This study aims to compare the increased time needed to perform advanced focused cardiac measurements in the emergency department, including diastolic heart failure evaluation via E/E′, and cardiac output with LVOT/VTI. Patients with pertinent cardiopulmonary symptoms in the emergency department had a focused cardiac ultrasound performed by the emergency department ultrasound team. The ability to obtain basic cardiac windows, evaluate for effusion, systolic ejection fraction, and right-sided heart pressures were recorded. Advanced measurements, along with time to obtain all images and the training level of the provider, were recorded.
Thoracic ultrasound is helpful to evaluate lung pathology in patients with acute dyspnea. Several studies have demonstrated the efficacy of point-of-care ultrasound in patients with extrapulmonary TB and HIV co-infection. This retrospective, open-label case–control study explores the role of lung ultrasound in the diagnosis of Pneumocystis jirovecii pneumonia (PJP) in HIV-positive patients. In particular, it highlights the potential role of specific sonographic features that may be unique to this population.
Background: Clinical lung ultrasound examinations are widely used in the primary assessment or monitoring of patients with dyspnoea or respiratory failure. Despite being increasingly implemented, there is no international consensus on education, assessment of competencies, and certification. Today, training is usually based on the concept of mastery learning, but is often unstructured and limited by bustle in a clinical daily life. The aim of the systematic review is to provide an overview of published learning studies in clinical lung ultrasound, and to collect evidence for future recommendations in lung ultrasound education and certification. Methods: According to PRISMA guidelines, three databases (PubMed, Embase, Cochrane Library) were searched, and two reviewers examined the results for eligibility. Included publications were described and assessed for level of evidence and risk of bias according to guidelines from Oxford Centre for Evidence-Based Medicine and Cochrane Collaboration Tool for Risk of Bias assessment. Results: Of 7796 studies screened, 16 studies were included. Twelve pre- and post-test studies, three descriptive studies and one randomized controlled trial were identified. Seven studies included web-based or online modalities, while remaining used didactic or classroom-based lectures. Twelve (75%) studies provided hands-on sessions, and of these, 11 assessed participants' hands-on skills. None of the studies used validated neither written nor practical assessment. The highest level of evidence score was 2 (n = 1), remaining scored 4 (n = 15). Risk of bias was assessed high in 11 of 16 studies (68.75%). Conclusion: All educational methods proved increased theoretical and practical knowledge obtained at the ultrasound courses, but the included studies were substantial heterogeneous in setup, learning-, and assessment methods, and outcome measures. On behalf of current published studies, it was not possible to construct clear guidelines for the future education and certification in clinical lung ultrasound, but the use of different hands-on training facilities tends to contribute to different aspects of the learning process. This systematic review proves a lack of learning studies within this content, and research with validated theoretical and practical tests for assessment is desired.
BACKGROUND:Point-of-care ultrasound (PoCUS) is spreading throughout Emergency Medicine, Critical Care and Pre-hospital Care. However, there is an underlying inherited conflict with the established specialties performing comprehensive examinations. It has been stated that PoCUS is disruptive innovation. If this is true the definition might open up for a new perspective on differentiating comprehensive ultrasound from PoCUS. PoCUS in the light of disruptive innovation is a different perspective on ultrasound that has not before been academically scrutinized.METHODS:In this paper we investigate if PoCUS is in fact disruptive innovation. This is done by comparative analysis with the point of departure in disruptive innovation theory known from the business world.RESULTS:We find that a disruptive innovation process is happening. This new knowledge allows us to put forward advice for the stakeholders in the field of ultrasound. It also allows us to challenge the conventional pyramid of expertise used to describe different types of ultrasound. The perspective of this paper is mutual understanding of similarities and differences between conventional and point-of-care ultrasound. Only with this understanding the stakeholders can collaborate and use the full spectrum of ultrasound for the benefit of the patient.
Failed extubation from mechanical ventilation in critically ill patients is multifactorial, complex and not well understood. We aimed to identify whether combined transthoracic echocardiography, lung and diaphragmatic ultrasound can predict extubation failure in critically ill patients.
Ultrasound can be used to assess diaphragm movement. Existing methods focus on movement at a single point at the hemidiaphragm and may not consider the anatomic and functional complexity. We aimed to develop an ultrasound method, the Area method, to assess movement of the entire hemidiaphragm dome and to compare it with existing methods to evaluate accuracy, inter-rater agreement, and feasibility.
Background: Point-of-care (POCUS) education is rapidly expanding within medical schools and internal medicine residency programs, but lack of trained faculty is a major barrier. While POCUS training can improve short-term outcomes, knowledge and skills rapidly decay without deliberate practice and feedback. The purpose of this study was to evaluate the performance of focused cardiac ultrasound (FCU) by volunteer general internal medicine (GIM) faculty participating in a longitudinal POCUS curriculum. Methods: Participants: Nine GIM clinician-educators participated in a 6-month POCUS curriculum. Faculty performance was compared to three cardiology fellows. Three diagnostic cardiac sonographers (DCS) were also evaluated and served as the gold standard. Evaluation: the primary outcome was a FCU efficiency score, calculated by dividing image quality score by exam duration. FCU exams were conducted on three standardized patients after completion of an introductory workshop, at 3 months, and at 6 months. Two blinded cardiologists scored the exams. Analysis: mean efficiency scores were compared using a linear mixed effects model, followed by pairwise comparisons using Tukey's test. Results: GIM faculty's FCU efficiency scores were maintained over the 6-month period (2.2, SE 1.0 vs. 3.8, SE 1.0, p = 0.076). Their scores at each session were similar to cardiology fellows (p > 0.69), but inferior to DCSs (p < 0.0001). Conclusion: GIM faculty participating in a POCUS curriculum maintained their FCU performance over 6 months with efficiency scores comparable to experienced cardiology fellows.
This study evaluates the agreement between emergency physician (EP) assessment of diastolic dysfunction (DD) by a simplified approach using average peak mitral excursion velocity (eʹA) and an independent cardiologist’s diagnosis of DD by estimating left atrial (LA) pressure using American Society of Echocardiography (ASE) guidelines.
Prehospital point-of-care ultrasound used by nonradiologists in emergency medicine is gaining ground. It is feasible on-scene and during aeromedical transport and allows health-care professionals to detect or rule out potential harmful conditions. Consequently, it impacts decision-making in prioritizing care, selecting the best treatment, and the most suitable transport mode and destination. This increasing relevance of prehospital ultrasonography is due to advancements in ultrasound devices and related technology, and to a growing number of applications. This narrative review aims to present an overview of prehospital ultrasonography literature. The focus is on civilian emergency (trauma and non-trauma) setting. Current and potential future applications are discussed, structured according to the airway, breathing, circulation, disability, and environment/exposure (ABCDE) approach. Aside from diagnostic implementation and specific protocols, procedural guidance, therapeutic ultrasound, and challenges are reviewed.
To show that medical students can evaluate the internal jugular vein (IJV) and its anatomical variations after rapid and focused training. We also aimed to evaluate the success rate of IJV puncture in simulation following traditional techniques (TTs) and monitored via ultrasound (US).
Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition.
Fluid responsiveness is an important topic for clinicians. Aggressive hydration has been shown to lead to worse outcomes. The aim of this study was to investigate the sensitivity and specificity of mitral valve (MV) velocity time integral (VTI) as a non-invasive marker of volume responsiveness.
Right iliac fossa abdominal pain is a common reason for emergency ward admissions, its etiology is difficult to diagnose. It can be facilitated by an imaging examination, such as a Computerized Tomography scan which exposes the patient to ionizing radiation and implies delays. A bedside ultrasound performed by emergency physicians could avoid these issues. The aim of our study was to assess the performance of ultrasound carried out at the patient’s bedside by an emergency physician compared with a clinical-laboratory examination for the diagnosis of a surgical pathology in right iliac fossa pain.
Hypertensive emergency is a life-threatening state. End-organ damage affecting the heart accounts for up to 52% of hypertensive emergencies commonly encountered in the emergency department. Recent evidence indicates that strain echocardiography with computerized speckle-tracking is more sensitive at identifying hypertension induced changes in the left ventricle (LV) mechanical function than traditional 2-D echocardiography. We present a case demonstrating the use of emergency physician performed point-of-care strain echocardiography to identify and quantify LV mechanical dysfunction during a hypertensive crisis and to monitor improvement over 6h.
Systolic anterior motion (SAM) after mitral valve repair (MVR) can adversely affect hemodynamics due to exacerbation of left ventricular outflow tract obstruction and mitral regurgitation. Intraoperative transient SAM after MVR can usually be managed with hemodynamic maneuvers under continuous monitoring by transesophageal echocardiography (TEE). However, during postoperative intensive care management, transient SAM is seldom diagnosed and the start of treatment may be delayed. We present a case of transient SAM after MVR with abrupt deterioration due to junctional rhythm in the intensive care unit (ICU). TEE revealed that conversion from normal sinus rhythm into junctional rhythm induced the exacerbation of SAM. TEE was useful for identifying the etiology of unstable hemodynamics after cardiac surgery in the ICU, similar to its use in the operating room.
An accurate physical examination is essential in the care of critically ill and injured patients. However, to diagnose or exclude a pneumothorax, chest auscultation is unreliable compared to lung ultrasonography. In the dynamic prehospital environment, it is desirable to have the best possible ultrasound transducer readily available. The objective is to assess the difference between a linear-array, curved-array, and phased-array ultrasound transducer in the assessment for pneumothorax and to determine which is best.
