Medical Clinics of North America最新文献

Point-of-care ultrasound (POCUS) infrastructure is the underpinning of a well integrated POCUS program. In order to achieve its full potential and fully integrate into the health care system, a POCUS program requires a robust and resilient infrastructure. The essential components of POCUS infrastructure are hardware, software, and an informed, well-integrated governance structure. This infrastructure can be leveraged for clinical decision-making, education, research, credentialing, documentation, health record integration as well as quality assurance and improvement.

Patients with abdominal symptoms are among the most common to present both urgently and non-urgently for medical evaluation. While intestinal ultrasound (IUS) is useful to aid management of these patients, it is not routinely taught, performed, or included as part of the core set of point-of-care ultrasound competencies. The authors present an approach to performing a systematic, but focused, IUS at the bedside and diagnostic accuracies for small bowel obstruction inflammatory bowel disease, appendicitis, and diverticulitis. An approach on how to integrate IUS findings and common pitfalls will also be discussed.

An accurate assessment of intracardiac pressure and etiology of its pathologic change is crucial in assessing volume status and cardiac hemodynamics. The assessment for abnormal central venous pressure in heart failure has driven the development of noninvasive assessment of the central veins: the inferior vena cava and, more recently, ultrasound assessment of the jugular venous pressure. This article discusses the evidence, techniques, and limitations of estimating central venous pressure by ultrasound assessment of the inferior vena cava and internal jugular vein.

Point-of-care ultrasound (POCUS) provides immediate and useful information that aids clinical decision making at the bedside. The purpose of this article is to describe how POCUS can be integrated in the evaluation of the urinary system. In the first section, the authors aim to describe image acquisition and typical sonoanatomy of the kidney and bladder. The rest of the article focuses on three common scenarios where POCUS can be integrated into clinical practice: hydronephrosis, nephrolithiasis, and bladder distension. The authors include evidence from the literature and describe commonly encountered pitfalls.

Point-of-care ultrasound (POCUS) bridges diagnostic gaps across the continuum of care worldwide and is a particularly potent tool in resource-limited settings (RLS). To capture the scope of its current impact in RLS, this narrative review of POCUS use in public health, primary care, outpatient specialty, pre-hospital, and palliative care settings discusses its use in reducing diagnostic health care inequities. Disease-specific protocols, longitudinal training, quality assurance, and task shifting are key to robust expansion of POCUS in RLS.

Bedside point-of-care ultrasound (POCUS) has a high utility in clinical settings for scanning soft tissue-related conditions such as skin and soft tissue infections, identifying abscesses or necrotizing soft tissue infections, localization and extraction of embedded foreign bodies, and assessing hospitalized patients for sarcopenia. Regular use of POCUS in patients with soft tissue conditions can improve clinical efficiency and care.

While point-of-care ultrasound (POCUS) use is expanding within Internal Medicine, basic yet important practices and key infrastructure are frequently underutilized. This is appropriately raising concerns that patients may be unintentionally harmed by POCUS. To mitigate this risk, this article advocates for ensuring POCUS users have adequate training to include understanding limitations and pitfalls arising from acquisition, interpretation, and clinical integration. It is also important to build infrastructure to allow for ongoing monitoring and quality assurance with an emphasis on transparency and objectivity of the clinician's POCUS findings. This will ensure the safe and effective integration of POCUS in Internal Medicine.

Abdominal point-of-care ultrasound is an essential diagnostic tool for internal medicine physicians. It can identify intraperitoneal free fluid, evaluate the liver for size, presence of steatosis, and assessment for possible cirrhosis. Diagnosing cholelithiasis or cholecystitis can expedite care. Physical examination for mild splenomegaly may be insensitive. In such cases, sonographic measurements may provide a more definitive diagnosis. With the proper training, these organs can be evaluated at the bedside and guide clinical decision making.

The information obtained from cardiac POCUS relies on the ability to acquire optimized images and identify errors in image acquisition. In the following, we describe basic approaches to image optimization and detail common measurements obtained by cardiac POCUS. We highlight the impact of image acquisition errors and patient anatomy on these measurements including LV/RV function, identification of RV strain, their pitfalls, and the impact of error in image acquisition and patient anatomy on their clinical interpretation or integration.