Seminars in Ultrasound Ct and Mri最新文献

Point-of-care ultrasound can provide critical diagnostic information and add to procedural safety. As with any clinical skill, however, it must be applied by an adequately trained provider, with systems to ensure safety. Training can include a mix of hands-on training with traditional didactics, online coursework, and simulation, but each carries its own costs and benefits worth of review. Following training it is essential to think about assessment of competency in point-of-care ultrasound to reflect the combination of cognitive and procedural skills that makes up the practice. Within the frameworks described, expansion can be expected across specialty and professional boundaries.

To assess point-of-care ultrasound (POCUS) in 2024, we should start by defining its expanded scope and integration into general and specialty practice. Clinicians should abide by the evolving evidence for POCUS utilization and patient outcomes different from mortality and morbidity, especially as there are notable advancements in handheld ultrasound technology with a clear shift from capability to portability. To reduce diagnostic errors, POCUS practitioners need a holistic framework that accounts for known and new applications. Defining the POCUS scope of practices, proper training, and innovation, like artificial intelligence, can play a bigger role in mitigating diagnostic errors as we move forward.

Ultrasound evaluation of the upper airway has emerged as an essential instrument for clinicians, offering real-time assessment that can help to guide interventions and improve patient outcomes. This review aims to provide health care providers with a practical approach to performing ultrasound evaluation of the upper airway, covering basic physics relevant to upper airway ultrasound, the identification of key anatomical structures, and elucidating its various clinical applications, such as prediction of difficult airway, confirmation of endotracheal intubation, and guidance for surgical airway procedures and airway blocks. We also discuss evidence-based training programs, limitations, and future directions of ultrasound imaging of the upper airway.

Point of care ultrasound has become an integral part of critical care medicine, particularly for recognizing shock etiologies and guiding management. Most of the current ultrasonography guided shock protocols have been tailored towards a qualitative assessment of patients on presentation with shock. Unfortunately, the evolving nature of shock, particularly in the face of resuscitation and physiologic changes, demands a more sophisticated approach. This manuscript serves to present a comprehensive algorithm called the transthoracic Subcostal To Apical, Respiratory to paraSternal and transesophageal Cardiac to Respiratory, Aortic to StomacH ultrasonographic evaluations for the assessment of shock. This protocol is better suited for the critically ill patient in its ability to move beyond pattern recognition and focus on monitoring shock states from their presentation through their evolution. Not only is importance placed on the sequence of the exam, but also the identification of signs of chronic disease, the early incorporation of pulmonary evaluation, and the role for transesophageal imaging in critically ill patients with difficult surface imaging. Given the broad capabilities of bedside ultrasound, the Subcostal To Apical, Respiratory to paraSternal-Cardiac to Respiratory, Aortic to StomacH protocol serves as a multifaceted algorithm allowing for a nuanced and dynamic approach for the resuscitation of critically ill patients in shock.

As the scope of point-of-care ultrasound (POCUS) expands in clinical medicine, its application in neurological applications offers a non-invasive, bedside diagnostic tool. With historical insights, detailed techniques and clinical applications, the chapter provides a comprehensive overview of neurology-based POCUS. It examines the applications, emphasizing its role when traditional neuroimaging is inaccessible or unsafe as well advocating for its use as an adjunctive tool, rather than a replacement of advanced imaging. The chapter covers a range of uses of neuro POCUS including assessment of midline shift, intracranial hemorrhage, hydrocephalus, vasospasm, intracranial pressure, cerebral circulatory arrest, and ultrasound-guided lumbar puncture.

Acute pericardial conditions, such as tamponade, are often rapidly progressive and can become life-threatening without timely diagnosis and intervention. In this review, we aim to describe bedside ultrasonographic evaluation of the pericardium and diagnostic criteria for tamponade, identify confounders in the diagnosis of pericardial tamponade, and delineate procedural details of ultrasound-guided pericardiocentesis.

Thoracic Ultrasonography involves the ultrasonographic examination of the lungs, pleura, and diaphragm. This provides a plethora of clinical information during the point of care assessment of patients. The air filled lungs create consistent artifacts and careful examination and understanding of these artefactual signs can provide useful information on underlying clinicopathologic states. This review aims to provide a review of the ultrasound signs and features that can be seen in horacic ultrasonography and summarize the clinical evidence to support its use.

In this review we explore Left Ventricular and Right Ventricular parameters that intensivists can use to evaluate, manage, and monitor the critically ill. Understanding these parameters, their clinical relevance, and potential pitfalls, is crucial for thorough and accurate patient assessment and management. Critical Care Echocardiography encompasses all the advanced cardiac and non-cardiac skillset needed to integrate the findings of Left Ventricular and Right Ventricular size and function. We advocate for a physiologic approach to the critically ill patient, tailoring therapy to reverse the etiology while simultaneously supporting circulation based on a sound understanding of left and right ventricular pressures, volumes, and flow.

Point of care ultrasound (POCUS) and critical care echocardiography (CCE) is increasingly being used in intensive care units (ICUs). POCUS and CCE may be limited in some ICU patients because of inadequate information from standard echocardiographic windows. At the same time, data from POCUS and CCE in ICU may be critical to managing patients with cardiorespiratory failure. Alternative echocardiographic views done at the bedside by ICU practitioners may yield additional information or replace the missing data from the standard views. Information obtained from multiple echocardiographic views should be integrated and interpreted within the patient’s other clinical information.