Medical Clinics of North America最新文献

Integrated multi-organ ultrasound is increasingly used across various medical specialties. It should be performed in conjunction with history, physical examination, and other investigations in the diagnostic process to enhance the detection of conditions in the lung, heart, and abdomen. Multi-organ ultrasound has been shown to improve diagnostic accuracy in a sizeable portion of patients, potentially altering treatment plans. Specifically, it aids in assessing shock, sepsis, dyspnea, delirium, and in the perioperative setting, contributing to a more comprehensive patient assessment process.

Basic cardiac point-of-care ultrasound (POCUS)/focused cardiac ultrasound (FoCUS) often reveals incidental findings. Consider a patient with dyspnea in whom FoCUS reveals left ventricular (LV) hypertrophy, calcified valves, and pericardial effusion but "normal" LV systolic function. Such findings may trigger comprehensive echocardiography. Although advanced cardiac POCUS cannot replace comprehensive echocardiography, its role at the bedside is evolving. This systematic review identified studies suggesting that a sufficiently trained practitioner can leverage advanced techniques to evaluate conditions such as hypertrophic cardiomyopathy (4), LV diastolic dysfunction (6), severe valvular heart disease (6), and tamponade (8). This article discusses the use of advanced cardiac POCUS in these conditions.

An increasing number of indications are emerging for point-of-care ultrasound to diagnose and treat musculoskeletal complaints. Low cost, dynamic imaging, immediate results, and added advantage of portability have made ultrasound an important imaging modality in urgent care, emergency department (ED), and other musculoskeletal care clinics. This article reviews the use of musculoskeletal ultrasound to help evaluate articular and periarticular structures to evaluate for mechanical injuries and inflammatory arthritis.

The use of point-of-care ultrasound (POCUS) of the vasculature has expanded beyond procedural guidance and is utilized by multiple specialties in varied clinical settings. Evidence supports the use of POCUS for diagnosing deep venous thrombosis in the lower extremities, while for thrombosis in the upper extremities or abdominal aortic aneurysm screening, the evidence is still nascent. Here, we review POCUS of the extremity veins and abdominal aorta with a summary of the pertinent literature, review of the relevant anatomy, description of the appropriate acquisition technique, introduction to associated pathology, and discussion of pitfalls one could encounter.

Ultrasound imaging is a safe diagnostic tool that has become ubiquitous, in part due to its portability, effectiveness, and safety record. The latter is aided be adherence to regulatory limits, safety guidelines, and the "as low as reasonably achievable" principle. Operators receive feedback on potential tissue heating and mechanical effects through output display standard that shows the thermal index and mechanical index. To prevent the spread of infections, ultrasound transducers require varying levels of disinfection based on procedure invasiveness, following detailed infection control protocols, even in resource-limited settings. Ergonomic sonography practices are emphasized to prevent work-related musculoskeletal disorders (WRMSD), with professional organizations encouraging the use of ergonomically designed equipment and proper body positioning during scans. Operators should understand and properly apply ergonomic practices. Administrators play a key role by providing ergonomic equipment, education on WRMSD prevention, and creating workplace policies.

The most commonly used outpatient primary care point-of-care ultrasound (POCUS) applications are similar to those used in the inpatient setting (eg, cardiac, pulmonary, and abdominal ultrasound). However, there are several additional POCUS applications that are highly applicable to the outpatient setting and should be considered for use by primary care practitioners. This article reviews 3 outpatient POCUS applications and their potential role in the primary care setting.

Doppler ultrasonography has evolved into a cornerstone of ultrasound imaging. In this article, we delve into the fundamental principles of Doppler ultrasonography, introduce color and spectral Doppler analysis, and highlight common applications relevant to point-of-care (POCUS) practitioners. From enhancing the safety of bedside procedures to estimating cardiac output, to exploring findings of venous congestion, we review the key advantages, disadvantages, and challenges of using Doppler in POCUS.

Ultrasound guidance for bedside procedures improves rates of success while reducing complications. It is the standard of care for most bedside procedures and has ever-increasing utility for peri-procedural assessment. Herein, we provide a concise description with associated images and videos detailing the proper technique for ultrasound image acquisition and interpretation, along with common pitfalls to be avoided.

Errors and pitfalls associated with the performance of point-of-care ultrasound (POCUS) are common and can stem from errors in image acquisition, interpretation, and clinical integration. In this article, the author discuss the technical and cognitive mechanisms involved and propose a framework in systematically approaching potential errors in POCUS, as well as strategies to mitigate them.