POCUS journal最新文献

Introduction: Cardiac point of care ultrasound (POCUS) has been used with increasing frequency. As a result of this trend, this study sought to characterize cardiologists' perspectives on cardiac POCUS. Methods: An 18-question survey on demographics, cardiac POCUS clinical practice, education, and infrastructure was distributed by 16 academic medical centers. Likert scale responses were categorized into three groups: 1) "strongly agree" or "agree" 2) "strongly disagree" and "disagree" and 3) "neutral." Results: Of the 140 survey responses collected from January to September 2021, 41% of respondents used cardiac POCUS more than twice in an inpatient week. Seventy-one percent of cardiologists believed that cardiac POCUS should be integrated more regularly into clinical practice and into cardiology fellowship education. Less than half of respondents (44%) reported easy access to POCUS devices, and more than half of respondents (56%) did not think there was appropriate institutional infrastructure to easily upload and document cardiac POCUS images (56%). Conclusions: Academic cardiologists had varying opinions on the use and impact of cardiac POCUS. However, most cardiologists believed that cardiac POCUS should be more incorporated within practice despite persisting infrastructure barriers.

A 68-year-old man presented with one week of vague abdominal symptoms and was found to have new ascites and pulmonary embolism for which a heparin drip was initiated. We report a case diagnosing hemoperitoneum with point of care ultrasound (POCUS). Identifying hemoperitoneum can be challenging, but POCUS can be a useful tool for its diagnosis. There is limited literature on the sonographic characteristics of hemoperitoneum. Echogenicity of fluid is not a reliable distinguisher between exudative and transudative effusions. The diagnosis of hemoperitoneum in this case was suggested by the progression of POCUS findings over time rather than sonographic characteristics by themselves.

Point of Care Ultrasound (POCUS) is used to evaluate many clinical scenarios. Chest POCUS has been integrated as a part of a clinical protocol to assess patients with lung pathology 1. The ability to detect pneumothorax using chest POCUS has been shown to be superior to chest radiography, with specificity reported to be as high as 100% when a lung point sign is identified. In addition to improved diagnostic accuracy, chest POCUS has the added benefits of ease of access and absence of ionizing radiation. Here we describe a case where a patient with a high pre-test probability for pneumothorax had a detected lung point sign, but pneumothorax was ruled out via Computed Tomography (CT). This case highlights the importance of considering the mimics of the lung point sign. This case also shows a unique and interesting finding related to pleural movement restriction post-Bronchoscopic lung volume reduction (BLVR).

Application of ultrasound to evaluate pediatric respiratory disease in the emergency department setting is rapidly growing, particularly as we often weigh the risks of exposure to radiation with other readily available imaging modalities in the acute care setting. In this case report, we describe how point of care ultrasound (POCUS) was utilized by emergency providers to characterize a lung abscess diagnosed in a pediatric patient. We also compare the ultrasound findings to other imaging studies.

Purpose: Renal ultrasound is a non-invasive method to assess for obstructive acute kidney injury (AKI). Point of care ultrasound (POCUS) has been shown to be a good screening tool for obstructive AKI, and with formal training, has high sensitivity and specificity. We aimed to evaluate the effectiveness and feasibility of integrating a novel renal POCUS curriculum into an existing two-week nephrology rotation for internal medicine residents. Methods: We enrolled internal medicine residents rotating on a two-week nephrology rotation between September 2022 and June 2023. Pre-recorded online lectures and a hands-on session on image acquisition were provided. Pre-and post-rotation confidence questionnaires and knowledge tests were collected. At the end of the rotation, participants were evaluated using a skills checklist. Evaluation for knowledge retention was assessed 6-12-months post-rotation with a post-survey and knowledge test. Results: Of the 16 residents that were enrolled, 12 residents completed pre- and post-rotation questionnaires and tests, and 15 residents completed the 6-12-month follow-up. The confidence level showed significant improvement post-test and at 6-12-month follow-up. Knowledge test scores showed a trend towards improvement that did not achieve statistical significance (pre- 6.0 [5.0-7.25], post- 6.5 [5.75-8.0], 6-12-months 7.0 [6.0-8.0] p=0.40). On the skills checklist, an average of 16.8 out of 18 steps were done correctly. Conclusion: Our study showed confidence improvement and a trend towards knowledge improvement after integrating a novel Renal POCUS curriculum into a nephrology rotation. Further iterative changes, such as deliberate practice, or practice with immediate feedback, should be considered.

Background: Visualization of the guidewire during internal jugular (IJ) vein catheterization by point of care ultrasound (POCUS) has been recommended for avoiding inadvertent carotid artery dilation. The purpose of this study was to determine the accuracy of POCUS for identifying guidewires inappropriately placed in the carotid artery. Methods: This prospective, observational study involved emergency medicine (EM) residents with varying experience in guidewire visualization. Using an inanimate model, investigators placed guidewires randomly into the carotid artery or IJ vein. Residents, blinded to guidewire location, scanned the model and recorded their findings. The test performance of POCUS for arterially placed guidewires was evaluated through calculation of sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and overall accuracy, using investigator placement as the non-reference standard. Results: Twenty-five residents performed 51 observations. The test performance of POCUS for identifying arterially placed guidewires was sensitivity 95.0% (95%CI = 73.1-99.7%), specificity 96.8% (95%CI = 81.5-99.8%), NPV 96.8% (95%CI = 81.5-99.8%), and PPV 95.0% (95%CI = 73.1-99.7%). The overall accuracy was 96.1% (95%CI = 86.8-98.9%). Residents reported being very confident in their findings in 88.2% of all observations (95%CI = 76.6-94.5%), somewhat confident in 9.8% (95%CI = 4.3-21.0%), and not very confident in 2.0% (95%CI = 0.4-10.3%). No errors occurred among upper-level residents (post-graduate years 2-3) or those reporting >5 prior wire visualizations in live patients. Conclusions: This study is the first to demonstrate that physicians can easily identify misplaced guidewires located in the carotid artery with a high degree of accuracy using POCUS. We recommend routine scanning of the IJ vein and carotid artery prior to vessel dilation to reduce the likelihood of carotid artery injury.

Introduction: There has been increasing interest in point of care ultrasound (POCUS) as a learning tool in preclinical medical anatomy and physiology courses. Few interventions have used team-based learning (TBL) to teach cardiac POCUS. This study investigates a novel TBL exercise designed to integrate cardiac anatomy, physiology, and cardiac POCUS education within a first-year cardiovascular (CV) course called Team-Based Learning - Ultrasound (TBL-US). Methods: The TBL-US exercise consisted of four phases: preparation, individual and team readiness assurance, image acquisition and application, and knowledge assessment. Six second-year students were trained to facilitate the session under physician supervision. Pre- and post-session knowledge assessments were administered to determine knowledge acquisition. Pre- and post-session surveys were administered to assess attitudes, beliefs, and confidence surrounding cardiac POCUS. Final exam scores were compared between participants and non-participants of TBL-US and stratified into high- and low-performing subgroups to account for pre-TBL baseline differences in ability between the groups. Results: A total of 54 first-year medical students completed TBL-US. Students showed significant improvement on the post-knowledge assessment compared to the pre-knowledge assessment (70.5% vs. 54.9% [p< 0.001]) and scored significantly higher on the final CV exam compared to non-participants (low-performing group: 85.92% vs. 81.02% [p=0.039], high-performing group: 89.22% vs. 85.95% [p=0.038]). Between 43.3-72.7% of students reported that TBL-US increased their understanding of CV anatomy, physiology, and cardiac POCUS. Discussion: Students found TBL-US to be a valuable teaching modality and improved student knowledge of CV anatomy, physiology, and cardiac POCUS. TBL-US effectively augments the learning of cardiac anatomy and physiology during the preclinical undergraduate medical curriculum.