Critical Ultrasound Journal[JOURNAL]
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167 papers
Looking a bit superficial to the pleura.
Blanco P, Volpicelli G
Crit Ultrasound J · 2014 · PMID 25489469 · Full text
BACKGROUND: The internal thoracic artery (ITA) is a descendant branch of the subclavian artery. The former is located bilaterally in both internal sides of the thorax near the sternum and is accompanied by two internal t...
BACKGROUND: The internal thoracic artery (ITA) is a descendant branch of the subclavian artery. The former is located bilaterally in both internal sides of the thorax near the sternum and is accompanied by two internal thoracic veins (ITV). From a practical point of view, the ITA (and the ITV) identification is important because these vessels can be injured when pericardiocentesis with the parasternal approach is used. Other advantage of the ITA recognition is to check the patency of the ITA grafts in coronary artery revascularizated patients with new onset chest pain. The purpose of this article is to introduce a simple ultrasonographic technique for recognition of the aforementioned vessels and to highlight the utility of this finding in clinical practice. FINDINGS: With linear probe and along paraesternal line, the internal thoracic vessels are recognized on grayscale imaging as an anechoic tubular structure immediately anterior to pleural line. Color Doppler identifies a pulsatile (ITA) and a non-pulsatile (ITV) flow. Spectral Doppler normally shows a high resistance velocity profile in non-grafted ITA and a phasic flow in ITV. A biphasic low resistance velocity profile is normally expected in the grafted and permeable ITA. CONCLUSIONS: The ITA (non-grafted) and ITV are recognized routinely along the parasternal line. The operators should identify these vessels when the parasternal approach pericardiocentesis is required and should also consider obtaining spectral Doppler images to check permeability of grafted ITA in coronary artery bypass graft patients with chest pain.
The importance of dynamic ultrasound in the diagnosis of tibialis anterior muscle herniation.
Artul S, Habib G
Crit Ultrasound J · 2014 · PMID 25436103 · Full text
Tibialis anterior muscle hernia is a challenging diagnosis. Ultrasound findings generally are negative because patients come to ultrasound study from home when they are at rest. When the operator of ultrasound suspects a...
Tibialis anterior muscle hernia is a challenging diagnosis. Ultrasound findings generally are negative because patients come to ultrasound study from home when they are at rest. When the operator of ultrasound suspects a muscle hernia, he has to scan the affected limb or the affected organ dynamically at rest and after stressing the limb. Here, we present a case of a 19-year-old dancer with anterior leg mass with negative ultrasonographic findings at rest but was diagnosed with tibialis anterior hernia after stress dynamic ultrasound.
Current practice of lung ultrasonography (LUS) in the diagnosis of pneumothorax: a survey of physician sonographers in Germany.
Berlet T, Fehr T, Merz TM
Crit Ultrasound J · 2014 · PMID 25411591 · Full text
BACKGROUND: The purpose of this study was to survey the current practice of the use of lung ultrasonography (LUS) in the diagnosis of pneumothorax. METHODS: Physician sonographers, accredited for diagnostic ultrasonograp...
BACKGROUND: The purpose of this study was to survey the current practice of the use of lung ultrasonography (LUS) in the diagnosis of pneumothorax. METHODS: Physician sonographers, accredited for diagnostic ultrasonography in surgery, anaesthesia and medicine were studied. Questions addressed the frequency of exposure to patients with suspected pneumothorax, frequency of LUS use, preferences regarding technical aspects of LUS examination, assessment of diagnostic accuracy of LUS and involvement in teaching. RESULTS: Of the respondents, 55.1% used LUS 'always' or 'frequently' for suspected pneumothorax. Also, 35.5% of physicians rated LUS as 'always reliable' in ruling out pneumothorax, and 21.3% of respondents rated LUS as 'always reliable' in ruling in pneumothorax. The mode of performing LUS for pneumothorax was highly variable. Statistically significant differences were found regarding the likelihood of LUS usage, the combined use of M-Mode and B-mode scanning and the confidence to exclude pneumothorax based on LUS findings for physicians with frequent exposure to pneumothorax cases. CONCLUSIONS: Physicians' use of LUS in the diagnosis of pneumothorax is modest. Confidence in diagnostic accuracy is not comprehensive. Further research is required to establish the most efficient way of performing LUS in this scenario to achieve the highest possible diagnostic accuracy and reliable documentation of examination results.
The BUDDY (Bedside Ultrasound to Detect Dehydration in Youth) study.
Jauregui J, Nelson D, Choo E … +4 more , Stearns B, Levine AC, Liebmann O, Shah SP
Crit Ultrasound J · 2014 · PMID 25411590 · Full text
BACKGROUND: Prior research suggests that the ratio of the ultrasound-measured diameter of the inferior vena cava to the aorta correlates with the level of dehydration in children. This study was designed to externally va...
BACKGROUND: Prior research suggests that the ratio of the ultrasound-measured diameter of the inferior vena cava to the aorta correlates with the level of dehydration in children. This study was designed to externally validate this and to access the accuracy of the ultrasound measured inspiratory IVC collapse and physician gestalt to predict significant dehydration in children in the emergency department. METHODS: We prospectively enrolled a non-consecutive cohort of children ≤18 years old. Patient weight, ultrasound measurements of the IVC and Ao, and physician gestalt were recorded. The percent weight change from presentation to discharge was used to calculate the degree of dehydration. A weight change of ≥5% was considered clinically significant dehydration. Receiver operating characteristic (ROC) curves were constructed for each of the ultrasound measurements and physician gestalt. Sensitivity (SN) and specificity (SP) were calculated based on previously established cutoff points of the IVC/Ao ratio (0.8), the IVC collapsibility index of 50%, and a new cut off point of IVC collapsibility index of 80% or greater. Intra-class correlation coefficients were calculated to assess the degree of inter-rater reliability between ultrasound observers. RESULTS: Of 113 patients, 10.6% had significant dehydration. The IVC/Ao ratio had an area under the ROC curve (AUC) of 0.72 (95% CI 0.53 to 0.91) and, with a cutoff of 0.8, produced a SN of 67% and a SP of 71% for the diagnosis of significant dehydration. The IVC collapsibility index of 50% had an AUC of 0.58 (95% CI 0.44 to 0.72) and, with a cutoff of 80% collapsibility, produced a SN of 83% and a SP of 42%. The intra-class correlation coefficient was 0.83 for the IVC/Ao ratio and 0.70 for the IVC collapsibility. Physician gestalt had an AUC of 0.61 (95% CI 0.44 to 0.78) and, with a cutoff point of 5, produced a SN of 42% and a SP of 65%. CONCLUSIONS: The ultrasound-measured IVC/Ao ratio is a modest predictor of significant dehydration in children. The inspiratory IVC collapse and physician gestalt were poor predictors of the actual level of dehydration in this study.
A low cost, high fidelity nerve block model.
Sparks S, Evans D, Byars D
Crit Ultrasound J · 2014 · PMID 25411589 · Full text
BACKGROUND: We have constructed a simple, inexpensive simulation model for ultrasound guided nerve blocks. To date there are no low cost, high fidelity models for nerve block simulations. The models that do exist are exp...
BACKGROUND: We have constructed a simple, inexpensive simulation model for ultrasound guided nerve blocks. To date there are no low cost, high fidelity models for nerve block simulations. The models that do exist are expensive and vaguely resemble actual anatomy. As ultrasound guided nerve blocks become more common in medical education it is essential to develop better training models to help increase the comfort level of the individual provider and increase the chances for success during live-patient procedures [Anaesth Intensive Care 37: 824-829, 2009]. METHODS: The nerve block model was produced with a single pork loin with pressure-injected ultrasound gel through both CAT 5 cable and IV tubing inserted length-wise into the pork loin. RESULTS: Our nerve block model had a realistic, life-like feel simulating human tissue. CONCLUSION: This ultrasound nerve block model was inexpensive with life-like feel allowing resident trainees to develop more confidence and tactile skill to increase the chance for success.
Point-of-care ultrasound detection of tracheal wall thickening caused by smoke inhalation.
Kameda T, Fujita M
Crit Ultrasound J · 2014 · PMID 25097745 · Full text
Smoke inhalation is the leading cause of death due to fires. When a patient presents with smoke inhalation, prompt assessment of the airway and breathing is necessary. Point-of-care ultrasonography (US) is used for the r...
Smoke inhalation is the leading cause of death due to fires. When a patient presents with smoke inhalation, prompt assessment of the airway and breathing is necessary. Point-of-care ultrasonography (US) is used for the rapid assessment of critically ill or injured patients. We herein present a case report of a 54-year-old male who was transferred to the emergency department with shortness of breath, coughing, carbonaceous sputa, and rhinorrhea after inhaling smoke caused by a fire in his locked bedroom. He had no surface burns on the face and no edema or erosion in the oral cavity. He had hoarseness without stridor. His breath sounds were positive for expiratory wheezes. Laryngoscopy showed light edema and erosive findings on the supraglottic region. Bedside point-of-care US revealed hypoechoic thickening of the tracheal wall. The thickening was confirmed by a computed tomographic scan. The patient was carefully monitored with preparation for emergency airway management and was treated with supplemental oxygen and an aerosolized beta-2 adrenergic agonist in the intensive care unit. The symptoms were subsequently relieved, and reexamination by US after 2 days showed remission of the wall thickening. Point-of-care US may therefore be a useful modality for the rapid diagnosis and effective follow-up of tracheal wall thickening caused by smoke inhalation.
Analysis of trainees' memory after classroom presentations of didactical ultrasound courses.
Hempel D, Stenger T, Campo Dell' Orto M … +6 more , Stenger D, Seibel A, Röhrig S, Heringer F, Walcher F, Breitkreutz R
Crit Ultrasound J · 2014 · PMID 25097744 · Full text
BACKGROUND: Emergency ultrasound is gaining importance in medical education. Widespread teaching methods are frontal presentations and hands-on training. The primary goal of our study was to evaluate the impact of fronta...
BACKGROUND: Emergency ultrasound is gaining importance in medical education. Widespread teaching methods are frontal presentations and hands-on training. The primary goal of our study was to evaluate the impact of frontal presentations (PS) by analysis of retained knowledge rate (RKR) and learning load (LL). METHODS: Our study was conducted during four introductory courses in emergency ultrasound covering Extended Focused Assessment with Sonography for Trauma (E-FAST) and Focused Echocardiography Evaluation in Life Support (FEEL). Standardized PS (length of 10 to 50 min) were presented by experienced trainers, who were asked to provide keywords, key messages, and images and assign a score to each. Group 1 consisted of 11 medical students with no prior ultrasound experience, and group 2 consisted of 80 physicians. Each group was audience to seven to eight standard PS and requested to answer a free text questionnaire after 0 h, 2.5 h, 24 h, and 14 days. RESULTS: In group 1, 168/176 questionnaires were analyzed, and 161/202 were analyzed in group 2. RKR in group 1 was 32.5%, 15%, 16%, and 12% at 0 h, 2.5 h, 24 h, and 2 weeks. The physicians' RKR were 23%, 20.5%, and 22.4% after 0, 2.5, and 24 h of a respective PS. The LL was 1.6/min for students and 1.2/min for physicians. There was no difference in RKR when comparing PS with higher and lower LL for both groups; shorter or case-based PS were associated with a higher RKR (p < 0.01). CONCLUSIONS: Our study provides evidence that only a limited amount of information can be processed at a time. Only 12% of knowledge is retained after 2 weeks. Presentations of short duration can increase the retained knowledge rate. Therefore, frontal presentations and classroom-based ultrasound training and teaching should be adapted.
Echocardiographic estimation of mean pulmonary artery pressure in critically ill patients.
Laver RD, Wiersema UF, Bersten AD
Crit Ultrasound J · 2014 · PMID 25024842 · Full text
BACKGROUND: Indirect assessment of mean pulmonary arterial pressure (MPAP) may assist management of critically ill patients with pulmonary hypertension and right heart dysfunction. MPAP can be estimated as the sum of ech...
BACKGROUND: Indirect assessment of mean pulmonary arterial pressure (MPAP) may assist management of critically ill patients with pulmonary hypertension and right heart dysfunction. MPAP can be estimated as the sum of echocardiographically derived mean right ventricular to right atrial systolic pressure gradient and right atrial pressure; however, this has not been validated in critically ill patients. METHODS: This prospective validation study was conducted in patients undergoing pulmonary artery catheterisation during intensive care admission. Pulmonary artery catheter (PAC) measurements of MPAP were contemporaneously compared to MPAP estimated utilising transthoracic echocardiography (TTE)-derived mean right ventricular to right atrial systolic pressure gradient added to invasively measured right atrial pressure. RESULTS: Of 53 patients assessed, 23 had estimable MPAP using TTE. The mean difference between TTE- and PAC-derived MPAP was 1.9 mmHg (SD 5.0), with upper and lower limits of agreement of 11.6 and -7.9 mmHg, respectively. The median absolute percentage difference between TTE- and PAC-derived MPAP was 7.5%. Inter-rater reliability assessment was performed for 15 patients, giving an intra-class correlation coefficient of 0.96 (95% confidence intervals, 0.89 to 0.99). CONCLUSIONS: This echocardiographic method of estimating MPAP in critically ill patients was not equivalent to invasively measured MPAP, based on our predefined clinically acceptable range (±5 mmHg). The accuracy of this method in critically ill patients was similar to the results obtained in ambulatory patients and compared favourably with regard to the accuracy with echocardiographic estimation of systolic pulmonary arterial pressure. The utility of this technique is limited by frequent inability to obtain an adequate tricuspid regurgitant time-velocity integral in critically ill patients.
Case report: transient small bowel intussusception presenting as right lower quadrant pain in a 6-year-old male.
Nelson MJ, Paterson T, Raio C
Crit Ultrasound J · 2014 · PMID 24982750 · Full text
In children presenting to the emergency room with right lower quadrant pain, ultrasound is the preferred initial modality. In our patient, a 6-year-old male with a sudden onset of severe right lower quadrant pain, the di...
In children presenting to the emergency room with right lower quadrant pain, ultrasound is the preferred initial modality. In our patient, a 6-year-old male with a sudden onset of severe right lower quadrant pain, the differential is broad, including appendicitis and intussusception. In order to narrow our differential and secure the diagnosis, our first modality was ultrasonography. With the increased use of point-of-care ultrasound in the emergency department, the diagnosis of appendicitis and ileo-colic intussusception has been made more frequently. In addition, other entities such as transient small bowel intussusception may be identified. As in our case, obstruction secondary to intussusception must be ruled out with observation, serial abdominal exams, clinical improvement, or further imaging.
Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation.
Ferrari G, De Filippi G, Elia F … +3 more , Panero F, Volpicelli G, Aprà F
Crit Ultrasound J · 2014 · PMID 24949192 · Full text
BACKGROUND: Predictive indexes of weaning from mechanical ventilation are often inaccurate. Among the many indexes used in clinical practice, the rapid shallow breathing index is one of the most accurate. We evaluated a...
BACKGROUND: Predictive indexes of weaning from mechanical ventilation are often inaccurate. Among the many indexes used in clinical practice, the rapid shallow breathing index is one of the most accurate. We evaluated a new weaning index consisting in the diaphragm thickening fraction (DTF) assessed by ultrasound. METHODS: Forty-six patients were prospectively enrolled. All patients were ventilated in pressure support through a tracheostomy tube. Patients underwent a spontaneous breathing trial (SBT) when they met all the following criteria: FiO2 < 0.5, PEEP ≤5 cmH2O, PaO2/FiO2 > 200, respiratory rate <30 breaths per minute, absence of fever, alert and cooperative, and hemodynamic stability without vaso-active therapy support. During the trial, the right hemi-diaphragm was visualized in the zone of apposition using a 10-MHz linear ultrasound probe. The patient was then instructed to perform breathing to total lung capacity (TLC) and then exhaling to residual volume (RV). Diaphragm thickness was recorded at TLC and RV, and the DTF was calculated as percentage from the following formula: Thickness at end inspiration - Thickness at end expiration / Thickness at end expiration. Also, the rapid shallow breathing index (RSBI) was calculated. Weaning failure was defined as the inability to maintain spontaneous breathing for at least 48 h, without any form of ventilatory support. RESULTS: A significant difference between diaphragm thickness at TLC and RV was observed both in patients who succeeded SBT and patients who failed. DTF was significantly different between patients who failed and patients who succeeded SBT. A cutoff value of a DTF >36% was associated with a successful SBT with a sensitivity of 0.82, a specificity of 0.88, a positive predictive value (PPV) of 0.92, and a negative predictive value (NPV) of 0.75. By comparison, RSBI <105 had a sensitivity of 0.93, a specificity of 0.88, a PPV of 0.93, and a NPV of 0.88 for determining SBT success. CONCLUSIONS: This study shows that in our cohort of patients, the assessment of DTF by diaphragm ultrasound may perform similarly to other weaning indexes. If validated by other studies, this method may be used in clinical practice.
Lung ultrasound imaging in avian influenza A (H7N9) respiratory failure.
Tsai NW, Ngai CW, Mok KL … +1 more , Tsung JW
Crit Ultrasound J · 2014 · PMID 24949191 · Full text
BACKGROUND: Lung ultrasound has been shown to identify in real-time, various pathologies of the lung such as pneumonia, viral pneumonia, and acute respiratory distress syndrome (ARDS). Lung ultrasound maybe a first-line...
BACKGROUND: Lung ultrasound has been shown to identify in real-time, various pathologies of the lung such as pneumonia, viral pneumonia, and acute respiratory distress syndrome (ARDS). Lung ultrasound maybe a first-line alternative to chest X-ray and CT scan in critically ill patients with respiratory failure. We describe the use of lung ultrasound imaging and findings in two cases of severe respiratory failure from avian influenza A (H7N9) infection. METHODS: Serial lung ultrasound images and video from two cases of H7N9 respiratory failure requiring mechanical ventilation and extracorporeal membrane oxygenation in a tertiary care intensive care unit were analyzed for characteristic lung ultrasound findings described previously for respiratory failure and infection. These findings were followed serially, correlated with clinical course and chest X-ray. RESULTS: IN BOTH PATIENTS, CHARACTERISTIC LUNG ULTRASOUND FINDINGS HAVE BEEN OBSERVED AS PREVIOUSLY DESCRIBED IN VIRAL PULMONARY INFECTIONS: subpleural consolidations associated or not with local pleural effusion. In addition, numerous, confluent, or coalescing B-lines leading to 'white lung' with corresponding pleural line thickening are associated with ARDS. Extension or reduction of lesions observed with ultrasound was also correlated respectively with clinical worsening or improvement. Coexisting consolidated pneumonia with sonographic air bronchograms was noted in one patient who did not survive. CONCLUSIONS: Clinicians with access to point-of-care ultrasonography may use these findings as an alternative to chest X-ray or CT scan. Lung ultrasound imaging may assist in the efficient allocation of intensive care for patients with respiratory failure from viral pulmonary infections, especially in resource scarce settings or situations such as future respiratory virus outbreaks or pandemics.
Immediate versus delayed integrated point-of-care-ultrasonography to manage acute dyspnea in the emergency department.
Pirozzi C, Numis FG, Pagano A … +3 more , Melillo P, Copetti R, Schiraldi F
Crit Ultrasound J · 2014 · PMID 24940478 · Full text
BACKGROUND: Dyspnea is one of the most frequent complaints in the Emergency Department. Thoracic ultrasound should help to differentiate cardiogenic from non-cardiogenic causes of dyspnea. We evaluated whether the diagno...
BACKGROUND: Dyspnea is one of the most frequent complaints in the Emergency Department. Thoracic ultrasound should help to differentiate cardiogenic from non-cardiogenic causes of dyspnea. We evaluated whether the diagnostic accuracy can be improved by adding a point-of-care-ultrasonography (POC-US) to routine exams and if an early use of this technique produces any advantage. METHODS: One hundred sixty-eight patients were enrolled and randomized in two groups: Group 1 received an immediate POC-US in addition to routine laboratory and instrumental tests; group 2 received an ultrasound scan within 1 h from the admission to the Emergency Department. The concordance between initial and final diagnosis and the percentage of wrong diagnosis in the two groups were evaluated. Mortality, days of hospitalization in Emergency Medicine department and transfers to other wards were compared. Sensitivity and specificity of the routine protocol and the one including ultrasonography for the diagnosis of the causes of dyspnea were also analyzed. RESULTS: Eighty-eight patients were randomized in group 1 and 80 in group 2. The concordance rate between initial and final diagnoses was significantly different (0.94 in group 1 vs. 0.22 in group 2, p < 0.005). The percentage of wrong initial diagnosis was 5% in group 1 and 50% in group 2 (p < 0.0001). CONCLUSIONS: Adding POC-US to routine exams improves the diagnostic accuracy of dyspnea and reduces errors in the Emergency Department.
The role of ultrasound in the management and diagnosis of infectious mononucleosis.
Farukhi SN, Fox JC
Crit Ultrasound J · 2014 Feb · PMID 24580968 · Full text
Currently, infectious mononucleosis (IM) is a clinically diagnosed condition. According to the American Family Physician criteria for IM, splenomegaly is the key factor that distinguishes IM from other causes of sore thr...
Currently, infectious mononucleosis (IM) is a clinically diagnosed condition. According to the American Family Physician criteria for IM, splenomegaly is the key factor that distinguishes IM from other causes of sore throat. Though heterophile antibody tests are often ordered to confirm diagnosis of IM, this test has a high false-negative rate early in the course of the disease. This case report provides an example of how the use of ultrasound to diagnose splenomegaly and subsequently mononucleosis increases diagnostic accuracy.
Prehospital stroke diagnostics based on neurological examination and transcranial ultrasound.
Herzberg M, Boy S, Hölscher T … +7 more , Ertl M, Zimmermann M, Ittner KP, Pemmerl J, Pels H, Bogdahn U, Schlachetzki F
Crit Ultrasound J · 2014 Feb · PMID 24572006 · Full text
BACKGROUND: Transcranial color-coded sonography (TCCS) has proved to be a fast and reliable tool for the detection of middle cerebral artery (MCA) occlusions in a hospital setting. In this feasibility study on prehospita...
BACKGROUND: Transcranial color-coded sonography (TCCS) has proved to be a fast and reliable tool for the detection of middle cerebral artery (MCA) occlusions in a hospital setting. In this feasibility study on prehospital sonography, our aim was to investigate the accuracy of TCCS for neurovascular emergency diagnostics when performed in a prehospital setting using mobile ultrasound equipment as part of a neurological examination. METHODS: Following a '911 stroke code' call, stroke neurologists experienced in TCCS rendezvoused with the paramedic team. In patients with suspected stroke, TCCS examination including ultrasound contrast agents was performed. Results were compared with neurovascular imaging (CTA, MRA) and the final discharge diagnosis from standard patient-centered stroke care. RESULTS: We enrolled '232 stroke code' patients with follow-up data available in 102 patients with complete TCCS examination. A diagnosis of ischemic stroke was made in 73 cases; 29 patients were identified as 'stroke mimics'. MCA occlusion was diagnosed in ten patients, while internal carotid artery (ICA) occlusion/high-grade stenosis leading to reversal of anterior cerebral artery flow was diagnosed in four patients. The initial working diagnosis 'any stroke' showed a sensitivity of 94% and a specificity of 48%. 'Major MCA or ICA stroke' diagnosed by mobile ultrasound showed an overall sensitivity of 78% and specificity of 98%. CONCLUSIONS: The study demonstrates the feasibility and high diagnostic accuracy of emergency transcranial ultrasound assessment combined with neurological examinations for major ischemic stroke. Future combination with telemedical support, point-of-care analysis of blood serum markers, and probability algorithms of prehospital stroke diagnosis including ultrasound may help to speed up stroke treatment.
Detection of soft tissue foreign bodies by nurse practitioner-performed ultrasound.
Atkinson P, Madan R, Kendall R … +2 more , Fraser J, Lewis D
Crit Ultrasound J · 2014 Jan · PMID 24476553 · Full text
BACKGROUND: This study aimed to evaluate the accuracy of emergency nurse practitioner (NP)-performed point-of-care ultrasound (POCUS) for the detection of soft tissue foreign bodies (FBs). METHODS: Following a 2-h traini...
BACKGROUND: This study aimed to evaluate the accuracy of emergency nurse practitioner (NP)-performed point-of-care ultrasound (POCUS) for the detection of soft tissue foreign bodies (FBs). METHODS: Following a 2-h training session, ten NPs were assessed on their ability to detect various FBs in an experimental model. FBs (wood, metal and plastic) were inserted randomly into eight experimental models (uncooked chicken thighs) by an independent observer. Control experimental models had no FB inserted, but all had a 1-cm incision made on their surface. NPs, blinded to the type of model, were then assessed on their ability to detect the FBs by ultrasound examination using high-frequency linear transducers (Toshiba Nemio). Models were also scanned by two experienced emergency physicians (EPs) as a further control. RESULTS: Overall, NP-performed POCUS detected 47 of the 60 foreign bodies with a sensitivity, specificity, positive predictive value and negative predictive value of 78.3%, 50%, 82% and 43%, respectively, compared with 83.3%, 75%, 90.9% and 60% for EPs. Sensitivity for detecting specific types of FB was 95%, 85% and 50% for wood, metal and plastic, respectively, for NP-performed POCUS, compared with 100%, 100% and 50% in the EP group. CONCLUSIONS: NPs with no previous ultrasound experience can detect soft tissue FBs with accuracy comparable to that of EPs in an experimental model. Test sensitivity was high for wood and metal foreign bodies. Specificity was generally low.
Personalized peer-comparison feedback and its effect on emergency medicine resident ultrasound scan numbers.
Hempel D, Pivetta E, Kimberly HH
Crit Ultrasound J · 2014 Jan · PMID 24422791 · Full text
BACKGROUND: Clinician-performed ultrasound has become a widely utilized tool in emergency medicine and is a mandatory component of the residency curricula. We aimed to assess the effect of personalized peer-comparison fe...
BACKGROUND: Clinician-performed ultrasound has become a widely utilized tool in emergency medicine and is a mandatory component of the residency curricula. We aimed to assess the effect of personalized peer-comparison feedback on the number of ultrasound scans performed by emergency medicine residents. FINDINGS: A personalized peer-comparison feedback was performed by sending 44 emergency medicine residents a document including personally identified scan numbers and class averages. The number of ultrasound scans per clinical shift for a 3-month period before and after the feedback intervention was calculated. The average number of ultrasound exams per shift improved from 0.39 scans/shift before to 0.61 scans/shift after feedback (p = 0.04). Among the second year residents, the scans/shift ratio improved from 0.35 to 0.87 (p = 0.07); for third year residents, from 0.51 to 0.58 (p = 0.46); and from 0.33 to 0.41 (p = 0.21) for the fourth year residents before and after the intervention, respectively. CONCLUSIONS: A personalized peer-comparison feedback provided to emergency medicine residents resulted in increased ultrasound scan numbers per clinical shift. Incorporating this method of feedback may help encourage residents to scan more frequently.
7th WINFOCUS Italian Congress on Ultrasound in Emergency, Anaesthesiology and Critical Care.
Martino IF, Statti G, Fancoli F … +2 more , Tinelli C, Bressan MA
Crit Ultrasound J · 2014 · PMID 25749456 · Full text
Abstract loading — click title to view on PubMed.
Unusual new signs of pneumothorax at lung ultrasound.
Volpicelli G, Boero E, Stefanone V … +1 more , Storti E
Crit Ultrasound J · 2013 Dec · PMID 24355346 · Full text
BACKGROUND: The diagnosis of pneumothorax with a bedside lung ultrasound is a powerful methodology. The conventional lung ultrasound examination consists of a step-by-step procedure targeted towards the detection of four...
BACKGROUND: The diagnosis of pneumothorax with a bedside lung ultrasound is a powerful methodology. The conventional lung ultrasound examination consists of a step-by-step procedure targeted towards the detection of four classic ultrasound signs, the lung sliding, the B lines, the lung point and the lung pulse. In most cases, a combination of these signs allows a safe diagnosis of pneumothorax. However, the widespread application of sonographic methodology in clinical practice has brought out unusual cases which raise new sonographic signs. The purpose of this article was to introduce some of these new signs that are described after the analysis of unusual and complex cases encountered during the clinical daily practice in an emergency department. FINDINGS: The double lung point consists of the alternating patterns of sliding and non-sliding lung intermittently appearing at the two opposite sides of the scan. The septate pneumothorax allows B lines and lung pulse to be still visible in a condition of pneumothorax with absent sliding. In hydropneumothorax, the air/fluid border is imaged by lung ultrasound as the interposition between an anechoic space and a non-sliding A-pattern, a sign that may be named hydro-point. CONCLUSIONS: In bedside lung ultrasound, the operator should be aware and interpret double lung point, septate pneumothorax and hydro-point. The conventional diagnostic protocol of bedside lung ultrasound for pneumothorax should be occasionally adapted to such complex cases.
Can medical learners achieve point-of-care ultrasound competency using a high-fidelity ultrasound simulator?: a pilot study.
Parks AR, Atkinson P, Verheul G … +1 more , Leblanc-Duchin D
Crit Ultrasound J · 2013 Nov · PMID 24245514 · Full text
BACKGROUND: Point-of-care ultrasound (PoCUS) is currently not a universal component of curricula for medical undergraduate and postgraduate training. We designed and assessed a simulation-based PoCUS training program for...
BACKGROUND: Point-of-care ultrasound (PoCUS) is currently not a universal component of curricula for medical undergraduate and postgraduate training. We designed and assessed a simulation-based PoCUS training program for medical learners, incorporating image acquisition and image interpretation for simulated emergency medical pathologies. We wished to see if learners could achieve competency in simulated ultrasound following focused training in a PoCUS protocol. METHODS: Twelve learners (clerks and residents) received standardized training consisting of online preparation materials, didactic teaching, and an interactive hands-on workshop using a high-fidelity ultrasound simulator (CAE Vimedix). We used the Abdominal and Cardiothoracic Evaluation by Sonography (ACES) protocol as the curriculum for PoCUS training. Participants were assessed during 72 simulated emergency cardiorespiratory scenarios. Their ability to complete an ACES scan independently was assessed. Data was analyzed using R software. RESULTS: Participants independently generated 574 (99.7%) of the 576 expected ultrasound windows during the 72 simulated scenarios and correctly interpreted 67 (93%) of the 72 goal-directed PoCUS scans. CONCLUSIONS: Following a focused training process using medical simulation, medical learners demonstrated an ability to achieve a degree of competency to both acquire and correctly interpret cardiorespiratory PoCUS findings using a high-fidelity ultrasound simulator.
Bone ultrasound velocity in pediatric intensive care unit: a pilot study.
Zerem A, Mimouni FB, Picard E … +1 more , Shahroor S
Crit Ultrasound J · 2013 Oct · PMID 24172205 · Full text
BACKGROUND: Bone loss has been documented in adults in intensive care wards. Children admitted to pediatric intensive care units (PICU) are also exposed to many potential risk factors for bone loss such as immobilization...
BACKGROUND: Bone loss has been documented in adults in intensive care wards. Children admitted to pediatric intensive care units (PICU) are also exposed to many potential risk factors for bone loss such as immobilization, catabolic state, and nutritional depletion. Quantitative ultrasound technique that measures speed of sound (SOS) correlates with bone mineral density (BMD) and strength. Herein is a clinical prospective longitudinal, observational pilot study to evaluate early bone changes that occur during the first few days of PICU admission. METHODS: Children are hospitalized in a pediatric intensive under general anesthesia and muscle paralysis. Bone SOS at the mid-shaft tibia was measured on the first day of hospitalization and on days 2 to 3 thereafter. RESULTS: Nineteen children were studied. Bone SOS decreased during the first 3 days of hospitalization from 3,297 ± 315 to 3,260 ± 311 m/min (p < 0.05). The decrease was approximately 1% of the original SOS over the first 2 to 3 days of admission. CONCLUSION: There is a significant decrease in bone strength after 3 days in pediatric patients admitted to an intensive care department. Longitudinal studies of a larger group of children are necessary to determine the clinical meaning of the results and to possibly evaluate preventive approaches.
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