POCUS journal最新文献

Background: In some clinical circumstances, it may be difficult to accurately measure systolic blood pressure (SBP) using direct auscultation technique or an automated oscillometric cuff pressure device. As an alternative method, this study compared the measurement of SBP using point of care ultrasound (POCUS) with color Doppler to the measurement of SBP using an intraarterial catheter.

Methods: Study subjects were 50 patients in an intensive care unit who had an intraarterial catheter placed for monitoring blood pressure. The intraarterial catheter systolic pressure was recorded and compared to the contemporaneous measurement of SBP using POCUS with color power Doppler (CPD). The operator placed the Doppler sample volume over the brachial artery with ipsilateral inflation of a prepositioned upper arm blood pressure cuff that was inflated sufficiently to ablate blood flow in the target artery. The blood pressure cuff was then deflated until there was return of CPD signal in the brachial artery. At this moment, the corresponding blood pressure was noted on a sphygmomanometer attached to the blood pressure cuff. The values of the two methods were compared using standard statistical technique.

Results: The intraarterial systolic pressures and CPD systolic pressures by POCUS were well correlated with a Pearsons correlation coefficient of 0.96. Bland-Altman analysis of bias and limits of agreement indicated that the POCUS with CPD measurement was sufficiently accurate to have clinical utility.

Conclusions: The use of POCUS with CPD to measure SBP may have utility in situations where direct auscultation or automated oscillometeric cuff pressure measurements may be unreliable.

Acute lymphadenopathy has a wide range of possible etiologies, ranging from self-limiting viral infections to life-threatening malignancy. Point of care ultrasound (POCUS) can play a crucial role in identifying lymphadenopathy and ruling out other potential causes of soft tissue swelling, such as hernias, abscesses, and malignancies. Furthermore, POCUS enables the characterization of lymphadenopathy by evaluating the size, shape, echogenicity, and vascularity of the involved lymph nodes, thereby helping to identify the presence and extent of pathology. When performed at the time of initial presentation, POCUS can narrow the differential diagnosis and guide appropriate work-up and management. We present a case of a teenage male evaluated in the pediatric emergency department for acute bilateral inguinal swelling, in which POCUS identified lymphadenopathy and guided the evaluation of a presumed infectious process, ultimately determined to be caused by cat scratch disease.

Background: Confirmation of pregnancy location using point of care ultrasound (POCUS) is an essential component of emergency obstetric care. The accuracy of a non-piezoelectric portable ultrasound device compared to obstetric sonographer-performed ultrasonography remains uncertain.

Objective: The objective of this study was to describe the practical utility of a non-piezoelectric POCUS system (Butterfly iQ+) in the emergency department, including characterizing the accuracy of findings relative to obstetric sonographer-performed ultrasound (OB-US) for obstetric and non-pregnant pelvis evaluations in the emergency department.

Methods: This retrospective cohort study was conducted at a Level 1 trauma center. Patients who underwent emergency physician-performed transabdominal obstetric or gynecologic POCUS examination using a non-piezoelectric transducer between November 2021 and November 2022 were included. Data from electronic medical records and ultrasound databases were abstracted. POCUS findings such as yolk sac presence, fetal heart motion, and gestational age were recorded alongside patient data including age, body mass index, human chorionic gonadotropin (hCG) levels, and ultrasound results. Descriptive statistics were analyzed using SPSS.

Results: Seventy-two obstetric POCUS studies were included with an average maternal age of 29.6 ± 7.8 years. Common indications included positive pregnancy tests, abdominal/pelvic pain, and vaginal bleeding. All first-trimester intrauterine pregnancies (IUPs) diagnosed by POCUS and referred for OB-US were confirmed, with no false positives. POCUS had a sensitivity of 83.3% (95% CI 61.8-94.5) and specificity of 100% (95% CI 71.7-100) for confirmation of an IUP. The lowest hCG levels at which IUP was detected with POCUS were 6,488 without fetal heart motion and 7,098 with heart motion. The agreement between POCUS and OB-US for gestational age measurements was moderate (ICC = 0.83, 95% CI 0.0-0.99). In the second trimester, POCUS accurately detected fetal heart rate, with a strong agreement for gestational age (ICC = 0.96, 95% CI 0.43-0.99) compared to OB-US. Transabdominal POCUS also identified gynecologic conditions such as postpartum hemorrhage, and normal POCUS exams led to alternate diagnoses such as pelvic inflammatory disease and pyelonephritis.

Conclusion: POCUS using a non-piezoelectric ultrasound device was able to accurately rule in first trimester IUP in the emergency department at relatively low hCG levels, with no false positive IUPs identified. During the second and third trimesters, POCUS consistently detected fetal heart motion and had good accuracy for gestational age measurements compared to OB-US. These findings suggest that POCUS using a non-piezoelectric ultrasound device is a useful tool for emergency department assessments, though further evaluation is needed.

Objective: This study aimed to investigate variations in fluid overload using point of care ultrasound (POCUS). We assessed patients undergoing peritoneal dialysis (PD) with full and drained peritoneum and their correlation with clinical parameters.

Methods: POCUS examination and intra-abdominal pressure (IAP) measurements were conducted in patients undergoing PD with a full peritoneum. Subsequently, after drainage, a new POCUS and bioimpedance analysis (BIA) were performed.

Results: Seventeen patients were included in the study: 70.6% male, mean age 66+/-9.5 years. Of these, 65% had fluid overload >1 L and 23% had overhydration (OH) adjusted for extracellular water (ECW) exceeding 15%, as assessed by BIA. B-lines with full peritoneum had a median of 1 (0-2.5), and with drained peritoneum 0 (0-0). This difference was not statistically significant (p=0.063). In the correlation analysis of variables, IAP and PD fluid volume per m2 of body surface did not correlate with the diameters or collapsibility of the inferior vena cava (IVC) with full or drained peritoneum. The degree of OH in liters correlated with IVC collapsibility with drained peritoneum (Spearman ρ=-0.43; p=0.08), as did the OH adjusted for ECW (Spearman ρ=-0.61; p=0.02). These correlations disappeared with full peritoneum (p>0.05).

Conclusions: There were no significant differences in ultrasound volume overload parameters in patients undergoing PD with full vs. drained peritoneum. However, there are indications of lower POCUS sensitivity to fluid overload with a full peritoneum.

Objectives: Primary: To determine if point of care ultrasound (POCUS) combined with a clinical decision rule (CDR) improves reliability in the diagnosis of transient synovitis of the hip (TS) in paediatric patients presenting with atraumatic limp. Secondary: To describe how POCUS improves diagnostic reliability and reduces the need for further investigations for the child with atraumatic limp.

Methods: We retrospectively applied a POCUS CDR to patients presenting to our paediatric emergency department (PED) with atraumatic limp over a 5-year period. This consisted of the following: ages 1 to 10 years old, able to weight bear, no history of fever, symptom duration for 7 days or less, and no pallor, lymphadenopathy, or hepatosplenomegaly.

Results: A total of 77 out of 178 patients presenting to the PED with a diagnosis of TS underwent a POCUS examination during their clinical assessment. Of these, 67 patients had hip effusion on POCUS. Our CDR could be applied to correctly rule-in TS in 63 out of 67 patients. Ten patients did not have hip effusion; five of which were diagnosed with another cause for their limp and five were categorized as being possible TS. When POCUS was not utilised as part of clinical assessment, three cases included a misdiagnosis for children presenting with atraumatic limp.

Conclusion: Our POCUS CDR could be applied to correctly rule-in TS in a very high proportion of cases. The integration of POCUS into the clinical assessment of children with atraumatic limp can reduce the need for unnecessary investigations while maintaining diagnostic reliability. We recognise that a large prospective study evaluating the role of a POCUS CDR is needed to further evaluate its reliability.

Background: Inferior vena cava (IVC) point of care ultrasound (POCUS) is essential for hemodynamic evaluation, with the subcostal view (SCV) being the gold standard. However, in situations where this view is inaccessible, the transhepatic view (THV) is a viable alternative. This study evaluates the concordance between these two views in ventilated and non-ventilated patients, categorizing the IVC as small, intermediate, or large.

Methods: This prospective observational study included 99 patients; healthy volunteers, ventilated patients, and non-ventilated patients. We measured end-expiratory IVC diameter, classified as small (<10 mm), intermediate (10-20 mm) or large (>20 mm), via SVC and THV. We then assessed agreement by categorical concordance, using Bland-Altman (mean bias ± 95% limits) and Pearson's correlation (r).

Results: The overall concordance between both views was 83.8% (83/99; 95% CI: 76.4-90%). By IVC diameter category, concordance was 93.8% (15/16; 95% CI: 69.8-99.8) for small, 84% (42/50; 95% CI: 70-90 %) for intermediate, and 82% (27/33; 95% CI: 77-95%) for large. Concordance was unaffected by ventilation status (p = 0.83), but patients with Body Mass Index (BMI) ≥ 30 had lower concordance than those with BMI < 30 (73.9% vs. 89.5%; p = 0.086). The Bland-Altman analysis showed a mean bias of +0.22 mm with 95% limits of agreement from -6.99 to +7.43 mm. Pearson's correlation coefficient for the 99 paired measurements was r = 0.86 (p < 0.001), overall, and when stratified by category was r = 0.81 (small), r = 0.78 (intermediate) and r = 0.74 (large) (all p < 0.001). The sensitivity and specificity of THV for identifying "responders" (CI > 42%) were 28% and 93%, respectively.

Conclusion: The THV is a reliable alternative for categorical evaluation of the IVC, particularly when the SCV is inaccessible. This method supports rapid and accurate clinical decision, especially for dichotomous POCUS decisions but should be used cautiously in patients with elevated BMI.

Abdominal surgeries make up a significant portion of all surgical procedures performed worldwide. Despite advances in surgical techniques, there is significant morbidity and mortality associated with abdominal surgeries. Cardiopulmonary complications in the postoperative period play an important part in the elevated risk associated with these surgeries. Preoperative medical assessments have therefore become the standard of care to evaluate the risk of surgery, optimize a patient's medical conditions, and mitigate the perioperative risk. While there has been increasing utilization of lung point of care ultrasound (POCUS) in the immediate preoperative setting, the use of lung POCUS at the preoperative medical assessment clinic visit has not been studied. While using risk stratification tools is common in current practice, the role of adjunctive office-based techniques like lung POCUS have not been studied in this setting. We conducted an observational prospective pilot study to evaluate the association of lung POCUS findings in the preoperative visit on the risk of adverse cardiopulmonary outcomes in the 30-day postoperative period after major abdominal surgery. A standardized scoring system called integrated lung ultrasound score (iLUS) is used for objective assessment. Our study attempted to determine whether the addition of lung POCUS can be used to better stratify the risk for postoperative complications.

Peripherally inserted central catheters (PICCs) are commonly used in pediatric patients, but rare complications such as cardiac tamponade can occur. This case report describes a 5-month-old ex-premature infant who developed cardiac tamponade associated with PICC line malposition. Point of care ultrasound (POCUS) was used to diagnose and effectively manage the condition peri-arrest via emergent pericardiocentesis. The report highlights the role of POCUS in the prompt identification and treatment of hemodynamic deteriorations and posits potential utilization of POCUS as a tool in preventative surveillance.

Background: Foreign body ingestion is a common and challenging complaint for physicians in the emergency department (ED). Although most foreign bodies pass naturally without surgical intervention, about 10-20% require removal based on their size, shape, and location within the gastrointestinal tract. X-rays and computed tomography (CT) scans are frequently used for evaluation. However, x-rays cannot detect radiolucent foreign bodies, both modalities emit ionizing radiation, and CT scans are notably expensive. Point of care ultrasound (POCUS) offers a valuable alternative for detecting foreign bodies, as it avoids radiation exposure, reduces costs, and is readily accessible.

Case series: We present a case series involving three distinct instances of foreign body ingestion, where POCUS enhanced patient outcomes and disposition. This series includes evidence on use of POCUS for an obstructed esophageal foreign body and two gastric foreign bodies in a stable patient and unstable altered patient suspected of medication overdose.

Conclusion: POCUS is an effective tool for identifying foreign bodies in the upper gastrointestinal tract, especially when x-rays fail to visualize non-radiopaque materials or when attempting to minimize radiation from CT scans. It allows emergency physicians to quickly confirm the presence and precise location of foreign bodies in the gastrointestinal tract, leading to faster clinical decision making and reduced risk of complications, such as perforation or obstruction.