POCUS journal最新文献

Pyonephrosis is a severe complication of hydronephrosis and can lead to the destruction of the renal parenchyma, sepsis, shock, and death. The clinical presentation is nonspecific, and 15% of patients are asymptomatic on presentation. In resource-limited settings, where Computed Tomography (CT) imaging is not available, point of care ultrasound (POCUS) plays an important role in evaluating kidney diseases in the emergency department (ED). In this case, a 36-year-old man presented to the ED with dyspnea, fever, abdominal pain, and abdominal distention in the area where an intra-abdominal tumor was reported. After ultrasound-guided aspiration, pyonephrosis was diagnosed. In the absence of other capable specialists, the emergency physician performed a percutaneous nephrostomy procedure, and eight liters of pus were removed. The patient improved significantly and was discharged from the ED with oral antibiotics and scheduled urology follow-up in the clinic.

Point of care ultrasound (POCUS)-use during short-term surgical missions (STSMs) to resource-limited settings has not been well studied. We conducted a retrospective analysis of POCUS use during the perioperative course of patients undergoing definitive surgical treatment over the course of two STSMs. A total of 58 perioperative POCUS exams were performed by emergency physicians on our team. Operative findings correlated with POCUS results in 90% of cases that underwent surgery, while surgery was deferred based on POCUS findings in 33% of scans. Our findings suggest that POCUS is a portable, rapid and cost-effective modality that can be used in a focused manner in the perioperative period. Specifically, our inter-disciplinary experience and results demonstrate that POCUS-use has a positive impact on patient safety and quality, and optimizes the use of valuable resources and time.

Background: Acute limb ischemia (ALI) is a vascular emergency associated with significant pain that can be challenging to manage, especially in opioid-tolerant patients.

Case report: A 44-year-old man with opioid use disorder presented with ALI of the right hand not amenable to surgical intervention after self-injection of fentanyl. Despite high-dose opioids, he continued to experience refractory pain. Point of care ultrasound (POCUS)-guided radial and median nerve blocks performed in the emergency department provided substantial relief.

Discussion: This case illustrates the novel use of POCUS-guided upper extremity regional anesthesia by emergency physicians to manage ALI pain. POCUS-guided regional anesthesia may be a safe, effective adjunct in select patients, though patients must be closely monitored for complications.

A previously healthy 12-year-old boy presented to the paediatric emergency department on three occasions in the space of four days with progressive right iliac fossa pain. His presentation appeared consistent with appendicitis; however, blood tests remained normal at each presentation. Point of care ultrasound (POCUS) revealed significant inflammatory changes in the right lower quadrant along with free fluid. Due to worsening pain and advancing findings on POCUS, the patient underwent a diagnostic laparoscopy which identified a normal appendix but had features consistent with omental infarction. Omental infarction is a rare condition that can mimic appendicitis, with few recorded cases in the literature. This is the first documented case of POCUS being utilised in the evaluation of a child with omental infarction. While the patient's diagnosis was less common than initially suspected, POCUS played a crucial role in guiding timely and effective patient care, highlighting its value in clinical decision-making However, there are indications of lower POCUS sensitivity to fluid overload with a full peritoneum.

Background: Point of care ultrasound (POCUS) training is increasingly incorporated in undergraduate medical education (UME). However, limited resources and lack of standard guidelines lead to questions regarding the most effective curriculum and assessment method. The authors aimed to develop a longitudinal UME POCUS curriculum through staged intervention. Year 1, which involved simulation alone, led to improved confidence without adequate knowledge. The authors hypothesized that the addition of resident-led workshops alongside faculty-led lectures would improve POCUS knowledge and confidence among third-year medical students.

Methods: A prospective cohort study of third-year students on the Internal Medicine (IM) clerkship at a large academic medical center was performed, assessing efficacy of stepwise POCUS curriculum development. Previously implemented year 1 involved comparing the control cohort receiving baseline POCUS education on rounds with the experimental cohort that had access to a high-fidelity POCUS simulator. The year 2 cohort added hands-on resident-led POCUS workshops. The year 3 cohort added faculty-led lectures. All cohorts completed pre- and post-intervention confidence and knowledge-based examinations. The year 1 control cohort served as a control for the current study.

Results: A total of 69 and 102 students completed both pre-/post-tests among year 2 and 3 cohorts, respectively. Both cohorts demonstrated statistically significant improvement in POCUS knowledge and confidence, with greater magnitude of improvement in year 3 with overall knowledge improving from 49.9% to 66.7% on pre- to post-intervention examination (p<0.0001).

Conclusion: While simulation alone was insufficient to instill knowledge, the addition of resident-led workshops and faculty-led lectures demonstrated benefits in POCUS knowledge and confidence among medical students and represents a sustainable model of training.

Background: Point of care ultrasound (POCUS) training in internal medicine (IM) training remains largely unavailable in lower-resourced health systems globally. Longitudinal inter-institutional collaboration, based in health equity principles, offers a potential mechanism for more accessible and effective IM POCUS education.

Methods: In a partnership between two academic medical centers in Caracas, Venezuela (Luis Razetti School of Medicine at the Universidad Central de Venezuela (UCV)) and New York, USA (New York University (NYU) Grossman School of Medicine), we evaluated the impact of an IM POCUS training program on knowledge and skills of IM physicians at UCV. During 2023-2024, 18 UCV IM physicians participated in the program. The program included online tutorials and quizzes, in-person image interpretation review, and supervised practice. Participants completed a pre-course knowledge assessment, post-course knowledge, skills, and self-confidence assessments, and qualitative feedback regarding course acceptability.

Results: Pre-to-post knowledge assessments demonstrated mean score improvement. Post-course knowledge scores were not significantly different between UCV and NYU cohorts (77% vs. 78%, respectively; p =0.82). Skill scores measured by a hands-on test were comparable between groups, with few significant differences. Learners self-rated increases in confidence during the course, and rated the course as locally acceptable and sustainable.

Conclusions: A standardized, longitudinal, international IM POCUS training program was successfully implemented with faculty learners in a lower-resourced health system, who demonstrated gains in knowledge and skills, and reported high educational value of the partnership. The results support expanding inter-institutional POCUS training programs founded in health equity principles.

Objective: Our objective was to evaluate and appraise the existing evidence on the use of point of care ultrasound (POCUS) for pulled elbow, including its positive findings and their reliability.

Methods: We searched PubMed, Medline, EMBASE, CINAHL and Google Scholar for prospective and retrospective studies evaluating POCUS use for suspected pulled elbow. We identified positive sonographic findings along with their sensitivity and specificity relating to this diagnosis.

Results: We included 13 studies that reviewed ultrasonographic findings in suspected pulled elbow. These studies discussed a range of sonographic findings between them, including radio- capitellar distance, 'J-sign'/'Hook sign', fat pad sign and partial eclipse sign. The studies were of mixed quality and were susceptible to bias.

Conclusions: Children presenting with suspected pulled elbow who have evidence of hook sign (or J-sign) and an absence of elbow effusion on POCUS can be diagnosed with pulled elbow and safely undergo reduction. POCUS can be used following reduction to demonstrate resolution of these signs and confirm its success. Elbow injuries with effusion are likely to have bony injury, meaning that X-ray is required. Additional prospective study of children presenting with elbow injury would be required to accurately determine the effectiveness of POCUS in the diagnosis of pulled elbow.

Background: Prolonged inpatient length of stay (LOS) is associated with worse clinical outcomes and increased healthcare costs. Transthoracic echocardiography (TTE) is commonly utilized in cardiac evaluation of hospital inpatients but is associated with prolonged LOS and may not always be necessary. Point of care ultrasound (POCUS) may help reduce the need for inpatient TTEs.

Objective: We aimed to demonstrate the feasibility of a POCUS-guided TTE triage protocol and estimate its impact on inpatient TTE utilization.

Methods: From September to December 2023, inpatient clinicians and participating patients at a large academic institution were surveyed about their perspectives and experiences with POCUS. Cardiac POCUS exams were performed and interpreted for pre-specified clinical indications by POCUS-trained hospitalists, then reviewed independently by at least two board-certified cardiologists. Interpretations were compared using pairwise agreement analysis (kappa (κ) statistic). Finally, hospitalists and cardiologists independently offered their TTE triage recommendation, categorized as either inpatient, outpatient, or cancellation. Triage agreement between the two groups was reported as a percentage of overall cases.

Results: Clinicians and patients were receptive to integrating POCUS exams into clinical care. Ninety POCUS exams were completed during the intervention period, on average 22 hours before TTE. Hospitalist and cardiologist agreement was moderate to very good (0.57-0.99) for specific cardiac findings. The hospitalist and at least one cardiologist agreed that 59 (66%) of 90 exams performed within the triage pathway could result in deferral or cancellation of inpatient TTE.

Conclusions: A POCUS-guided TTE triage protocol can reduce low-value inpatient TTE use, potentially expediting necessary TTEs and reducing TTE backlog.

Background: Ultrasound guided (USG) peripheral intravenous (PIV) access is a vital use of point of care ultrasound (POCUS) that decreases time to access, reduces need for more invasive access, preserves vasculature, and improves patient experience.

Objectives: We describe the impact of an Emergency Department (ED) based vascular access program with a specialized team of paramedics and emergency medical technicians (EMTs). This team is trained in USG PIV access to assist with patients that have difficult intravenous access (DIVA) both in the ED and throughout the academic medical center.

Methods: This descriptive report details the implementation, development, and evolution of a highly skilled vascular access team trained in USG PIV placement at a single academic center. Under the guidance of ultrasound fellowship trained, board-certified Emergency Medicine (EM) ultrasound faculty, ED paramedics and EMTs are provided comprehensive training and oversight of USG PIV placement. Program description, patient selection, and billing capture are described. This report met Institutional Review Board exemption criteria as a descriptive quality improvement project.

Conclusions: This report details the formation and maintenance of a highly skilled vascular access team. The team is comprised of paramedics and EMTs who have been trained in USG PIV placement allowing them to care for patients with DIVA. The evolution of this team has allowed the development of a tiered approach to vascular access and vascular preservation throughout the organization, benefitting both patients and hospital staff.