Cystic fibrosis (CF) is a multi-system autosomal recessive disorder affecting the respiratory, gastrointestinal and reproductive systems. One of its manifestations is pancreatic insufficiency. This could lead to constipation and impaired intestinal activity predisposing patients to intestinal obstruction and intussusception.
This report discusses a case of a 25-year-old male with CF who presented with abdominal pain and constipation. Point-of-care ultrasound (POCUS) was instrumental in the early diagnosis of intussusception, showing the classical sonographic features of intussusception.
This case highlights the importance of clinical vigilance and the utility of POCUS when managing patients with multi-systemic diseases, as they may present with atypical symptoms and rare diagnoses. Ultrasound is highly sensitive for diagnosing intussusception in the paediatric populations, but further studies may be needed to translate that finding to the adult population. Complementary computed tomography (CT) is of high value in evaluating for possible complications.
Post-induction hypotension (PIH) is a common complication following anaesthetic induction and is associated with adverse perioperative outcomes. Ultrasound-generated inferior vena cava collapsibility index (IVC-CI) is a non-invasive measure of volume status that may predict PIH. This systematic review and meta-analysis evaluated the diagnostic accuracy of IVC-CI in predicting PIH in adult, non-obstetric patients undergoing general anaesthesia.
A systematic search of PubMed, Embase, and Cochrane Library (up to June 2024) identified studies reporting IVC-CI as a predictor of PIH. Prospective and retrospective observational studies were included, while studies involving paediatric, obstetric, or hypotensive patients pre-induction were excluded. The QUADAS-2 tool assessed risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was utilised to assess certainty of evidence. Pooled diagnostic performance was measured via area under the receiver operating characteristic curve (AUROC). Meta-regression explored heterogeneity across studies.
Twenty-three studies (n = 1973) were included, with 16 studies (n = 1585) providing AUROC data. The pooled AUROC for IVC-CI in predicting PIH was 0.72 (95% CI, 0.64–0.80), indicating moderate diagnostic accuracy. High heterogeneity was observed (I2 = 94.4%). Meta-regression showed no significant associations between AUROC and age, sex, American Society of Anesthesiologists status, or induction agents. Publication bias was identified (Egger's test, p < 0.001). The quality of evidence, as evaluated using the GRADE approach, was ‘very low’.
IVC-CI shows potential as a predictive tool for PIH; however, significant heterogeneity, inconsistent protocols, and publication bias limit its robustness. Standardised measurement methods and larger studies are needed to confirm its clinical utility.
Ultrasound-generated IVC-CI demonstrates moderate accuracy in predicting PIH and may assist in guiding pre-induction management strategies, such as fluid administration or vasopressor use.
Lung ultrasound (LUS) is increasingly recognised as an essential diagnostic and monitoring tool in acute and critical care. As its use grows, understanding how LUS education is designed, delivered, and evaluated for practicing healthcare professionals has become essential.
To map the evidence on educational interventions for LUS training, focusing on study characteristics, instructional strategies, and learning outcomes.
This scoping review followed the Joanna Briggs Institute methodology and PRISMA-ScR reporting guidelines. It identified and charted studies on LUS training for practicing healthcare professionals. Data extraction covered study characteristics, learner profiles, instructional strategies, instructor credentials, training duration and setting, and learning outcomes, categorised using the New World Kirkpatrick Model.
Thirty eight studies involving physicians, paramedics, respiratory therapists, physiotherapists, and nurses met inclusion criteria. Most interventions combined didactic teaching with hands-on practice, including supervised scanning and simulation. Training was typically brief (median duration = 3.5 h). Outcomes focused mainly on learning (Level 2: 86.8%) and less often on behaviour (Level 3: 47.4%). Considerable variation in educational designs and outcome measures limited cross-study comparisons, and few studies assessed long-term retention or clinical impact.
Current LUS training uses multimodal approaches that integrate theory with supervised practice. However, programs and assessments remain heterogeneous and rarely theory-informed. Future research should strengthen pedagogical foundations, align evaluation with competency frameworks, and examine learning sustainability, interprofessional training, and patient-centred outcomes to support effective and scalable LUS education.
One examiner might not be able to acquire and interpret every image when examining rotator cuff tears in large cohort studies due to logistical issues. The aim of this study was to determine the repeatability of supraspinatus tear size measurements performed by multiple observers using previously acquired ultrasound images by a separate set of examiners.
Seventy-two ultrasound examinations of individuals with symptomatic isolated supraspinatus tears were performed by five ultrasound examiners. Fifteen examinations were randomly chosen to be evaluated by three observers with varying amounts of ultrasound experience using repeated measurements. The maximum anterior–posterior tear size using these previously acquired ultrasound examinations was assessed and the repeatability and minimal detectable change were calculated.
The intra-observer repeatability was improved with greater experience to 0.87 (95% confidence interval [CI] 0.72–0.95) but was 0.51 (95% CI 0.20–0.77) and 0.75 (95% CI 0.51–0.90) for observers with low experience. For all observers, the inter-observer repeatability was 0.32 (95% CI 0.00–0.65). For all observers, the minimal detectable change was 4.6 mm and was lower in observers with more experience.
Changes in supraspinatus tear size of 4.6 mm can be detected using previously acquired ultrasound images. This is comparable to ultrasound examinations performed and measured by the same individual as previously reported in the literature. Repeatability is poor among examiners with less experience.
Clinical studies that cannot utilise measurements by a single examiner can be performed within current thresholds for determining changes in tear size of the supraspinatus tendon.
III.
Patients presenting with pulseless electrical activity (PEA) in out-of-hospital cardiac arrest (OHCA) may receive inappropriate care if a manual pulse check is relied upon to determine pulselessness. This study aimed to investigate whether ultrasound-naïve paramedics could acquire an ultrasound image within a 10-s pause during a pulse check in a simulated cardiac arrest environment and interpret ultrasound-detectable pathology. Secondary aims focus on the quality of ultrasound image acquisition and the retention of learned knowledge.
Thirty paramedics participated in three sequential phases. Phase I involved a self-directed e-learning program covering an overview of ultrasound applications, including cultural considerations for indigenous New Zealand Māori in cardiac arrest. Phase II included face-to-face education, simulation assessments, and a knowledge quiz. Phase III included simulation assessments and a knowledge quiz. Ultrasound images were scored against the cardiac ultrasound structural assessment score (CUSAS) for quality.
During simulated cardiac arrest scenarios, the mean time to acquire an ultrasound scan was 9.6 s (SD = 2.9, 95% CI [9.3, 10.0]). Forty-seven per cent of study scans were captured within the 10-s pulse check pause. Of the acquired images, 73% (95% CI [67.8, 79.4]) of scans scored a CUSAS of ≥ 3, demonstrating adequate image quality. Participants correctly interpreted 91% (95% CI [88.5, 94.5]) of 243 pathological scans during the simulations. In Phase II, 83 of 87 interpretations were correct (95%, 95% CI [91.0, 99.7]), while in Phase III, 140 of 156 interpretations were correct (90%, 95% CI [84.9, 94.4]).
During cardiac arrest simulations, paramedics on average took 9.6 s to acquire an ultrasound scan, with 47% of scans completed within the 10-s pulse-check pause.
To determine if paramedics can acquire an ultrasound image within the 10-s pulse check pause in simulated pulseless electrical activity (PEA) cardiac arrest. Secondary aims focus on the quality of ultrasound image acquisition, interpretation and retention of learned knowledge.
Point-of-care ultrasound (POCUS) is an important diagnostic bedside tool, yet a gap remains between Emergency Department (ED) POCUS programme implementation and achieving sustained POCUS use and retention. We performed an impact evaluation of a co-designed POCUS programme implementation intervention and assessed programme acceptability, effectiveness and feasibility.
Our mixed-methods cohort study implemented a co-designed, multifaceted intervention using the consolidated framework for implementation research at a single Veterans Affairs ED (November 2021–October 2022) to enhance POCUS usability and sustainability, including provider education, image review and archival. Primary ED providers (20/25) participated in hands-on POCUS training sessions between February and May 2022. We assessed POCUS program acceptability, appropriateness, and feasibility via provider pre/post-course surveys, interviews, and health record data using a validated tool (AIM-IAM-FIM; assessing ED POCUS, radiology ultrasound orders, and ED metrics).
ED POCUS significantly increased (from 72 to 267 scans, p < 0.001) 6 months post-intervention, with no significant change in radiology ultrasounds ordered (from 355 to 361, p = 0.417) or ED length-of-stay (from 6.7 to 7.5 h, p = 0.0849). Cardiac, deep vein thrombosis (DVT), soft tissue, musculoskeletal, and biliary ED POCUS were most common; and radiology studies were DVT, biliary and scrotal ultrasound. The pre/post-intervention surveys showed provider comfort with performing and teaching diagnostic and procedural POCUS changed minimally. All respondents approved of POCUS use and education (acceptability), endorsed clinical tool applicability (appropriateness) and stated the course/training was doable (feasibility).
POCUS use increased post-program implementation. Future studies should evaluate program sustainability, incorporate methods to reduce radiology ultrasound and improve patient-centered outcomes.
Ultrasound-guided supraclavicular block (UGSCB) can provide upper limb regional anaesthesia and is an emerging technique in the emergency department (ED). A potential adverse event is phrenic nerve block causing hemi-diaphragmatic paresis, but its incidence in ED remains unclear.
This nested prospective cohort study evaluated adult patients (≥ 18 years) without lung disease who underwent UGSCB for closed reduction of distal radius fractures. UGSCB was performed on the injured side using a two-injection method with 20 mL of 0.75% ropivacaine. The primary outcome was ipsilateral diaphragmatic excursion assessed using bedside ultrasound dynamic imaging before and 30 min post-UGSCB during three respiratory manoeuvres: tidal volume breathing (TV), deep inspiration (DI) and sniff inspiration (SI). Diaphragmatic paralysis was defined as ≥ 75% reduction in diaphragmatic excursion, averaged across the three manoeuvres. Secondary outcomes included vital signs including respiratory rate, oxygen saturations, blood pressure and heart rate.
Sixteen participants were evaluated. UGSCB was associated with reduced ipsilateral diaphragmatic excursion for TV (mean difference [MD] 1.21 cm, 95% confidence interval [95% CI] 0.69–1.75), DI (MD 3.37, 95% CI 2.15 to 4.59) and SI manoeuvres (MD 1.95, 95% CI 1.23 to 2.68). Diaphragmatic paralysis was observed in 10 participants (62.5%). No significant changes in vital signs were observed following UGSCB.
ED physician-performed UGSCB using a two-injection technique was commonly associated with hemi-diaphragmatic paresis, likely due to concomitant phrenic nerve block. However, this was not associated with respiratory or haemodynamic compromise in adult patients without lung disease.
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