POCUS journal最新文献

Point-of-care ultrasound (POCUS) is a useful tool for the evaluation of soft tissue masses. We present the case of a patient with a mass on his forehead initially thought to be a slowly resolving hematoma. POCUS examination of the mass revealed a vascular structure more consistent with a post-traumatic arteriovenous malformation (AVM). This case illustrates how POCUS can be utilized to rapidly assess soft tissue masses and even identify unexpected vascularity.

Objective: The main objective of this study is the evaluation of the accuracy and reliability of a handheld point of care ultrasound device (POCUS-hd) for intrauterine pregnancy (IUP) detection compared to comprehensive reference transabdominal ultrasound (TU). The secondary objectives were to evaluate POCUS-hd for intrauterine pregnancy (IUP) detection compared to transabdominal and transvaginal ultrasound (TUTV), evaluate the inter-device agreement and inter-rater reliability of gestational age during early pregnancy. Methods: It is an observational transverse study with consecutive patient recruitment. Two blinded operators systematically used POCUS-hd and reference transabdominal ultrasound for IUP diagnosis. The accuracy of POCUS-hd for IUP diagnosis was expressed as sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV). The gestational age (GA) was assessed based on the crown-rump length. The reliability and agreement of gestational age evaluation were assessed by Bland-Altman plots, kappa statistic, and intraclass correlation coefficients (ICC). Results: POCUS-hd compared to TU had a sensitivity of 95-100%, a specifcity of 90-100%, PPV of 95-100% and NPV of 90-100%. Inter-rater agreement for IUP detection using POCUS-hd was very good, kappa=1.0; CI95% [0.9-1.0]. The inter-device agreement limits (mean difference ± 2SD) for GA were: -3 to +2.3 days by Operator 1, -3.4 to +3.3 days by Operator 2 for POCUS-hd vs. TU and -3.1 to +2.3 days for POCUS-hd versus TUTV. Conclusion: This handheld POCUS device is an accurate and reliable diagnostic tool that can be used for IUP positive findings and GA assessment during early pregnancy by clinicians in family planning settings or general practice.

The severe acute respiratory virus covariate-2 (SARS CoV-2) that causes Corona Virus Disease 2019 (COVID-19) has affected more than 194 million people worldwide and has attributed to or caused more than 4 million deaths. Acute kidney injury (AKI) is a common complication of COVID-19. Point of care ultrasonography (POCUS) can be a useful tool for the nephrologist. POCUS can be used to elucidate the cause of kidney disease and then also help to manage volume status. Here, we review pearls and pitfalls of using POCUS to manage COVID-19 associated AKI with special attention to kidney, lung, and cardiac ultrasound.

Point of care ultrasound (POCUS) is a reliable diagnostic tool for the evaluation of a patient with dyspnea. This case provides an example of an acutely dyspneic patient in which standard evaluation failed to elucidate the true etiology of the patient's dyspnea. The patient was initially diagnosed with pneumonia but returned to the emergency department with acute worsening of his symptoms despite empiric antibiotics leading to the presumption of antibiotic failure. POCUS revealed a large pericardial effusion requiring pericardiocentesis ultimately leading to the accurate diagnosis. This case highlights the importance of POCUS in evaluating patients with shortness of breath.

Objective: At Texas College of Osteopathic Medicine (TCOM), point of care ultrasound (POCUS) is taught to medical students in conjunction with trained medical student teaching assistants (TAs). The purpose of our study is to evaluate the effectiveness of near peer teaching in the setting of ultrasound education. We hypothesized that this would be the preferred learning technique among TCOM students and TAs. Methods: To evaluate our hypotheses about the value of near peer instruction, we created two comprehensive surveys for students to share their experiences with the ultrasound program. One survey was for general students and the other survey was for students designated as TAs. The surveys were sent via email to second and third-year medical students. Results: General Student Population Survey Results: Of the 63 students who took the survey, 90.4% agreed that ultrasound is an integral part of medical education, 79.4% of students either agreed or strongly agreed that ultrasound improves their understanding of systems-based course material, 53.9% of students prefer near peer techniques over other teaching methods, while only 38.7% of students would prefer faculty-led sessions. 73% of students agreed that their ultrasound skills have improved with peer-led sessions, 71.4% of students agreed that peer-led sessions have made them want to pursue additional ultrasound training, and 96.8% of students report that they are very likely or somewhat likely to use POCUS in their future practice. Ultrasound Teaching Assistant Survey Results: Nineteen TAs responded to the survey, of which 78.9% assisted with more than 4 teaching sessions, 84.2% attended more than 4 TA training sessions, 94.7% reported spending additional time practicing ultrasound outside of TA activities each week, 100% agreed or strongly agreed that being an ultrasound TA has helped their medical education, and 78.9% either agreed or strongly agreed that they feel competent in their ultrasound skills. Among TAs, 78.9% preferred near peer techniques over other teaching methods, 100% agreed or strongly agreed that being a TA has helped develop their ultrasound skills, and 100% were likely or very likely to use POCUS in their future practice. Conclusions: Based on the results of our surveys, we were able to conclude that near peer teaching is the preferred learning method among students at our institution, and TCOM students found ultrasound to be a beneficial adjunct to systems courses in medical school education.

Volume status assessment is a critical but challenging clinical skill and is especially important for the management of patients in the emergency department, intensive care unit, and dialysis unit where accurate intravascular assessment is necessary to guide appropriate fluid management. Assessment of volume status is subjective and can vary from provider to provider, posing clinical dilemmas. Traditional non-invasive methods of volume assessment include assessment of skin turgor, axillary sweat, peripheral edema, pulmonary crackles, orthostatic vital signs, and jugular venous distension. Invasive assessments of volume status include direct measurement of central venous pressure and pulmonary artery pressures. Each of these has their own limitations, challenges, and pitfalls and were often validated based on small cohorts with questionable comparators. In the past 30 years, the increased availability, progressive miniaturization, and falling price of ultrasound devices has made point of care ultrasound (POCUS) widely available. Emerging evidence base and increased uptake across multiple subspecialities has facilitated the adoption of this technology. POCUS is now widely available, relatively inexpensive, free of ionizing radiation, and can help providers make medical decisions with more precision. POCUS is not intended to replace the physical exam, but rather to complement clinical assessment, guiding providers to give thorough and accurate clinical care to their patients. We should be mindful of the nascent literature supporting the use of POCUS and other limitations as uptake increases among providers and be wary not to use POCUS to substitute clinical judgement, but integrate ultrasonographic findings carefully with history and clinical examination.