Pub Date : 2024-04-22DOI: 10.24908/pocus.v9i1.16895
Edwin Jackson, Heather Andrade, Julie Carroll
Abstract Catheter-associated right atrial thrombus (CRAT) is a potential complication of central venous catheter placement and is associated with an increase in morbidity and mortality. The precise incidence of CRAT is unknown, and there is a lack of clear screening and management guidelines for this condition. Additionally, the diagnosis is often missed when using transthoracic echocardiography (TTE) alone. Here, we present a case of a 64-year-old female admitted to the medical intensive care unit with multiorgan dysfunction who was diagnosed with hemodialysis catheter-associated right atrial thrombus (HDCRAT) via intensivist-performed point of care transesophageal echocardiography (TEE) after an initial TTE was negative. This patient was successfully treated with systemic anticoagulation, local thrombolysis, and delayed removal of the temporary hemodialysis catheter. Our experience serves to highlight the improved visualization of the right atrium and the diagnostic superiority of HDCRAT with TEE. We suspect that with greater utilization of TEE among intensivists, CRAT and HDCRAT will have increased recognition. It is imperative that intensivists are aware of this complication and various management strategies. Still, more studies are needed to establish clear management guidelines for CRAT and the associated complications.
{"title":"Hemodialysis Catheter-Associated Right Atrial Thrombus Diagnosed via Point of Care Transesophageal Echocardiogram","authors":"Edwin Jackson, Heather Andrade, Julie Carroll","doi":"10.24908/pocus.v9i1.16895","DOIUrl":"https://doi.org/10.24908/pocus.v9i1.16895","url":null,"abstract":"Abstract Catheter-associated right atrial thrombus (CRAT) is a potential complication of central venous catheter placement and is associated with an increase in morbidity and mortality. The precise incidence of CRAT is unknown, and there is a lack of clear screening and management guidelines for this condition. Additionally, the diagnosis is often missed when using transthoracic echocardiography (TTE) alone. Here, we present a case of a 64-year-old female admitted to the medical intensive care unit with multiorgan dysfunction who was diagnosed with hemodialysis catheter-associated right atrial thrombus (HDCRAT) via intensivist-performed point of care transesophageal echocardiography (TEE) after an initial TTE was negative. This patient was successfully treated with systemic anticoagulation, local thrombolysis, and delayed removal of the temporary hemodialysis catheter. Our experience serves to highlight the improved visualization of the right atrium and the diagnostic superiority of HDCRAT with TEE. We suspect that with greater utilization of TEE among intensivists, CRAT and HDCRAT will have increased recognition. It is imperative that intensivists are aware of this complication and various management strategies. Still, more studies are needed to establish clear management guidelines for CRAT and the associated complications.","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"81 13","pages":"25 - 28"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22eCollection Date: 2024-01-01DOI: 10.24908/pocus.v9i1.16795
Sabina Yampolsky, Alan Kwan, Susan Cheng, Ilan Kedan
Background: Cardiac point of care ultrasound (POCUS) has shown increasing utility as a tool for diagnosing and managing heart failure (HF). Within cardiology, intravascular volume assessment leveraging visualization of the inferior vena cava (IVC) is a central aspect of care, as IVC size correlates with central venous pressure. This targeted literature review aimed to examine the existing literature assessing the use of POCUS in diagnosis and management of HF patients utilizing POCUS-based IVC measurement either alone or in combination with secondary methods.
Methods: A targeted PubMed and Ovid database search up until August 28, 2023 using a keyword search was completed. Studies that did not include IVC assessment with POCUS in HF were excluded.
Results: The initial search using both PubMed and Ovid resulted in 370 journal publications. After exclusion criteria were used 15 studies were included in the review. Studies were grouped into three categories: 1) how well POCUS was able to identify HF, 2) whether POCUS-based findings correlated with other measures evaluating HF and was able to predict the effect of diuretic administration, and 3) whether POCUS-based findings served as a good prognostic indicator. The 5 studies that evaluated HF identification with POCUS found that both diagnostic sensitivity and specificity may reach 90%-100% when IVC measurement was coupled with a lung ultrasound assessing the presence of B-lines or pleural effusion. Five studies assessing POCUS findings correlating with other HF measures and diuretic effect found that IVC diameter changed significantly with diuretic administration (p<0.05). All 6 studies assessing POCUS as a predictor of long-term mortality or hospital readmission found measures that achieved statistical significance with p<0.05.
Conclusions: Including POCUS as standard-of-care - both as a diagnostic tool in the emergency department and a management tool in in-patient and out-patient facilities - may improve the treatment of HF.
{"title":"Point of Care Ultrasound for Diagnosis and Management in Heart Failure: A Targeted Literature Review.","authors":"Sabina Yampolsky, Alan Kwan, Susan Cheng, Ilan Kedan","doi":"10.24908/pocus.v9i1.16795","DOIUrl":"https://doi.org/10.24908/pocus.v9i1.16795","url":null,"abstract":"<p><strong>Background: </strong>Cardiac point of care ultrasound (POCUS) has shown increasing utility as a tool for diagnosing and managing heart failure (HF). Within cardiology, intravascular volume assessment leveraging visualization of the inferior vena cava (IVC) is a central aspect of care, as IVC size correlates with central venous pressure. This targeted literature review aimed to examine the existing literature assessing the use of POCUS in diagnosis and management of HF patients utilizing POCUS-based IVC measurement either alone or in combination with secondary methods.</p><p><strong>Methods: </strong>A targeted PubMed and Ovid database search up until August 28, 2023 using a keyword search was completed. Studies that did not include IVC assessment with POCUS in HF were excluded.</p><p><strong>Results: </strong>The initial search using both PubMed and Ovid resulted in 370 journal publications. After exclusion criteria were used 15 studies were included in the review. Studies were grouped into three categories: 1) how well POCUS was able to identify HF, 2) whether POCUS-based findings correlated with other measures evaluating HF and was able to predict the effect of diuretic administration, and 3) whether POCUS-based findings served as a good prognostic indicator. The 5 studies that evaluated HF identification with POCUS found that both diagnostic sensitivity and specificity may reach 90%-100% when IVC measurement was coupled with a lung ultrasound assessing the presence of B-lines or pleural effusion. Five studies assessing POCUS findings correlating with other HF measures and diuretic effect found that IVC diameter changed significantly with diuretic administration (p<0.05). All 6 studies assessing POCUS as a predictor of long-term mortality or hospital readmission found measures that achieved statistical significance with p<0.05.</p><p><strong>Conclusions: </strong>Including POCUS as standard-of-care - both as a diagnostic tool in the emergency department and a management tool in in-patient and out-patient facilities - may improve the treatment of HF.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 1","pages":"117-130"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11044942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.24908/pocus.v9i1.16831
S. Alerhand, Marwa Ali, Sean Beckman
Abstract A pseudoaneurysm results from a tear in a vessel wall. This leads to extravasation of blood into adjacent tissue and eventual formation of a fibrous sac that maintains continuity with the lumen. These vascular injuries very rarely occur in deeper vessels of the face (e.g. maxillary artery) due to protection from structures like the bony mandible and parotid gland. If left untreated, these pseudoaneurysms can lead to infection, thromboembolism, hemorrhage, and compression of surrounding structures such as facial nerve branches. Pseudoaneurysms are typically diagnosed by advanced imaging techniques including computed tomography angiography and magnetic resonance angiography. However, these tests require time to perform and interpret, are costly, and take place outside the patient care area. Computed tomography also confers ionizing radiation. Fortunately, point of care ultrasound (POCUS) is a readily available, dynamic imaging tool that can be performed at the bedside. Here we present the first known case report of a maxillary artery pseudoaneurysm diagnosed by POCUS in the emergency department. Early differentiation from a typical hematoma led to rapid management in the form of a compression bandage, as well as expedited consultation to the appropriate services.
{"title":"Point of Care Ultrasound Diagnosis of Maxillary Artery Pseudoaneurysm in the Emergency Department","authors":"S. Alerhand, Marwa Ali, Sean Beckman","doi":"10.24908/pocus.v9i1.16831","DOIUrl":"https://doi.org/10.24908/pocus.v9i1.16831","url":null,"abstract":"Abstract A pseudoaneurysm results from a tear in a vessel wall. This leads to extravasation of blood into adjacent tissue and eventual formation of a fibrous sac that maintains continuity with the lumen. These vascular injuries very rarely occur in deeper vessels of the face (e.g. maxillary artery) due to protection from structures like the bony mandible and parotid gland. If left untreated, these pseudoaneurysms can lead to infection, thromboembolism, hemorrhage, and compression of surrounding structures such as facial nerve branches. Pseudoaneurysms are typically diagnosed by advanced imaging techniques including computed tomography angiography and magnetic resonance angiography. However, these tests require time to perform and interpret, are costly, and take place outside the patient care area. Computed tomography also confers ionizing radiation. Fortunately, point of care ultrasound (POCUS) is a readily available, dynamic imaging tool that can be performed at the bedside. Here we present the first known case report of a maxillary artery pseudoaneurysm diagnosed by POCUS in the emergency department. Early differentiation from a typical hematoma led to rapid management in the form of a compression bandage, as well as expedited consultation to the appropriate services.","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"03 4","pages":"20 - 24"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Using point of care ultrasound (POCUS) to evaluate patients with syncope in the emergency department facilitates the timely diagnosis of life-threatening pathologies. Case: A 56-year-old woman presented to the emergency department of a hospital in Bogotá, Colombia, for a syncopal episode. Vital signs, physical examination, electrocardiogram, and routine laboratory tests were normal. Cardiac POCUS was performed, which identified an echogenic mass located in the left atrium, measuring 35x28mm, which in left atrial systole appeared to occupy the entire chamber. She underwent surgical resection of the mass and histopathology revealed atrial myxoma. Conclusions: POCUS was useful in the rapid diagnosis of atrial myxoma in a woman presenting with syncope.
{"title":"Point of Care Ultrasound as a Key Tool in the Evaluation of a Woman with Syncope","authors":"Jenniffer Katherine Guío Rodríguez, Elkin Rene Barrios Peralta, Jenny del Pilar Rico Mendoza","doi":"10.24908/pocus.v9i1.17329","DOIUrl":"https://doi.org/10.24908/pocus.v9i1.17329","url":null,"abstract":"Abstract Using point of care ultrasound (POCUS) to evaluate patients with syncope in the emergency department facilitates the timely diagnosis of life-threatening pathologies. Case: A 56-year-old woman presented to the emergency department of a hospital in Bogotá, Colombia, for a syncopal episode. Vital signs, physical examination, electrocardiogram, and routine laboratory tests were normal. Cardiac POCUS was performed, which identified an echogenic mass located in the left atrium, measuring 35x28mm, which in left atrial systole appeared to occupy the entire chamber. She underwent surgical resection of the mass and histopathology revealed atrial myxoma. Conclusions: POCUS was useful in the rapid diagnosis of atrial myxoma in a woman presenting with syncope.","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"23 9","pages":"60 - 62"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140676714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.24908/pocus.v9i1.16987
Antonio Calvo-Cebrián, Rafael Alonso Roca, Ignacio Manuel Sánchez-Barrancos
Abstract The aim of this study is to estimate the diagnostic accuracy of abdominal point of care ultrasound (POCUS) performed by family physicians (FPs) in primary care (PC), in comparison with the findings in the medical record (MR) at 12 months of follow-up. This study is conducted entirely in PC healthcare centers in Spain. Abdominal ultrasound scans performed by FPs (selected on the basis of their ultrasound knowledge and experience) are compared with the findings, or not, in the patient's MR after a 12-month follow-up period. The study will involve 100 FPs in Spain and an estimated sample size of 1334 patients who are to undergo abdominal POCUS at the indication of their physician. The results of the abdominal POCUS will be collected and compared with the findings of the MR. This comparison will be performed by another physician of the research team, different from their FP after one year of follow-up. The diagnostic accuracy of abdominal POCUS has been addressed in the hospital setting but not in PC. This lack of evidence can begin to be resolved with studies such as the one we present, designed for unselected populations such as those treated in PC and taking the patient's MR as the gold standard, which will allow us to make comparisons with the patient's clinical course.
摘要 本研究旨在估算初级保健（PC）中由家庭医生（FPs）进行的腹部护理点超声检查（POCUS）的诊断准确性，并与随访 12 个月后的病历（MR）结果进行比较。这项研究完全在西班牙的 PC 医疗中心进行。在 12 个月的随访期后，将全科医生（根据其超声波知识和经验进行筛选）进行的腹部超声波扫描结果与患者病历中的检查结果进行比较。这项研究将涉及西班牙的 100 名 FP 和 1334 名估计样本量的患者，这些患者将在医生的指示下接受腹部 POCUS 检查。将收集腹部 POCUS 的结果，并与 MR 的结果进行比较。这种比较将由研究小组的另一名医生在一年随访后进行，该医生不同于他们的 FP。腹部 POCUS 的诊断准确性已在医院环境中进行过研究，但在 PC 中尚未进行过研究。这种证据不足的问题可以通过像我们介绍的这种研究开始得到解决，这种研究针对的是未经选择的人群，如在 PC 中接受治疗的人群，并将患者的 MR 作为金标准，这将使我们能够与患者的临床病程进行比较。
{"title":"Diagnostic Accuracy of Abdominal Point of Care Ultrasound in Primary Care: Study Design and Protocol","authors":"Antonio Calvo-Cebrián, Rafael Alonso Roca, Ignacio Manuel Sánchez-Barrancos","doi":"10.24908/pocus.v9i1.16987","DOIUrl":"https://doi.org/10.24908/pocus.v9i1.16987","url":null,"abstract":"Abstract The aim of this study is to estimate the diagnostic accuracy of abdominal point of care ultrasound (POCUS) performed by family physicians (FPs) in primary care (PC), in comparison with the findings in the medical record (MR) at 12 months of follow-up. This study is conducted entirely in PC healthcare centers in Spain. Abdominal ultrasound scans performed by FPs (selected on the basis of their ultrasound knowledge and experience) are compared with the findings, or not, in the patient's MR after a 12-month follow-up period. The study will involve 100 FPs in Spain and an estimated sample size of 1334 patients who are to undergo abdominal POCUS at the indication of their physician. The results of the abdominal POCUS will be collected and compared with the findings of the MR. This comparison will be performed by another physician of the research team, different from their FP after one year of follow-up. The diagnostic accuracy of abdominal POCUS has been addressed in the hospital setting but not in PC. This lack of evidence can begin to be resolved with studies such as the one we present, designed for unselected populations such as those treated in PC and taking the patient's MR as the gold standard, which will allow us to make comparisons with the patient's clinical course.","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"35 22","pages":"63 - 70"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.24908/pocus.v9i1.17638
Benjamin Galen
Dear Readers, We are thrilled to bring you the first issue of the ninth volume of POCUS Journal. Published since 2016, POCUS Journal is the only multi-disciplinary, peer-reviewed, POCUS-focused journal that is free for authors and readers alike. We are grateful for the vision of our founder Dr. Amer and for the support of CINQUILL Medical Publishers, Inc. as we enter our ninth year of publication. POCUS is an ever-changing field as clinicians seek out better and faster solutions for patient care at the bedside. We at POCUS Journal continue to evolve as well. Our editorial board is growing to meet the demands of our high volume and high-quality manuscript submissions. We welcome Dr. Andre Kumar of Stanford University and Dr. Manpreet Malik of Emory University to the Internal Medicine section. We also welcome Dr. Andrea of the University of Southern California to the Pediatrics section. Natalie joins us from Queen’s University as the Social media Editor. If you haven’t seen her high-yield on social media I highly encourage you to visit POCUS Journal on X and Instagram for summaries of research articles and other content published in our journal. A journal our size also needs help with statistics, and we are excited that Nicholas has joined our team from the University of Toronto as Statistical Editor. We also have a new Editorial Director of Artificial Intelligence, Dr. Bredon Crawford. We are the first journal to feature an AI bot on our website, which is thanks to Dr. Crawford. Its name is “PJ” and you can find it on the bottom right of our website: www.pocusjournal.com. And finally, we are excited to have had Kathryn Matsushita join our team as , helping us preserve our standard of high quality publishing as the volume of submitted articles and size of our issues continues to grow. With the addition of these new members, I also share the bittersweet news that our Managing Editor Braeden Hill will be leaving POCUS Journal to pursue MD/PhD studies at The University of Toronto. started at POCUS Journal in 2020 as Social Media Editor and his contributions these past few years have been remarkable. We welcome Laura Guzman of Queen’s University into the role of Managing Editor. Every issue I oversee at POCUS Journal strikes me as better than the last, with fascinating cases and important research that answers key questions related to point of care ultrasound. This issue is no exception. Please find our author guidelines here: https://pocusjournal.com/author-guidelines/ Sincerely, Benjamin T. Galen, MD Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY Editor-In-Chief POCUS Journal
亲爱的读者，我们很高兴为您带来《POCUS 期刊》第九卷第一期。POCUS 杂志》自 2016 年起出版，是唯一一本对作者和读者免费的多学科、同行评审、以 POCUS 为重点的杂志。在《POCUS 杂志》出版进入第九个年头之际，我们非常感谢创始人 Amer 博士的远见卓识，以及 CINQUILL Medical Publishers, Inc.POCUS 是一个日新月异的领域，因为临床医生在床边寻找更好、更快的患者护理解决方案。我们《POCUS 杂志》也在不断发展。我们的编辑委员会正在不断壮大，以满足大量高质量稿件的需求。我们欢迎斯坦福大学的 Andre Kumar 博士和埃默里大学的 Manpreet Malik 博士加入内科版块。我们还欢迎南加州大学的 Andrea 博士加入儿科版块。娜塔莉来自皇后大学，担任社交媒体编辑。如果您还没有看到她在社交媒体上的高产，我强烈建议您访问 X 和 Instagram 上的《POCUS 杂志》，了解我们杂志上发表的研究文章和其他内容的摘要。像我们这样规模的期刊在统计方面也需要帮助，我们很高兴来自多伦多大学的尼古拉斯加入了我们的团队，担任统计编辑。我们还新增了人工智能编辑总监 Bredon Crawford 博士。我们是第一本在网站上展示人工智能机器人的期刊，这要归功于克劳福德博士。它的名字叫 "PJ"，您可以在我们网站的右下方找到它：www.pocusjournal.com。最后，我们很高兴凯瑟琳-松下（Kathryn Matsushita）加入了我们的团队，帮助我们在投稿量和刊物规模不断增长的情况下保持高质量的出版标准。随着这些新成员的加入，我也要与大家分享一个苦乐参半的消息：我们的执行主编 Braeden Hill 将离开《POCUS 期刊》，前往多伦多大学攻读医学博士/博士学位。 Braeden Hill 于 2020 年开始在《POCUS 期刊》担任社交媒体编辑，他在过去几年中做出了卓越的贡献。我们欢迎皇后大学的劳拉-古兹曼（Laura Guzman）担任总编辑一职。我在《POCUS 期刊》监督的每一期都比上一期更好，每一期都有精彩的病例和重要的研究，回答了与护理点超声相关的关键问题。本期也不例外。请点击这里查看我们的作者指南： https://pocusjournal.com/author-guidelines/ Sincerely,Benjamin T. Galen, MDDepartment of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NYPOCUS Journal主编
{"title":"Inside the April 2024 Issue","authors":"Benjamin Galen","doi":"10.24908/pocus.v9i1.17638","DOIUrl":"https://doi.org/10.24908/pocus.v9i1.17638","url":null,"abstract":"Dear Readers,\u0000 \u0000We are thrilled to bring you the first issue of the ninth volume of POCUS Journal. Published since 2016, POCUS Journal is the only multi-disciplinary, peer-reviewed, POCUS-focused journal that is free for authors and readers alike. We are grateful for the vision of our founder Dr. Amer and for the support of CINQUILL Medical Publishers, Inc. as we enter our ninth year of publication. POCUS is an ever-changing field as clinicians seek out better and faster solutions for patient care at the bedside. We at POCUS Journal continue to evolve as well. Our editorial board is growing to meet the demands of our high volume and high-quality manuscript submissions. We welcome Dr. Andre Kumar of Stanford University and Dr. Manpreet Malik of Emory University to the Internal Medicine section. We also welcome Dr. Andrea of the University of Southern California to the Pediatrics section. Natalie joins us from Queen’s University as the Social media Editor. If you haven’t seen her high-yield on social media I highly encourage you to visit POCUS Journal on X and Instagram for summaries of research articles and other content published in our journal. A journal our size also needs help with statistics, and we are excited that Nicholas has joined our team from the University of Toronto as Statistical Editor. We also have a new Editorial Director of Artificial Intelligence, Dr. Bredon Crawford. We are the first journal to feature an AI bot on our website, which is thanks to Dr. Crawford. Its name is “PJ” and you can find it on the bottom right of our website: www.pocusjournal.com. And finally, we are excited to have had Kathryn Matsushita join our team as , helping us preserve our standard of high quality publishing as the volume of submitted articles and size of our issues continues to grow.\u0000 \u0000\u0000With the addition of these new members, I also share the bittersweet news that our Managing Editor Braeden Hill will be leaving POCUS Journal to pursue MD/PhD studies at The University of Toronto. started at POCUS Journal in 2020 as Social Media Editor and his contributions these past few years have been remarkable. We welcome Laura Guzman of Queen’s University into the role of Managing Editor.\u0000 \u0000Every issue I oversee at POCUS Journal strikes me as better than the last, with fascinating cases and important research that answers key questions related to point of care ultrasound. This issue is no exception.\u0000 \u0000Please find our author guidelines here: https://pocusjournal.com/author-guidelines/\u0000 \u0000Sincerely,\u0000Benjamin T. Galen, MD\u0000Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY\u0000Editor-In-Chief POCUS Journal\u0000","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"21 16","pages":"4 - 4"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Venous Excess Ultrasound (VExUS) is a valuable bedside tool for nephrologists within a multi-organ point of care ultrasound (POCUS) framework. VExUS can address limitations of conventional physical examination in identifying hemodynamic congestion and monitoring treatment efficacy. A 53-year-old man with heart failure and end-stage kidney disease on hemodialysis presented with elevated liver function tests. Despite an unremarkable right upper quadrant ultrasound done by radiology, the review of images by the nephrology team uncovered severe venous congestion, evidenced by a dilated inferior vena cava (IVC) and abnormal hepatic and portal vein flow. Follow-up assessments included VExUS scans and daily ultrafiltration that resulted in a notable 8-liter fluid removal. The dynamic changes in IVC shape and improvement in Doppler waveforms underscored successful decongestion. This case demonstrates the clinical utility of VExUS in guiding therapy for fluid overload in complex patients.
{"title":"VExUS to Guide Ultrafiltration in Hemodialysis: Exploring a Novel Dimension of Point of Care Ultrasound","authors":"Abhilash Koratala, Mohamed Ibrahim, Sirisha Gudlawar","doi":"10.24908/pocus.v9i1.16985","DOIUrl":"https://doi.org/10.24908/pocus.v9i1.16985","url":null,"abstract":"Abstract Venous Excess Ultrasound (VExUS) is a valuable bedside tool for nephrologists within a multi-organ point of care ultrasound (POCUS) framework. VExUS can address limitations of conventional physical examination in identifying hemodynamic congestion and monitoring treatment efficacy. A 53-year-old man with heart failure and end-stage kidney disease on hemodialysis presented with elevated liver function tests. Despite an unremarkable right upper quadrant ultrasound done by radiology, the review of images by the nephrology team uncovered severe venous congestion, evidenced by a dilated inferior vena cava (IVC) and abnormal hepatic and portal vein flow. Follow-up assessments included VExUS scans and daily ultrafiltration that resulted in a notable 8-liter fluid removal. The dynamic changes in IVC shape and improvement in Doppler waveforms underscored successful decongestion. This case demonstrates the clinical utility of VExUS in guiding therapy for fluid overload in complex patients.","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"45 8","pages":"16 - 19"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140672870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.24908/pocus.v9i1.16950
Kandria Ledesma, MD, Joseph Kim, MD, Allison Cohen, MD, Nicholas Bielawa, PA-C, Mathew Nelson, DO
Abstract Ischemic colitis is the most common form of gastrointestinal ischemia 1. The diagnosis of ischemic colitis is made by clinical data and computed tomography (CT) imaging of the abdomen and pelvis 1. While colonoscopy is considered the gold standard for diagnosis, this is not performed in the emergency department (ED) 2. Few studies have been performed to describe the sonographic findings of ischemic colitis using point of care ultrasound (POCUS). We report a case that highlights the sonographic findings of ischemic colitis in a patient who had two separate visits to the ED, showcasing the utility of POCUS in making this diagnosis. POCUS can be used as a diagnostic tool for early detection of ischemic colitis leading to prompt treatment with antibiotics, CT imaging, and surgical consultation.
{"title":"Return of the Living Dead Gut – A Case Report of Ischemic Colitis Identified on Point of Care Ultrasound","authors":"Kandria Ledesma, MD, Joseph Kim, MD, Allison Cohen, MD, Nicholas Bielawa, PA-C, Mathew Nelson, DO","doi":"10.24908/pocus.v9i1.16950","DOIUrl":"https://doi.org/10.24908/pocus.v9i1.16950","url":null,"abstract":"Abstract Ischemic colitis is the most common form of gastrointestinal ischemia 1. The diagnosis of ischemic colitis is made by clinical data and computed tomography (CT) imaging of the abdomen and pelvis 1. While colonoscopy is considered the gold standard for diagnosis, this is not performed in the emergency department (ED) 2. Few studies have been performed to describe the sonographic findings of ischemic colitis using point of care ultrasound (POCUS). We report a case that highlights the sonographic findings of ischemic colitis in a patient who had two separate visits to the ED, showcasing the utility of POCUS in making this diagnosis. POCUS can be used as a diagnostic tool for early detection of ischemic colitis leading to prompt treatment with antibiotics, CT imaging, and surgical consultation.","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"7 9","pages":"51 - 54"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140673499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.24908/pocus.v9i1.16668
B. Wubben, Jad Dandashi, Omar Rizvi, Srikar Adhikari
Abstract Background: Emergency physicians commonly perform ultrasound-assisted abdominal paracentesis, using point of care ultrasound (POCUS) to identify ascites and select a site for needle insertion. However, ultrasound-guided paracentesis has the benefit of real-time needle visualization during the entire procedure. Our objective was to characterize the performance of emergency physician-performed ultrasound-guided paracentesis using POCUS, their ability to achieve good in-plane needle visualization, and factors associated with procedural success. Methods: A POCUS database was retrospectively reviewed for examinations where abdominal paracentesis was performed by an emergency physician at two academic urban emergency departments over a six-year period. Medical records were reviewed for demographics, presenting history, complications, and hospital course. Descriptive statistics were used to summarize the data. Results: 131 patients were included in the final analysis. The success rate for ultrasound-guided paracentesis was 97.7% (84/86 [95% CI: 92-100%]) compared to 95.6% (43/45 [95% CI: 85-99%]) for ultrasound-assisted paracentesis (p=0.503). 58% (50/86) demonstrated good in-plane needle visualization; 17% (15/86) had partial or out-of-plane visualization; and 24% (21/86) did not demonstrate needle visibility on their saved POCUS images. All four procedural failures were performed by first- or second-year residents using a curvilinear transducer, while all procedures using a linear transducer were successful. The most common complications were ascites leak, infection at the site, and minor bleeding. Conclusions: Emergency physicians with training in real-time needle guidance with ultrasound were able to use POCUS to perform ultrasound-guided paracentesis in the emergency department with a high success rate and no fatal complications. Based on our experience, we recommend performing ultrasound-guided paracentesis using a linear transducer, with attention to identifying vessels near the procedure site and maintaining sterile technique.
{"title":"Emergency Physician Performed Ultrasound-Guided Abdominal Paracentesis: A Retrospective Analysis","authors":"B. Wubben, Jad Dandashi, Omar Rizvi, Srikar Adhikari","doi":"10.24908/pocus.v9i1.16668","DOIUrl":"https://doi.org/10.24908/pocus.v9i1.16668","url":null,"abstract":"Abstract Background: Emergency physicians commonly perform ultrasound-assisted abdominal paracentesis, using point of care ultrasound (POCUS) to identify ascites and select a site for needle insertion. However, ultrasound-guided paracentesis has the benefit of real-time needle visualization during the entire procedure. Our objective was to characterize the performance of emergency physician-performed ultrasound-guided paracentesis using POCUS, their ability to achieve good in-plane needle visualization, and factors associated with procedural success. Methods: A POCUS database was retrospectively reviewed for examinations where abdominal paracentesis was performed by an emergency physician at two academic urban emergency departments over a six-year period. Medical records were reviewed for demographics, presenting history, complications, and hospital course. Descriptive statistics were used to summarize the data. Results: 131 patients were included in the final analysis. The success rate for ultrasound-guided paracentesis was 97.7% (84/86 [95% CI: 92-100%]) compared to 95.6% (43/45 [95% CI: 85-99%]) for ultrasound-assisted paracentesis (p=0.503). 58% (50/86) demonstrated good in-plane needle visualization; 17% (15/86) had partial or out-of-plane visualization; and 24% (21/86) did not demonstrate needle visibility on their saved POCUS images. All four procedural failures were performed by first- or second-year residents using a curvilinear transducer, while all procedures using a linear transducer were successful. The most common complications were ascites leak, infection at the site, and minor bleeding. Conclusions: Emergency physicians with training in real-time needle guidance with ultrasound were able to use POCUS to perform ultrasound-guided paracentesis in the emergency department with a high success rate and no fatal complications. Based on our experience, we recommend performing ultrasound-guided paracentesis using a linear transducer, with attention to identifying vessels near the procedure site and maintaining sterile technique.","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"16 17","pages":"75 - 79"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140674241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.24908/pocus.v9i1.16660
Mark Johnson
Abstract In acute care environments, accurately assessing complications of intracranial pathology can be challenging. Ocular complications in acute intracranial disease are not consistently evaluated despite their high morbidity. We report on a case of monocular diplopia in a 63-year-old man with subacute traumatic brain injury with localized subarachnoid hemorrhage. Ocular point of care ultrasound (POCUS) identified features of vitreous hemorrhage in one globe, leading to a diagnosis of Terson syndrome and a timely referral to ophthalmology. This finding was made on the medical floor days after the initial presentation during rehabilitation when ophthalmoscopy was not possible, and vitreous hemorrhage had not been identified on presentation. Terson syndrome is a seldom discussed but important complication of intracranial hemorrhage generally associated with poor patient outcomes. Ocular POCUS can provide a useful alternative in assessing ocular complications of acute intracranial disease on the medical floor, particularly when the practicalities of performing ophthalmoscopy are challenged.
{"title":"Terson Syndrome Diagnosed by Ocular Point of Care Ultrasound on the Medical Floor","authors":"Mark Johnson","doi":"10.24908/pocus.v9i1.16660","DOIUrl":"https://doi.org/10.24908/pocus.v9i1.16660","url":null,"abstract":"Abstract In acute care environments, accurately assessing complications of intracranial pathology can be challenging. Ocular complications in acute intracranial disease are not consistently evaluated despite their high morbidity. We report on a case of monocular diplopia in a 63-year-old man with subacute traumatic brain injury with localized subarachnoid hemorrhage. Ocular point of care ultrasound (POCUS) identified features of vitreous hemorrhage in one globe, leading to a diagnosis of Terson syndrome and a timely referral to ophthalmology. This finding was made on the medical floor days after the initial presentation during rehabilitation when ophthalmoscopy was not possible, and vitreous hemorrhage had not been identified on presentation. Terson syndrome is a seldom discussed but important complication of intracranial hemorrhage generally associated with poor patient outcomes. Ocular POCUS can provide a useful alternative in assessing ocular complications of acute intracranial disease on the medical floor, particularly when the practicalities of performing ophthalmoscopy are challenged.","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"13 7","pages":"36 - 40"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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