 cm area of painful swelling and erythema at the medial plantar aspect of his foot. A cutaneous abscess was the working diagnosis and preparations were made for an incision and drainage procedure. However, POCUS revealed a medial plantar artery pseudoaneurysm. Incision and drainage would have led to unexpected arterial bleeding. Instead, the pediatric surgery service was consulted for pseudoaneurysm excision and arterial ligation.Why Should an Emergency Physician Be Aware of This?Incision of a pseudoaneurysm in the sole of the foot—thought to be an abscess based on clinical examination—would lead to unforeseen arterial bleeding. POCUS at the bedside can differentiate between simple abscess and pseudoaneurysm in order to guide appropriate and time-sensitive management. Historical and clinical clues to the diagnosis may include heavier-than-expected bleeding at the time of laceration and a pulsatile quality to the painful erythema and swelling.