POCUS journal最新文献

Background : Feedback on Point of Care Ultrasound (POCUS) skills is essential for skill development. Providing feedback can be difficult in a large province with several distributed medical education sites. Use of handheld POCUS devices and a cloud-based image archiving enables virtual supervision. We evaluated the quality of uploaded images as well as feedback provided to students. Methods: Volunteer third year students were given access to handheld POCUS devices at various training sites. Students were encouraged to upload educational POCUS scans to their accounts where they would then receive feedback from faculty. Subsequently, images that met inclusion criteria were randomized and reviewed by a blinded expert using a global rating scale. Feedback was also analyzed. Finally, students completed a questionnaire on their technology-enhanced POCUS learning experience. Results: An independent-sampled t-test comparing mean ratings for initial images submitted prior to any feedback with those submitted after three rounds of feedback showed significant effect on image scores (2.60 vs 3.50, p = .040, d = .93). Feedback included 4 performance domains (indications, image generation, interpretation, and integration). Students found the technology easy to use and felt feedback was tailored to their learning needs. Conclusions: We observed that virtual feedback provided to medical students through a cloud-based work platform can be effective for enhancing POCUS skills.

Intraosseous (IO) line placement can be a life-saving procedure in the management of critically ill patients. Confirmation of correct IO line placement can be difficult. Prior studies have examined the use of point of care ultrasound (POCUS) to confirm IO line placement by using power Doppler over bone to detect flow within the intraosseous space. This case illustrates a novel use of POCUS in which agitated saline is visualized within the right heart as a means of confirming correct IO placement.

Upper extremity acute limb ischemia (ALI) is a limb-threatening and potentially lethal pathology that is most commonly caused by vascular embolization. Outcomes of limb ischemia are time-sensitive due to the correlation between a longer time from symptom onset to intervention with a vastly higher risk of amputation. In this report, point of care ultrasound (POCUS) was utilized to rapidly diagnose a patient with a proximal right brachial artery embolic occlusion, prompting expedited surgical consultation and successful embolectomy. POCUS can provide a focused vascular examination of the limbs to expedite diagnosis of time-sensitive ALI and facilitate timely medical intervention and surgical consultation.

The use of point of care ultrasound (POCUS) to aid diagnosis of tuberculosis has been investigated in countries where concomitant endemic prevalence of HIV increases the incidence of extrapulmonary tuberculosis (EPTB). In such cases, using a focused assessment with sonography for HIV-associated tuberculosis (FASH) scan has found to be immensely advantageous as a rapid diagnostic tool in low resource settings where other imaging modalities are scarce. The prevalence of EPTB in immunocompetent patients in industrialised countries is growing. Since EPTB can manifest itself in almost any part of the human body, symptomatic patients present with constitutional and non-specific symptoms. In our case, a 44-year-old male presented to the emergency department (ED) with a 3-month history of left-sided chest pain and swelling of the chest wall. Clinical examination revealed a swollen and tender lump above the left first rib. Palpation of the thoracic (T7) vertebral body demonstrated localised pain. POCUS showed a collection of heterogenous material with fluid content and specks of hyperechoic 'ring-like' structures. Further investigations led to the diagnosis of EPTB. The patient was admitted and treated for EPTB where he went on to make a full recovery. This case report highlights the role of integrating POCUS in clinical examination of patients with suspected EPTB, which can expedite its diagnosis and management.

A previously healthy, 4-year-old boy visited our emergency department due to chest pain after a fall from a skate scooter. Physical examination revealed tenderness over the sternal body. Point of care ultrasound (POCUS) of the sternum demonstrated a discontinuation of a hyperechoic structure of the sternal cortex, suggesting a sternal fracture. POCUS did not detect intraperitoneal fluid, pericardiac effusion, or pneumothorax. Plain radiograph confirmed the diagnosis of isolated sternal fracture and the patient was discharged with conservative treatment. POCUS was useful not only in diagnosing a sternal fracture but also to rule out concurrent injuries.

Bladder rupture is an uncommon injury that leads to significant morbidity and mortality. Though occurring mostly due to trauma, this life-threatening pathology may also occur spontaneously or after a procedure such as transurethral resection of bladder tumor (TURBT). Computed tomography (CT) cystography is the standard imaging modality for diagnosis. However, this test is unlikely to be ordered in a patient with undifferentiated abdominal pain unless there is specific suspicion for this diagnosis. In our emergency department, a 48 year-old male with history of bladder cancer and TURBT two weeks prior to arrival presented with severe abdominal pain and difficulty urinating for 3 days. Point of care ultrasound (POCUS) revealed an irregularly shaped bladder, likely site of bladder rupture, and large amount of abdominal free fluid with sediment. These findings prompted an expedited diagnostic CT scan with cystography. Emergent exploratory laparotomy ultimately confirmed a small bladder defect with 2.5 L of urinary ascites. The diagnosis of non-traumatic bladder rupture can be overlooked in patients presenting with a peritonitic abdominen. The typically ordered test for such patients is standard CT, which carries a high false-negative rate for bladder rupture. This case highlights the utility of POCUS in facilitating a rapid diagnosis.

Point of Care Ultrasound (POCUS) is a growing diagnostic modality across a variety of specialties and is increasingly being taught in undergraduate medical education. Uptake within internal medicine has been slow but is becoming more commonplace. Training of extant hospital medicine faculty, including senior members, in POCUS is an unmet need in graduate medical education with significant pedagogical and patient safety implications. With this in mind, we created a training program for the core teaching faculty at our academic internal medicine residency program. The experiential, hands-on curriculum explored the reasoning behind concepts and emphasized psychological safety for senior faculty learners and was successful and well-received. In our piece, we aim to explore the existing literature around training this unique population in POCUS and report on our single-center experience. We also provide a framework for how our program succeeded, collate tips derived from the expert ultrasound teachers and list pearls learned while teaching these experienced educators. Although this worthwhile effort requires planning and support, it was appreciated even by senior faculty.

Introduction: Pediatric residency programs often do not include a point of care ultrasound (POCUS) curriculum. We analyzed a novel POCUS curriculum for pediatric residents that incorporated an online question bank (QB), in addition to a traditional teaching model of didactic instruction and hands-on learning experience. Methods: Four high-yield POCUS topics were chosen: Focused Assessment by Sonography for Trauma (FAST), soft tissue, lung, and cardiac. Residents completed online multiple-choice quizzes before and after each of four in-person learning sessions, taught by ultrasound faculty and fellows. At the end of the academic year participants completed a knowledge retention quiz. Confidence surveys were administered to participants throughout the course of the study. Differences in means were compared by Student's t-test. Results: Learners demonstrated post-intervention score improvement for each of the four modules. Retention testing demonstrated retained improvement for the soft tissue and cardiac modules, but not for the FAST module. Self-reported confidence increased across all four topics. Conclusion: A multimodal POCUS curriculum utilizing a combination of an online QB and in-person teaching demonstrated lasting knowledge for pediatric trainees.

Point of care Ultrasound (POCUS) has been adopted into clinical practice across many fields of medicine. Undergraduate medical education programs have recognized the need to incorporate POCUS training into their curricula, traditionally done in small groups with in-person sessions. This method is resource intensive and requires sufficient equipment and expertise. These requirements are often cited as barriers for implementation. During the Coronavirus Disease 2019 (COVID-19) pandemic, POCUS education was required to adapt to physical distancing regulations, giving rise to novel teaching methods for POCUS. This article outlines the implementation of a POCUS teaching session before and during the pandemic. It describes how these innovations can scale POCUS teaching and overcome barriers moving forward. A flipped classroom model was implemented for all learners. Learners were given an introductory POCUS module before the scheduled in-person or virtual teaching session. Sixty-nine learners participated in conventional in-person teaching, while twenty-two learners participated in virtual teaching following the pandemic-related restrictions. Learners completed a written test before and following the teaching. In-person learners were assessed using an objective structured assessment of ultrasound skills (OSAUS) pre- and post-learning sessions. A follow-up survey was conducted three years after the teaching sessions were completed. Both in-person and virtual groups demonstrated statistically significant improvement in knowledge scores (p <0.0001). Both groups had similar post-test learning scores (74.2 ± 13.6% vs. 71.8 ± 14.5 %, respectively). On follow-up questionnaires, respondents indicate that they found our online and in-person modes of teaching helpful during their residency. POCUS education continues to face a variety of barriers, including limitations in infrastructure and expertise. This study describes an adapted POCUS teaching model that is scalable, uses minimal infrastructure and retains the interactivity of conventional small-group POCUS teaching. This program can serve as a blueprint for other institutions offering POCUS teaching, especially when conventional teaching methods are limited.