POCUS journal最新文献

Acute appendicitis is the most common pediatric surgical emergency. Diagnosis may be made by targeted point of care ultrasound (POCUS) of the right lower quadrant (RLQ) abdomen. This can be performed by trained emergency physicians and has similar accuracy to ultrasound performed by radiology technologists and interpreted by radiologists (RADUS) [1,2]. Pediatric patients with appendicitis may present without classical clinical signs and symptoms. Retrocecal appendicitis is often diagnosed late at perforation due to the anatomical position limiting diagnosis with ultrasound, despite the high prevalence of retrocecal appendix as an anatomic variation (up to 65%). Given the limited sensitivity for ultrasound in the diagnosis of appendicitis in patients with retrocecal appendix, these patients often undergo advanced imaging with computed tomography (CT) or magnetic resonance imaging (MRI), especially when increased abdominal wall thickness and/or high Body Mass Index (BMI) further limit the ultrasound examination [4-6]. We present a case series of retrocecal appendicitis imaged and diagnosed with POCUS, using novel transducer and patient positioning. In addition to standard graded compression of the RLQ with POCUS, this technique may add to the diagnostic accuracy of patients presenting atypically with anatomic variants.

Objective: We aimed to evaluate and appraise the existing evidence on the use of point of care ultrasound (POCUS) for identifying soft tissue foreign bodies (FBs).

Methods: We searched PubMed, Medline, CINAHL, and Cochrane databases for prospective and retrospective studies evaluating the reliability of POCUS in identifying soft tissue FBs. Our primary intention was to review the paediatric-specific evidence base. However, due to a paucity of literature in this area, we also included relevant adult studies and case reports.

Results: We identified a total of 42 unique articles with relevance to our study objective, of which 3 were paediatric cohort studies and 5 were cohort studies involving paediatric patients. There were two paediatric case series and six individual case reports relating to paediatric patients. The remaining studies either involved adults, did not specify the age of their subjects, or were relevant in-vitro studies.

Conclusion: POCUS-users regard it as an effective tool for detecting soft tissue FBs. However, the existing evidence base for POCUS use in paediatric patients is limited. Evidence in adults is also relatively lacking compared with other areas of POCUS research, with few large studies evaluating its reliability. This literature review highlights the need for a large prospective paediatric study in order to confirm its effectiveness compared to traditional radiological imaging.

During cardiopulmonary resuscitation (CPR), chest compressions are critical for augmenting cardiac output, primarily through left ventricular (LV) compression. However, achieving optimal compression without direct visualization can be challenging. Point of care transesophageal echocardiography (TEE) serves as an invaluable tool for real-time guidance, ensuring accurate chest compression positioning over the LV apex. In this case, initial compressions were misaligned over the left ventricular outflow tract (LVOT) and aortic valve (AV). TEE assessment enabled real-time identification and precise repositioning of compressions to the LV apex, resulting in marked improvements in arterial pressure waveforms and end-tidal CO₂ (ETCO₂)-both reliable indicators of CPR quality. This case highlights the critical role of TEE in cardiac arrest management, offering real-time diagnostic insights and optimizing compression mechanics. Integrating TEE into resuscitation protocols enhances the quality of chest compressions, supports hemodynamic stability, and may ultimately improve patient outcomes.

We describe how to make an ultrasound compatible, low-cost, non-perishable, durable skin and soft tissue infection (SSTI) phantom model that simulates multiple pathologies including abscess and necrotizing fasciitis. The SSTI simulator has an extended shelf-life, can be recreated, and can serve as a needle aspiration simulator.

The aim of this study was to investigate the role of point of care ultrasound (POCUS) as an alternative imaging modality to confirm the location of gastric and post-pyloric feeding tubes in patients admitted to the pediatric intensive care unit (PICU). This was a prospective descriptive study performed at a tertiary care children's hospital. Patients from birth to 17 years of age in whom the medical team placed a temporary enteral feeding tube were eligible for enrollment. The study physician, who was blinded to the radiographic findings, performed a POCUS study of the abdomen. An abdominal radiograph was obtained to confirm the placement in all patients. A total of 13 patients were enrolled, and 14 abdominal POCUS exams were completed. POCUS accurately identified the location of the enteral feeding tube in 10 of the 14 cases. POCUS had a sensitivity and specificity of 85.7% and 57.1%, respectively, in identifying gastric tubes. It had a sensitivity and specificity of 66.7% and 87.5%, respectively, in identifying post-pyloric tubes. No adverse events were reported. This study showed that POCUS had moderate sensitivity and specificity and was, overall, safe. Further studies can assess the level of training needed for improvement in accuracy, and larger studies can help support the findings of this data that POCUS is a safe and accurate alternative to radiographs for enteral feeding tube placement confirmation.

Point of care ultrasound (POCUS) is useful in diagnosing intussusception. In this case file, we describe a 69-year-old man presenting with nausea, vomiting, left upper quadrant abdominal pain and recent weight loss who had findings concerning for intussusception on POCUS. This led the emergency provider to order computed tomography (CT) which confirmed the diagnosis.

Infective endocarditis (IE) is a life-threatening condition often diagnosed using the modified Duke's criteria, including bacteremia and pathognomonic echocardiographic findings. However, up to 30% of cases yield inconclusive results with transthoracic echocardiograms (TTE) or transesophageal echocardiograms (TEE). We present a case of a 68-year-old man with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia and recurrent fevers, in which multiple echocardiograms failed to detect valvular vegetations. However, an advanced cardiac point of care ultrasound (POCUS) examination identified a vegetation on the aortic valve, later confirmed by TTE and TEE. Although generalization is limited due to operator expertise and patient characteristics, this case demonstrates the utility of advanced cardiac POCUS in diagnosing IE in critically ill patients with negative initial echocardiograms. Incorporating advanced cardiac POCUS into routine diagnostic workflows may improve diagnostic accuracy and patient outcomes. Increasing use of advanced cardiac POCUS also highlights the importance of expanding proficiency among intensivists.

Introduction: It is estimated that over 55 million people suffer ocular injuries each year. Of these injuries, approximately 1.6 million are found to suffer permanent visual impairment secondary to traumatic cataract. Although a traumatic cataract can be a vision threatening pathology, it may be overlooked or difficult to diagnose. The objective of this report is to demonstrate the utility of ocular point of care ultrasound (POCUS) in the emergency department while highlighting its potential to diagnose a traumatic cataract. Case.

Report: A 66-year-old man presented to the emergency department with suspected cervical spine injury after being involved in a bicycle accident. During the secondary survey, the patient developed sudden painless loss of vision in his left eye. Computed tomography (CT) and external ocular exam did not reveal the cause of his vision loss. Emergency physicians employed the use of point of care ultrasound POCUS to diagnose an acute traumatic cataract as the etiology, which was later confirmed by Ophthalmology.

Conclusion: With the adoption of ocular POCUS as a staple in emergency medicine residency training, this case is testimony to its growing functionality in the setting of ocular trauma. We pose that it may aid as a diagnostic tool, avoid gratuitous testing, and ultimately expedite specialist evaluation and definitive treatment.

Cor triatriatum is a rare congenital heart defect, occurring in less than 0.1% of all such cases. It is characterized by a fibrous membrane dividing the atrium into two compartments. While often asymptomatic in infants and children, it can cause symptoms like shortness of breath, fatigue, and malnutrition. Early diagnosis and treatment are crucial to prevent further cardiac complications and ensure normal childhood growth and development. We discuss the case of a 4-year-old girl diagnosed with cor triatriatum, who was admitted to the emergency room exhibiting symptoms of pneumonia and poor weight gain. A point of care ultrasound (POCUS) test revealed a membrane in the left atrium. The child was admitted and treated for pneumonia and then referred for surgical repair of her heart defect. Following surgery, she was discharged home in stable condition. This case emphasizes the importance of POCUS - particularly in resource-limited settings - for early detection and treatment of congenital heart defects in children. It also shows the need for comprehensive assessment of symptoms for timely diagnosis and management of rare cardiac anomalies, such as cor triatriatum.