POCUS journal最新文献

Point of care ultrasound (POCUS) is used in internal medicine (IM) to augment clinical decision making and improve procedural safety. Institutionally-supported archiving software can help learners track scan numbers and receive feedback on image acquisition and interpretation. At the University of Saskatchewan, IM residents use POCUS for procedures and assessments but rarely save images, limiting feedback opportunities. Our quality improvement project aimed to increase the number of POCUS images saved by Postgraduate Year One (PGY-1) IM residents, targeting over 75% of non-procedural scans and ensuring over 50% of residents save at least one scan. This quality improvement project was conducted on a clinical teaching unit at an academic hospital over two years. We used four Plan-Do-Study-Act (PDSA) cycles each year to measure the percentage of non-procedural scans saved by PGY-1 IM residents. As a balance measure, we compared the number of scans performed historically and during the study period to monitor for changes in usage. Data was collected using an ultrasound sign-out sheet. At baseline, no diagnostic scans were saved by PGY-1 IM residents. Post-intervention, 56% of scans were archived in cohort one and 76% in cohort two. Additionally, 79% of residents in cohort one and 94% in cohort two archived at least one scan. The balance measure improved from 1.13 in the first year to 2.25 in the second, suggesting image archiving is not a deterrent to performing scans. Through this intervention, we significantly increased the archiving of non-procedural scans by PGY-1 IM residents. We advocate for implementing a formal POCUS archiving system to promote quality assurance in residency programs.

Systemic venous congestion is a known cause of acute kidney injury (AKI), but its presence in kidney transplant patients has not been previously described in the literature. The objective of this study was to determine the prevalence of systemic venous congestion in recent kidney transplant recipients. We conducted a prospective, longitudinal, descriptive study including 30 adult patients during the first week post-renal transplant at the Instituto de Trasplante y Alta Complejidad in Buenos Aires, Argentina. Venous congestion was detected in 53% of patients (16/30), but only 13.3% (4/30) presented moderate to severe congestion. Pulmonary congestion was more frequent: 70% (21/30) of the patients presented some degree of pulmonary congestion, and 30% (9/30) had moderate or severe congestion. In the venous congestion group, 75% of patients developed delayed graft function (DGF) compared to 57% in the non-congestion group, although this difference was not statistically significant (p<0.3). Body weight and physical examination-two commonly used methods to guide decisions on dialysis initiation and fluid management-were found to be unreliable for assessing the true volume status. In conclusion, venous congestion was observed during the first week following renal transplantation; however, moderate to severe congestion was uncommon, affecting only 13.3% of patients. While DGF was more frequently observed in patients with congestion, a statistically significant association could not be established. Further studies with larger sample sizes are needed to better evaluate this potential relationship.

Background: Point of care ultrasound (POCUS) use is increasing among pediatric clinicians, but lack of access to ultrasound devices is a major barrier. The availability of pocket-sized handheld ultrasound devices ("handhelds") has improved access. However, no head-to-head comparative studies of handhelds in children have been performed to guide purchasing decisions.

Methods: This cross-sectional study compared six handhelds: Butterfly iQ+™ (Butterfly Network Inc.), Clarius® (Clarius Mobile Health™), Kosmos™(EchoNous), TE Air™ (Mindray®), Vscan Air™ SL (General Electric), and Lumify™ (Philips Healthcare). Eight pediatric POCUS experts acquired views showing the abdominal right upper quadrant (RUQ), cardiac apical 4-chamber, and superficial neck and lung on a standardized pediatric model using each handheld. Experts rated each handheld by its image quality, ease of use, and their overall satisfaction.

Results: Vscan Air™, Kosmos™, and Lumify™ were rated highest for ease of use, image quality, and overall satisfaction. Most experts recommended Vscan Air™ for purchase. The five most desirable characteristics of handhelds were image quality, ease of use, total costs, transducer size, and availability of different transducer types. All six handhelds had important advantages and disadvantages per experts, and no single device had all the desired characteristics.

Conclusions: Pediatric POCUS experts rated Vscan Air™, Kosmos™, and Lumify™ highest for ease of use, image quality, and overall satisfaction. No device was clearly superior across all applications. Subjective characteristics, particularly probe ergonomics, may be a deciding factor when selecting handhelds in pediatrics. There is a need to develop handhelds specifically for use in pediatric populations.

Sialoliths are the most common salivary gland pathology. Point of care ultrasound (POCUS) is a useful method for identifying and locating sialoliths in acutely presenting patients. POCUS can detect salivary stones with high sensitivity and accuracy and decreases the need for radiation exposure from other imaging modalities. In this case, we describe a 58-year-old woman without significant past medical history who presented to the emergency department with left-sided facial pain and swelling without infectious symptoms. A facial POCUS examination was performed on her left cheek, which identified an echogenic sialolith obstructing the parotid duct with associated ductal dilation. This allowed for prompt diagnosis without a need for further imaging.

Background: Point of care ultrasound (POCUS) is an important tool for bedside diagnostics and procedures within internal medicine. In 2017 the Canadian Internal Medicine Ultrasound (CIMUS) group provided recommendations for applications to teach POCUS to internal medicine trainees. The way that training programs have implemented these recommendations has not been assessed. We aim to assess POCUS applications taught within internal medicine training programs, five years after the CIMUS group's recommendations.

Methods: An anonymous survey was distributed in 2022 to POCUS leads at Canadian internal medicine residency and general internal medicine subspecialty training programs. This voluntary survey assessed which POCUS applications were being taught to trainees.

Results: A total of 17 responses for the core training program and 12 responses for the subspecialty training program were collected. There was widespread uptake of the CIMUS-recommended POCUS applications within core and subspecialty level training. The compliance was higher for procedures than diagnostics. Many applications recommended at the subspecialty level were being incorporated into the core training program curriculum. Many applications that were not commented on by the CIMUS group were also incorporated into POCUS curricula.

Conclusions: POCUS education within Canadian internal medicine residency programs are largely in sync with the CIMUS recommendations published in 2017. Many programs have expanded their training beyond the CIMUS group's recommendations.

Abdominal aortic aneurysms (AAAs) possess significant patient morbidity and mortality, but diagnosis can be missed or delayed given variable presenting symptoms. Renal colic is a potential "red herring" in cases of symptomatic AAA. This case involves an atypical presentation of flank pain likely due to both nephrolithiasis and an AAA. Prompt recognition of AAAs by the emergency department (ED) is critical to prevent misdiagnosis and initiate rapid treatment when indicated.

We detail the case of a 61-year-old patient with a history of metastatic ovarian cancer who presented to our emergency department (ED) with findings consistent with localized gallbladder perforation and abscess development on an outpatient computed tomography (CT) scan. The differential etiology included primary cholecystitis or infiltrative metastatic mass in the setting of known peritoneal carcinomatosis. Point of care contrast-enhanced ultrasound (CEUS) examination was performed and was able to rule out local tumor infiltration, which was later confirmed by pathology after cholecystectomy. In this case, the identification and confirmation of gallbladder perforation on imaging allowed for more conservative management with image-guided drain placement in a patient who was not an optimal surgical candidate at the time and underwent delayed cholecystectomy. This case report emphasizes the role of CEUS in providing detailed information about gallbladder wall perfusion and integrity with the potential to predict impending gallbladder perforation by demonstrating areas of gallbladder wall hypoperfusion and necrosis as well as visualizing infiltrative lesions.

Morel-Lavallee Lesion (MLL) is a rare diagnosis of a closed internal degloving injury that can occur with high energy trauma. The pain, soft tissue swelling, and ecchymosis that patients describe mimic many other emergent diagnoses to include compartment syndrome and fractures. The following case highlights the importance of the role of Emergency Medicine physicians using point-of-care ultrasound (POCUS) to recognize and treat a potentially life-threatening injury. Our patient was initially managed with a bedside needle aspiration with drainage of 25cc of serosanguinous fluid that resulted in immediate pain relief. Patient was then admitted for further Interventional Radiology drainage of 160cc of serosanguinous fluid by Interventional Radiology.