POCUS journal最新文献

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.

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.

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.

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.

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.