Abstract The diversity of healthcare systems across Europe has predictably resulted in significant variations in point-of-care ultrasound (PoCUS) training and practice for emergency medicine (EM). To encourage a more synchronized approach and address these inconsistencies, the European Society for Emergency Medicine (EUSEM) chartered its Ultrasound Section to develop a comprehensive curriculum compendium that should serve as a foundational guide for European Emergency Medicine PoCUS clinical and educational guidelines and policies. Under the leadership of a dedicated task force, the EUSEM Ultrasound Section developed this compendium to provide a structured, tiered framework designed to meet the needs of physicians at every skill level, from novice to advanced users. The compendium emphasizes applications that are currently practiced in different and diverse emergency departments in Europe, including a broad range of topics. An important goal was allowing flexibility to accommodate the unique resources and challenges of different healthcare environments, so that EM physicians can achieve PoCUS competencies matching their local circumstances and needs. To achieve this goal, good educational and clinical stewardship throughout this process is a key part to the success of advancing PoCUS in European EM. This compendium is intended as a resource for creating standardized yet adaptable training pathways. It represents a major step toward harmonizing and advancing PoCUS practice in European EM.

Navigating the ultrasound (US) probe to the standardized imaging plane (SIP) for image acquisition is a critical but operator-dependent task in conventional freehand diagnostic US. Robotic US systems (RUSS) offer the potential to enhance imaging consistency by leveraging real-time US image feedback to optimize the probe pose, thereby reducing reliance on operator expertise. However, determining the proper approach to extracting generalizable features from the US images for probe pose adjustment remain challenging. In this work, we propose a SIP navigation framework for RUSS, exemplified in the context of robotic lung ultrasound (LUS). This framework facilitates automatic probe adjustment when in proximity to the SIP. This is achieved by explicitly extracting multiple anatomical features presented in real-time LUS images and performing non-patient-specific template matching to generate probe motion towards the SIP using image-based visual servoing (IBVS). This framework is further integrated with the active-sensing end-effector (A-SEE), a customized robot end-effector that leverages patient external body geometry to maintain optimal probe alignment with the contact surface, thus preserving US signal quality throughout the navigation. The proposed approach ensures procedural interpretability and inter-patient adaptability. Validation is conducted through anatomy-mimicking phantom and in-vivo evaluations involving five human subjects. The results show the framework's high navigation precision with the probe correctly located at the SIP for all cases, exhibiting positioning error of under 2 mm in translation and under 2 degree in rotation. These results demonstrate the navigation process's capability to accomondate anatomical variations among patients.

Ultrasound has become an essential tool in clinical diagnosis. Traditionally, ultrasound was predominantly taught during postgraduate medical training. However, today ultrasound education is increasingly being incorporated into preclinical curricula of medical students. Although extensive literature on individual ultrasound training programs is available, research on the effective development and implementation of ultrasound education for students remains limited. This article identified five key considerations for incorporating student ultrasound education into existing medical curricula, based on an analysis of working examples in various parts of the world: The synergistic relationship between anatomy and ultrasound, didactic evolutions such peer-assisted learning, the role of Point-of-Care-Ultrasound (POCUS) and e-Learning in resource-limited settings, the considerations of possible side effects and lastly, the early engagement with key stakeholders. These five key considerationsshould help the successful and long-term development, adaptation and implementation of a new or existing ultrasound education program in undergraduate education, thereby contributing to the training of competent future healthcare professionals.

To acquire ultrasound skills, students need access to educational resources for both theoretical and practical knowledge. Effective training depends on the availability of educational content, training opportunities, and facilities - all of which are often scarce. E-learning platforms, simulation, and ultrasound skills labs are potential solutions to complement supervised real-life bedside training on patients and improve ultrasound education. This review discusses the advantages and disadvantages of e-learning, simulation, and ultrasound skills labs in the specific context of student education. E-learning platforms and teaching videos support students by offering flexible, accessible learning, allowing them to engage with material at their own pace. These digital resources complement practical lessons by providing essential theoretical knowledge that can be applied during hands-on sessions. Simulation creates a controlled environment for skill development and enhances patient safety, especially during interventional procedures. However, simulation equipment's high cost and technical complexity strain budgets and require specialized staff and training. Simulators often fail to replicate real-life variability, limiting skill transfer to patient care. The establishment of ultrasound skills labs offers a solid, long-term opportunity for skill retention but requires sufficient and sustainable funding. In conclusion, e-learning, simulation, and ultrasound skills labs can be valuable components of student ultrasound education if used deliberately. They should be included in a blended medical curriculum incorporating real-world clinical experiences to ensure effective transfer of learning to clinical practice.

Ultrasound diagnostics is a widely used, radiation-free, cost-effective, and bedside-applicable imaging technique. Given its numerous advantages and broad application, it appears reasonable to integrate practical use and theory into medical education at an early stage. Since the content of student ultrasound courses varies significantly on an international scale, the aim of this paper is to establish foundations for a more standardized approach to student's ultrasound education (SUSE) especially with focus on abdominal ultrasound. This review examines to what extent measurements can be effectively incorporated into student ultrasound training and under which conditions the teaching of pathologies should be included in these courses. Additionally, the handling of false-positive and false-negative findings in student training is discussed. Considering the growing relevance of interventional ultrasound (INVUS), the paper further explores the extent to which interventional procedures should already be taught during SUSE.

Emergency ultrasound, or point-of-care ultrasound (POCUS), has been established into daily patient care over the last decades. The use of abdominal and pelvic ultrasound in clinical practice has the potential to improve the efficiency and safety of pediatric emergency care. This article will provide a review of current applications of pediatric emergency abdominal and urogenital ultrasound, forming the second part of the series.

Aim:To evaluate the benefit of abdominal ultrasonography performed routinely and thus independently of symptomatology in patients in the intensive care unit, and to assess the value of a portable ultrasound device. Diagnostic yield and documented results with clinical consequences were considered and compared with findings obtained using a high-end ultrasound device. Material and methods:A total of 120 patients of an internal medicine intensive care unit were included over 12 months. The investigator had limited experience in sonography (approximately 300 abdominal sonographies performed). The abdomen and basal portions of the thorax were examined. Results:The most common pathological findings were renal cysts in 34/120 (28.3%), left-sided or right-sided pleural effusions in 33/120 (27.5%) and 29/120 (24.2%) patients, respectively, dilatation of the vena cava in 24/120 (20.0%), and urinary retention in 14/120 (11.7%) patients. In 13/120 (10.8%) patients, the sonographic examination resulted in a diagnostic consequence, while in 38/120 (31.7%) patients in a therapeutic consequence. Among the false-negative findings using the hand-held ultrasound device, no finding was of therapeutic relevance. Four findings that were missed by the hand-held ultrasound device were diagnostically significant: two lesions of the kidney, one lesion of the liver, and one case of urinary stasis kidney. Conclusions:With the hand-held ultrasound device, only 33 of 52 focal lesions were detected. Thus, a high-end ultrasound device cannot be replaced by a hand-held ultrasound device for this purpose, but certain clinical questions can be answered reliably with a hand-held ultrasound device (such as the presence of a puncture-worthy pleural effusion in patients with dyspnea, or verification of the volume status based on the diameter of the vena cava).

Student ultrasound education (SUSE) is currently composed of heterogeneous curricular training formats, and new approaches are continually being explored to enhance undergraduate ultrasound training. Based on a literature review, this report aims to analyze and compare different forms and methods of assessment of acquired skills in ultrasound training. Therefore, the advantages and disadvantages of assessment formats and certification systems used in SUSE were discussed collaboratively between medical students, postgraduate physicians, and medical didactics experts. Ultrasound competency should be tested using structured examination formats that are objective and standardized. In addition to cognitive skills, the examination format should cover translational and behavioral components. Self-assessments and evaluations provide additional valuable perspectives. Certification systems can contribute to quality assurance by externally ensuring the achievement of milestones in SUSE. They also have the potential to support the necessary standardization of undergraduate ultrasound teaching by aligning the curricular learning objectives with qualifications to be achieved.

This update is aimed at various specialists who deal with fractures, such as emergency physicians, general practitioners, orthopedists, and sports medicine physicians. The Global Burden of Disease 2019 Fracture Collaborators estimated the worldwide incidence to be at 178 million, i.e., 2.2 fractures per 1000 people per year. Traditionally, X-rays are the first choice for suspected fractures. However, many fractures can also be detected or excluded with ultrasound. This option is especially attractive when available at the “point of care,”, i.e., at the patient’s bedside in the ambulatory or emergency setting. Point-of-care ultrasound provides clinicians with a simple, cost-effective imaging tool without radiation and complex infrastructure. The evidence suggests that ultrasound has high diagnostic sensitivity and can reliably rule out many fractures with a high degree of certainty. When applied correctly, it could potentially save millions of radiographs and, in some cases, even compete with the accuracy of X-rays and CT scans. These findings suggest a potential paradigm shift. This update discusses the advantages of ultrasound, its examination technique, sonoanatomy of fractures, and relevant indication groups, including its application for analgesia through nerve, fascia, and fascial plane blocks. Ultrasound’s diagnostic value supports its integration into routine fracture assessment, particularly in emergency and ambulatory care settings

Background Previous studies demonstrate that acute coronary syndromes (ACS) cause cardiac regional wall-motion abnormalities (RWMA) identifiable with comprehensive echocardiography (CE). Emerging evidence supports emergency physician (EP)-performed point-of-care cardiac echocardiography (POCE) to detect RWMA in ACS. Objectives The objective of this study is to evaluate the degree to which EP-performed POCE can accurately identify RWMA in patients presenting with concern for ACS. Methods This retrospective review evaluated patients presenting to two emergency departments over 26 months, with high clinical suspicion for ACS and EP diagnosis of RWMA on POCE. All POCE were performed by EPs with advanced emergency ultrasound training. Data regarding a patient’s clinical course were abstracted and compared against EP performed POCE. Results Twenty-seven patients were enrolled. Six (22.2%) presented with ST segment elevation myocardial infarctions (STEMI) and all had POCE with RWMA corresponding with ischemia on ECG. Fifteen (55.6%) had non-STEMI. Twenty-one (77.8%) patients had CE performed that confirmed RWMA seen on POCE (100%). Of 16 (59.3%) patients who underwent cardiac catheterizations, 14 (87.5%) had coronary lesions compatible with the distribution of RWMA seen on POCE and two (12.5%) had alternate diagnoses (takotsubo cardiomyopathy and myocarditis). Ten (37.0%) patients were transferred from community hospitals. Seven (70.0%) transferred patients were diagnosed with non-STEMI. Conclusion POCE performed by trained EPs consistently identified RWMA in patients presenting with chest pain and clinical concern for ACS. POCE may be a useful adjunct in identifying a subset of high-risk chest pain patients in the ED who could benefit from expedited care, particularly those not meeting STEMI activation criteria.

Outcomes in acute limb ischemia (ALI) depend on early recognition. Rapid evaluation methods in the emergency department (ED) include physical exam, hand-held Doppler (HH), or spectral Doppler (SD) using point-of-care ultrasound (POCUS). This study aims to estimate performance characteristics of HH versus emergency medicine (EM)-performed SD compared to angiography along with clinician confidence when evaluating for ALI. This was a prospective observational pilot study. A convenience sample of patients presenting to an urban, academic ED with concern for ALI who underwent angiography were eligible. The primary aim evaluated diagnostic performance of HH and SD in correctly classifying flow in posterior tibial (PT) and dorsalis pedis (DP) arteries in patients with 100

8. Februar 2024, 18.00 Uhr. Notfallsonografie Notfallsonografie in der Traumatologie – Vom Polytrauma bis zur Verletzung in der HausarztpraxisNotfallsonografie in Schock und Polytrauma – Was gibt es Neues?OA. PD. Dr. Thomas Hamp, Berufsrettung Wien

As an extension of the clinical examination and as a diagnostic and problem-solving tool, ultrasound has become an established technique for clinicians. A prerequisite for high-quality clinical ultrasound practice is adequate student ultrasound training. In light of the considerable heterogeneity of ultrasound curricula in medical studies worldwide, this review presents basic principles of modern medical student ultrasound education and advocates for the establishment of an ultrasound core curriculum embedded both horizontally and vertically in medical studies.

AbstractThe digitization of medicine will play an increasingly significant role in future years. In particular, telemedicine, Virtual Reality (VR) and innovative Artificial Intelligence (AI) systems offer tremendous potential in imaging diagnostics and are expected to shape ultrasound diagnostics and teaching significantly. However, it is crucial to consider the advantages and disadvantages of employing these new technologies and how best to teach and manage their use. This paper provides an overview of telemedicine, VR and AI in student ultrasound education, presenting current perspectives and controversies.

Point-of-care ultrasound (POCUS) plays an essential role in emergency medicine, providing a range of diagnostic and procedural modalities. It does not involve any ionizing radiation and can improve procedural accuracy and safety. The role of POCUS in the care of pediatric patients differs somewhat from that of adult patients, as there are a range of conditions specific to infants and children. The technical background of pediatric POCUS and its current applications for trauma and thoracic scanning are reviewed and illustrated in this first article of this series.

Acquiring diagnostic ultrasound competencies and skills is crucial in modern health care, and achieving the practical experience is vital in developing the necessary anatomy interpretation and scan acquisition skills. However, traditional teaching methods may not be sufficient to provide hands-on practice, which is essential for this skill acquisition. This paper explores various modalities and instructors involved in ultrasound education to identify the most effective approaches. The field of ultrasound instruction is enriched by the diverse roles of physicians, anatomists, peer tutors, and sonographers. All these healthcare professionals can inspire and empower the next generation of ultrasound practitioners with continuous training and support. Physicians bring their clinical expertise to the table, while anatomists enhance the understanding of anatomical knowledge through ultrasound integration. Peer tutors, often medical students, provide a layer of social congruence and motivation to the learning process. Sonographers provide intensive practical experience and structured learning plans to students. By combining different instructors and teaching methods, success can be achieved in ultrasound education. An ultrasound curriculum organized by experts in the field can lead to more efficient use of resources and better learning outcomes. Empowering students through peer-assisted learning can also ease the burden on faculty. Every instructor must receive comprehensive didactic training to ensure high-quality education in diagnostic ultrasound.

Introduction: The point-of-care lung ultrasound (LUS) score has been used in coronavirus 2019 (COVID-19) patients for diagnosis and risk stratification, due to excellent sensitivity and infection control concerns. We studied the ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration (PO2/FiO2), intubation rates, and mortality correlation to the LUS score. Methods: We conducted a systematic review using PRISMA guidelines. Included were articles published from December 1, 2019–November 30, 2021 using LUS in adult COVID-19 patients in the intensive care unit or the emergency department. Excluded were studies on animals and on pediatric and pregnant patients. We assessed bias using QUADAS-2. Outcomes were LUS score and correlation to PO2/FiO2, intubation, and mortality rates. Random effects model pooled the meta-analysis results. Results: We reviewed 27 of 5,267 studies identified. Of the 27 studies, seven were included in the intubation outcome, six in the correlation to PO2/FiO2 outcome, and six in the mortality outcome. Heterogeneity was found in ultrasound protocols and outcomes. In the pooled results of 267 patients, LUS score was found to have a strong negative correlation to PO2/FiO2 with a correlation coefficient of −0.69 (95% confidence interval [CI] −0.75, −0.62). In pooled results, 273 intubated patients had a mean LUS score that was 6.95 points higher (95% CI 4.58–9.31) than that of 379 non-intubated patients. In the mortality outcome, 385 survivors had a mean LUS score that was 4.61 points lower (95% CI 3.64–5.58) than that of 181 non-survivors. There was significant heterogeneity between the studies as measured by the I2 and Cochran Q test. Conclusion: A higher LUS score was strongly correlated with a decreasing PO2/FiO2 in COVID-19 pneumonia patients. The LUS score was significantly higher in intubated vs non-intubated patients with COVID-19. The LUS score was significantly lower in critically ill patients with COVID-19 pneumonia that survive.

Point-of-care ultrasound (POCUS) plays an essential role in pediatric emergency medicine by improving diagnostics and procedural safety. The role of POCUS in the care of pediatric patients in the emergency department has expanded considerably in recent years. Cranial and musculoskeletal imaging has significant potential, yet POCUS has also become a vital tool for common procedures, such as central and difficult peripheral intravenous access. The purpose of this article is to provide an overview of pediatric POCUS applications for cranial, small parts (head, eyes, nose, throat, and soft tissue), musculoskeletal, and common procedural applications, forming the third part of the series.

Abstract Aims  To evaluate the evidence and produce a summary and recommendations for the most common heart and lung applications of point-of-care ultrasound (PoCUS). Methods  We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendation were produced, including assignment of levels of evidence (LoE) and grading of the recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement regarding the summary and recommendation for each question (using a 5-point Likert scale), which was approved if a level of agreement of greater than 75 % was reached. A level of agreement was defined as a summary of “strongly agree” and “agree” on the Likert scale responses. Findings and Recommendations  One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1). The remaining 9 questions achieved broad agreement with one assigned an LoE of 4 and weak GRADE recommendation (question 2), three achieving an LoE of 3 with a weak GRADE recommendation (questions 3–5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6–8), and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10). Conclusion  These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings.