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Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus 医疗点超声最佳实践:跨学科专家共识
Pub Date : 2024-04-22 DOI: 10.24908/pocus.v9i1.17240
Brandon Oto, Robert Baeten, Leon Chen, Puja Dalal, Ria Dancel, Steven Fox, Carl William Lange, Cameron M. Baston, Paul Bornemann, Siddharth P. Dugar, Andrew Goldsmith, M. Herbst, James N. Kirkpatrick, Abhilash Koratala, Michael J Lanspa, Viveta Lobo, Jason Nomura, A. Pustavoitau, Mourad Senussi, Vincent L Sorrell, Frances Mae West, A. Sarwal
Abstract Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice. Using a three-round modified Delphi process, a multi-disciplinary panel of 22 POCUS experts based in the United States reached consensus on 57 statements in domains including: (1) The definition and clinical role of POCUS; (2) Training pathways; (3) Credentialing; (4) Cleaning and maintenance of POCUS devices; (5) Consent and education; (6) Security, storage, and sharing of POCUS studies; (7) Uploading, archiving, and reviewing POCUS studies; and (8) Documenting POCUS studies. The consensus statements are provided here. While not intended to establish a standard of care or supersede more targeted guidelines, this document may serve as a useful baseline to guide clinicians, leaders, and systems considering initiation or enhancement of POCUS programs.
摘要 尽管护理点超声(POCUS)在当代医疗实践中的应用越来越广泛,而且针对其具体应用的临床指南也已出台,但在 POCUS 使用的几个领域中,仍然缺乏标准化和最佳实践的共识。医疗点超声学会(SPOCUS)于 2022 年成立了一个工作小组,旨在为 POCUS 建立一套推荐的最佳实践,适用于临床医生,无论他们接受过何种培训、从事何种专业、拥有何种资源或属于何种执业范围。由美国 22 位 POCUS 专家组成的多学科小组采用三轮改良德尔菲流程,就以下领域的 57 项声明达成共识:(1) POCUS 的定义和临床作用;(2) 培训途径;(3) 资格认证;(4) POCUS 设备的清洁和维护;(5) 同意和教育;(6) POCUS 研究的安全性、存储和共享;(7) POCUS 研究的上传、归档和审查;以及 (8) POCUS 研究的记录。此处提供了共识声明。本文件并非旨在建立护理标准或取代更有针对性的指南,但可作为一个有用的基准,为考虑启动或加强 POCUS 计划的临床医生、领导者和系统提供指导。
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引用次数: 0
Point of Care Ultrasound Used to Diagnose Nontyphoidal Endocarditis 用于诊断非类风湿性心内膜炎的护理点超声检查
Pub Date : 2024-04-22 DOI: 10.24908/pocus.v9i1.16937
Zahraa Yousef Alqallaf, O. Maadarani, M. Elhabibi, Mohamad AbdelFatah, Z. Bitar
Abstract Point of care ultrasound (POCUS) can make an expedited diagnosis, which might lead to early correct management. POCUS should be used in a systemic and integrated approach to evaluate multiple organs in patients with sepsis and septic shock. We present a rare case of sepsis due to nontyphoidal Salmonella endocarditis with splenic abscess in which a multiorgan POCUS examination led to expedited treatment.
摘要 护理点超声检查(POCUS)可以快速做出诊断,从而及早采取正确的治疗措施。在对脓毒症和脓毒性休克患者进行多器官评估时,应采用系统性综合方法。我们介绍了一例罕见的非类风湿沙门氏菌性心内膜炎并发脾脓肿的败血症病例,在该病例中,多器官 POCUS 检查为患者带来了快速治疗。
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引用次数: 0
Vaginal Bleeding in a Peri-Menopausal Woman 围绝经期妇女的阴道出血问题
Pub Date : 2024-04-22 DOI: 10.24908/pocus.v9i1.16621
Ambika Shivarajpur, Brian Kohen
Abstract Point of care ultrasound (POCUS) is a useful modality to initially identify a molar pregnancy. In this case, we describe a 51-year-old perimenopausal woman who presented to the emergency department (ED) with vaginal bleeding. A transvaginal POCUS was performed, revealing findings concerning for a molar pregnancy. These findings led to prompt diagnosis and treatment.
摘要 护理点超声检查(POCUS)是初步确定磨牙妊娠的一种有效方法。在本病例中,我们描述了一名 51 岁的围绝经期妇女因阴道出血到急诊科就诊。对她进行了经阴道 POCUS 检查,结果显示其为磨牙状妊娠。由于这些发现,我们及时进行了诊断和治疗。
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引用次数: 0
Point of Care Ultrasound Identification and Aspiration of a Neck Lymph Node 颈部淋巴结的定点超声波识别和抽吸
Pub Date : 2024-04-22 DOI: 10.24908/pocus.v9i1.16761
Andrew W. Moore, Ali Mrad, Leonard Riley, Sonia Castillo
Abstract The tissue diagnosis and staging of all types of lung cancer is foundational for prognosis and establishing the optimal treatment plan. In order to appropriately stage lung cancer, the highest stage should be established using the 8th edition TNM criteria, where tumor size (T), nodal involvement (N), and metastasis (M) are all taken into account. Establishing a tissue diagnosis may involve the use of CT guided biopsy, navigational bronchoscopy, endobronchial biopsy, EBUS, percutaneous lymph node biopsy and/or excisional biopsy of supraclavicular nodes. It is recommended to proceed with the method that is considered least invasive and provides the highest staging. We present a case of recurrent lung adenocarcinoma diagnosed with real time ultrasound-guided fine needle aspiration of a neck lymph node.
摘要 各种肺癌的组织诊断和分期对于预后和制定最佳治疗方案至关重要。为了对肺癌进行适当分期,应使用第 8 版 TNM 标准确定最高分期,其中肿瘤大小(T)、结节受累(N)和转移(M)均应考虑在内。组织诊断可能需要使用 CT 引导活检、导航支气管镜检查、支气管内活检、EBUS、经皮淋巴结活检和/或锁骨上结节切除活检。建议采用创伤最小、分期最高的方法。我们介绍了一例通过实时超声引导颈部淋巴结细针穿刺确诊的复发性肺腺癌病例。
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引用次数: 0
The Application of Point of Care Ultrasound to Screen for Pulmonary Hypertension: A Narrative Review 应用护理点超声波筛查肺动脉高压:叙述性综述
Pub Date : 2024-04-22 DOI: 10.24908/pocus.v9i1.17494
Danny Yu Jia Ke, Melissa Tso, Amer Johri
Abstract Background: Pulmonary Hypertension (PH) is a condition with several cardiopulmonary etiologies that has the potential of progressing to right heart failure without proper intervention. After a history, physical exam, and investigations, cases of suspected PH typically undergo imaging via a transthoracic echocardiogram (TTE). This is a resource-intensive procedure that is less accessible in remote communities. However, point of care ultrasound (POCUS), a portable ultrasound administered at the bedside, has potential to aid in the diagnostic process of PH. Methods: The MEDLINE, Embase, and CENTRAL databases were searched to screen the intersection of POCUS and PH. Studies involved adult patients, and only English articles were accepted. Reviews, case reports, unfinished research, and conference abstracts were excluded. Our aim was to identify primary studies that correlated POCUS scan results and additional clinical findings related to PH. Results: Nine studies were included after our search. In these studies, POCUS was effective in identifying dilatation of inferior vena cava (IVC); internal jugular vein (IJV); and hepatic, portal, and intrarenal veins in patients with PH. The presence of pericardial effusion, pleural effusion, or b-lines on POCUS are also associated with PH. Conclusions: This review suggests important potential for the use of POCUS in the initial screening of PH. IVC and basic cardiopulmonary POCUS exams are key for PH screening in patients with dyspnea. Right-heart dilatation can be visualized, and peripheral veins may be scanned based on clinical suspicion. POCUS offers screening as an extension of a physical exam, with direct visualization of cardiac morphology. However, more studies are required to develop a statistically validated POCUS exam for PH diagnosis. More studies should also be conducted at the primary-care level to evaluate the value of screening using POCUS for PH in less-differentiated patients.
摘要 背景:肺动脉高压(PH)是一种有多种心肺病因的疾病,如果不进行适当干预,有可能发展为右心衰竭。经过病史、体检和检查后,疑似肺动脉高压的病例通常要接受经胸超声心动图(TTE)成像检查。这是一种资源密集型程序,偏远社区较难获得。然而,床旁便携式超声检查(POCUS)可协助 PH 的诊断过程。方法:检索 MEDLINE、Embase 和 CENTRAL 数据库,筛选 POCUS 与 PH 的交叉点。研究涉及成年患者,只接受英文文章。综述、病例报告、未完成的研究和会议摘要均被排除在外。我们的目的是找出将 POCUS 扫描结果与 PH 相关的其他临床发现联系起来的主要研究。结果:经过检索,共纳入九项研究。在这些研究中,POCUS 能有效识别 PH 患者的下腔静脉 (IVC)、颈内静脉 (IJV)、肝静脉、门静脉和肾内静脉扩张。POCUS 上出现心包积液、胸腔积液或 b 线也与 PH 有关。结论:本综述表明,POCUS 在 PH 的初步筛查中具有重要的应用潜力。IVC 和基本心肺 POCUS 检查是呼吸困难患者 PH 筛查的关键。可观察到右心扩张,并可根据临床怀疑扫描外周静脉。POCUS 可作为体格检查的延伸提供筛查,直接观察心脏形态。不过,还需要进行更多的研究,才能开发出经统计学验证的用于 PH 诊断的 POCUS 检查方法。此外,还应在初级保健层面开展更多研究,以评估使用 POCUS 对分化程度较低的患者进行 PH 筛查的价值。
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引用次数: 0
Effectiveness of a Brief Point of Care Ultrasound Course at a National Nephrology Conference 在全国肾脏病学会议上举办简短的护理点超声课程的效果
Pub Date : 2024-04-22 DOI: 10.24908/pocus.v9i1.16858
Abhilash Koratala, Nilam J Soni, Rupal Mehta, Nathaniel C Reisinger
Abstract The rising demand for point of care ultrasound (POCUS) instruction during nephrology fellowship has been limited due to a shortage of trained faculty and courses designed specifically for nephrologists. A hands-on POCUS pre-course was organized during the April 2023 National Kidney Foundation (NKF) Spring Clinical Meeting to address this challenge. The course consisted of pre-recorded lectures and a 4-hour hands-on workshop guided by multidisciplinary POCUS experts. The anonymous post-course survey received responses from 25 out of 39 participants, yielding a 64.1% response rate. On a scale of 0-10, confidence levels for acquiring kidney images rose from 2.6 + 2.3 (mean + SD) pre-workshop to 7.8 + 1.5 post-workshop (p<0.001). Similarly, a remarkable improvement in confidence for acquiring lung and cardiac images was seen as scores increased from 1.8 + 2.4 to 7.7 + 1.5 (p<0.001) and from 1.5 + 2.2 to 7.2 + 1.3 (p<0.001), respectively. Additionally, respondents reported a substantial improvement in their confidence to interpret kidney, lung, and cardiac POCUS images, with scores increasing from 4.5 + 2.2 to 7.7 + 1.1 (p<0.001), 2.3 + 2.4 to 7.6 + 1.5 (p<0.001), and 2 + 2 to 7.3 + 1.5 (p<0.001), respectively. Barriers to implementing POCUS use at institutions included a perceived lack of trained faculty, limited protected time for faculty, and insufficient support from division leadership. The NKF POCUS pre-course successfully improved participants’ confidence in acquiring and interpreting basic POCUS images.
摘要 由于缺乏训练有素的教师和专为肾脏病学家设计的课程,肾脏病学研究期间对护理点超声(POCUS)教学的需求不断增加。为了应对这一挑战,我们在 2023 年 4 月美国国家肾脏基金会 (NKF) 春季临床会议期间组织了一次 POCUS 实践预科课程。课程包括预先录制的讲座和由多学科 POCUS 专家指导的 4 小时实践研讨会。课后匿名调查收到了 39 名参与者中 25 人的回复,回复率为 64.1%。在 0-10 分的评分中,学员对获取肾脏图像的信心水平从研修班前的 2.6 + 2.3(平均值 + 标准差)上升到研修班后的 7.8 + 1.5(P<0.001)。同样,获取肺部和心脏图像的信心也有显著提高,得分分别从 1.8 + 2.4 上升到 7.7 + 1.5(p<0.001)和从 1.5 + 2.2 上升到 7.2 + 1.3(p<0.001)。此外,受访者表示他们解读肾脏、肺部和心脏 POCUS 图像的信心大幅提高,得分分别从 4.5 + 2.2 提高到 7.7 + 1.1 (p<0.001)、2.3 + 2.4 提高到 7.6 + 1.5 (p<0.001) 和 2 + 2 提高到 7.3 + 1.5 (p<0.001)。医疗机构实施 POCUS 的障碍包括缺乏训练有素的教师、教师受保护的时间有限以及科室领导的支持不足。NKF POCUS 预科课程成功提高了学员获取和解读基本 POCUS 图像的信心。
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引用次数: 0
Gas Forming Pyogenic Liver Abscess Diagnosed by Point of Care Ultrasound 通过医疗点超声诊断出气体形成的化脓性肝脓肿
Pub Date : 2024-04-22 DOI: 10.24908/pocus.v9i1.16854
Wei Ven Chin, Mae Jane Khaw
Abstract Gas-forming pyogenic liver abscess (GFLPA) carries a high mortality rate. Early identification of the source of infection in sepsis results in better survival. Bedside point of care ultrasound (POCUS) can be used to help localize a source of infection. A 59-year-old man presented with systemic inflammatory response syndrome (SIRS) and was diagnosed with GFLPA on the initial encounter via clinical assessment and POCUS examination. After commencing antibiotics, optimal glucose control, adequate fluid resuscitation, and early infective source control, he achieved full recovery and was followed up in outpatient medical and surgical clinics. This case illustrates the role of POCUS as a diagnostic tool in sepsis and raises awareness among clinicians to recognize the features of GFLPA on POCUS.
摘要 气体形成的化脓性肝脓肿(GFLPA)死亡率很高。及早发现败血症感染源可提高存活率。床旁护理点超声(POCUS)可用于帮助定位感染源。一名 59 岁的男子出现全身炎症反应综合征(SIRS),初诊时通过临床评估和 POCUS 检查确诊为 GFLPA。在开始使用抗生素、最佳血糖控制、充分液体复苏和早期感染源控制后,他完全康复,并在内科和外科门诊接受了随访。本病例说明了 POCUS 作为脓毒症诊断工具的作用,并提高了临床医生识别 POCUS 上 GFLPA 特征的意识。
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引用次数: 0
Testicular Torsion with Intact Blood Flow: A Point of Care Ultrasound Case-Series 血流完整的睾丸扭转:护理点超声病例系列
Pub Date : 2024-04-22 DOI: 10.24908/pocus.v9i1.17201
E. Scheier
Abstract Studies have demonstrated the high sensitivity and specificity of pediatric emergency department (PED) point of care ultrasound (POCUS) in the evaluation of testicular torsion. Rarely, testicular torsion may present with intact blood flow. Here, we present a case series of four children with testicular torsion confirmed intraoperatively, who had intact blood flow on POCUS. Markers of testicular torsion can include surrounding hydrocele, heterogenous echotexture, absent venous or high resistance arterial flow, or a torsed cord complex. POCUS practitioners should be familiar with these findings, and the presence of any one or more of these findings should prompt urgent urology consultation to avoid missed torsion.
摘要 研究表明,儿科急诊室(PED)护理点超声检查(POCUS)在评估睾丸扭转方面具有很高的灵敏度和特异性。在极少数情况下,睾丸扭转可能伴有完整的血流。在此,我们介绍了四例经术中确认为睾丸扭转的患儿的病例系列,这些患儿在 POCUS 检查中血流完好。睾丸扭转的标志可能包括周围鞘膜积液、异质回声纹理、静脉或高阻力动脉血流缺失或扭索复合体。POCUS 医生应熟悉这些检查结果,如果出现上述任何一种或多种检查结果,应立即到泌尿科就诊,以避免漏诊。
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引用次数: 0
Trends in Point of Care Ultrasound Familiarity Among Undergraduate Medical Clerkship Educators 本科生实习医生对护理点超声波熟悉程度的变化趋势
Pub Date : 2024-04-22 DOI: 10.24908/pocus.v9i1.16678
Nilan Schnure, Mahmoud Mohamed Elfadil, Wilma Chan, Cameron M. Baston, Frances Shofer, Nova Panebianco
Abstract Objectives: Despite growing use of point of care ultrasound (POCUS), there remains a paucity of data about familiarity with POCUS among educators who dictate curricular content in undergraduate medical education. This paper aims to longitudinally characterize the level of comfort and frequency of POCUS use among faculty involved in undergraduate clerkship education. Methods: A web-based cross-sectional survey assessing comfort, frequency of use, and awareness of indications for POCUS among faculty involved in Internal Medicine, Family Medicine, and Surgery undergraduate clerkship education in a single urban academic medical center in 2016 and again in 2022. Results: A total of 45 responses from 2016 and 30 responses from 2022 are included. The percentage of faculty “not comfortable” with performing POCUS decreased from 78% to 46%, although the overall change in comfort was not statistically significant. Comfort interpreting POCUS images, frequency of POCUS use, and familiarity with the clinical applications of POCUS all improved. Faculty identified multiple barriers to more frequent POCUS use. Conclusions: Over a six-year period at one urban, academic medical center, comfort with POCUS and frequency of use have increased slightly but remain low among core faculty responsible for clerkship education. There are still large gaps in knowledge and very few faculty regularly use POCUS, which can be attributed to multiple different barriers.
摘要 目的:尽管护理点超声波(POCUS)的应用日益广泛,但有关本科医学教育中课程内容的教育者对 POCUS 的熟悉程度的数据仍然很少。本文旨在纵向描述参与本科生实习教育的教师对 POCUS 使用的舒适度和频率。方法:基于网络的横断面调查,评估一个城市学术医学中心内科、全科和外科参与本科实习教育的教师在 2016 年和 2022 年使用 POCUS 的舒适度、使用频率和对适应症的认识。结果:共收录了 2016 年的 45 份回复和 2022 年的 30 份回复。对 POCUS 操作 "不熟悉 "的教员比例从 78% 降至 46%,但整体舒适度变化无统计学意义。解读 POCUS 图像的舒适度、使用 POCUS 的频率以及对 POCUS 临床应用的熟悉程度均有所提高。教员们发现了更频繁使用 POCUS 的多种障碍。结论:在一家城市学术医疗中心的六年时间里,POCUS 的舒适度和使用频率略有提高,但在负责实习教育的核心教员中仍处于较低水平。由于存在多种不同的障碍,教职员工对 POCUS 的认识仍有很大差距,经常使用 POCUS 的教职员工也寥寥无几。
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引用次数: 0
Hematometra: A Rare Case of Pelvic Pain in Females Identified with Point of Care Ultrasound 子宫出血:通过医疗点超声波检查发现的女性盆腔疼痛罕见病例
Pub Date : 2024-04-22 DOI: 10.24908/pocus.v9i1.16988
Andrew Helber, Margaret Provencher, Christy Moore, Nova Panebianco
Abstract The differential diagnosis for abdominal or pelvic pain in women of child-bearing age that present to the emergency department is broad. A rare cause of abdominal and pelvic pain is hematometra, or a collection of blood products within the uterus. While blood is normally expelled through menses, this process is disrupted in some patients due to congenital or acquired abnormalities. This can lead to progressive uterine distension and pain, which may ultimately require medical or surgical intervention. Hematometra is rare, but is a serious condition that can be diagnosed easily at bedside using point of care ultrasound.
摘要 育龄妇女因腹痛或骨盆疼痛到急诊科就诊时,鉴别诊断的范围很广。导致腹痛和骨盆疼痛的一个罕见原因是血子宫,即子宫内聚集血制品。正常情况下,血液会通过月经排出,但有些患者由于先天或后天畸形,这一过程会被打乱。这会导致子宫逐渐胀大和疼痛,最终可能需要药物或手术干预。子宫出血虽然罕见,但却是一种严重的疾病,可通过床旁超声检查轻松诊断。
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引用次数: 0
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