Critical Ultrasound Journal[JOURNAL]
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167 papers
9th WINFOCUS World Congress on Ultrasound in Emergency and Critical Care.
Ibrahim RZ
Crit Ultrasound J · 2013 Nov · PMID 24625284 · Full text
Abstract loading — click title to view on PubMed.
Accuracy of emergency physician performed bedside ultrasound in determining gestational age in first trimester pregnancy.
Saul T, Lewiss RE, Rivera Mdel R
Crit Ultrasound J · 2012 Dec · PMID 23216683 · Full text
BACKGROUND: Patient reported menstrual history, physician clinical evaluation, and ultrasonography are used to determine gestational age in the pregnant female. Previous studies have shown that pregnancy dating by last m...
BACKGROUND: Patient reported menstrual history, physician clinical evaluation, and ultrasonography are used to determine gestational age in the pregnant female. Previous studies have shown that pregnancy dating by last menstrual period (LMP) and physical examination findings can be inaccurate. An ultrasound performed in the radiology department is considered the standard for determining an accurate gestational age. The aim of this study is to determine the accuracy of emergency physician performed bedside ultrasound as an estimation of gestational age (EDUGA) as compared to the radiology department standard. METHODS: A prospective convenience sample of ED patients presenting in the first trimester of pregnancy (based upon self-reported LMP) regardless of their presenting complaint were enrolled. EDUGA was compared to gestational age estimated by ultrasound performed in the department of radiology (RGA) as the gold standard. Pearson's product moment correlation coefficient was used to determine the correlation between EDUGA compared to RGA. RESULTS: Sixty-eight pregnant patients presumed to be in the 1st trimester of pregnancy based upon self-reported LMP consented to enrollment. When excluding the cases with no fetal pole, the median discrepancy of EDUGA versus RGA was 2 days (interquartile range (IQR) 1 to 3.25). The correlation coefficient of EDUGA with RGA was 0.978. When including the six cases without a fetal pole in the data analysis, the median discrepancy of EDUGA compared with RGA was 3 days (IQR 1 to 4). The correlation coefficient of EDUGA with RGA was 0.945. CONCLUSION: Based on our comparison of EDUGA to RGA in patients presenting to the ED in the first trimester of pregnancy, we conclude that emergency physicians are capable of accurately performing this measurement. Emergency physicians should consider using ultrasound to estimate gestational age as it may be useful for the future care of that pregnant patient.
Focused assessment with sonography for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review.
Heller T, Wallrauch C, Goblirsch S … +1 more , Brunetti E
Crit Ultrasound J · 2012 Nov · PMID 23171481 · Full text
BACKGROUND: Ultrasound can rapidly identify abnormal signs, which in high prevalence settings, are highly suggestive of extra-pulmonary tuberculosis (EPTB). Unfortunately experienced sonographers are often scarce in thes...
BACKGROUND: Ultrasound can rapidly identify abnormal signs, which in high prevalence settings, are highly suggestive of extra-pulmonary tuberculosis (EPTB). Unfortunately experienced sonographers are often scarce in these settings. METHODS: A protocol for focused assessment with sonography for HIV-associated tuberculosis (FASH) which can be used by physicians who are relatively inexperienced in ultrasound was developed. RESULTS: The technique as well as normal and pathological findings are described and the diagnostic and possible therapeutic reasoning explained. The protocol is intended for settings where the prevalence of HIV/TB co-infected patients is high. CONCLUSION: FASH is suitable for more rapid identification of EPTB even at the peripheral hospital level where other imaging modalities are scarce and most of the HIV and TB care will be delivered in the future.
Sonographic cervical motion tenderness: A sign found in a patient with pelvic inflammatory disease.
Lewiss RE, Saul T, Goldflam K
Crit Ultrasound J · 2012 Sep · PMID 22989255 · Full text
No single historical, physical, laboratory, or imaging finding is both sensitive and specific for the diagnosis of pelvic inflammatory disease (PID). Cervical motion tenderness (CMT), when present, is classically found o...
No single historical, physical, laboratory, or imaging finding is both sensitive and specific for the diagnosis of pelvic inflammatory disease (PID). Cervical motion tenderness (CMT), when present, is classically found on bimanual examination of the cervix and uterus. CMT is often associated with PID but can be present in other disease entities. We present a case report of a patient who was ultimately diagnosed with acute PID. The evaluating physician performed a trans-vaginal bedside ultrasound, and the operator appreciated 'sonographic CMT'. In cases where the physical examination is equivocal or in patients where the exact location of tenderness is difficult to discern, performing a trans-vaginal bedside ultrasound examination can increase the physician's confidence that CMT is present as the cervix is being directly visualized as pressure is applied with the probe. Bedside ultrasound and specifically sonographic CMT may prove useful in diagnosing PID in patients with equivocal or unclear physical examination findings.
The V-line: a sonographic aid for the confirmation of pleural fluid.
Atkinson P, Milne J, Loubani O … +1 more , Verheul G
Crit Ultrasound J · 2012 Aug · PMID 22920298 · Full text
BACKGROUND: Ultrasound is being used increasingly to diagnose pathological free fluid accumulation at the bedside. In addition to the detection of peritoneal and pericardial fluid, point-of-care ultrasound allows rapid b...
BACKGROUND: Ultrasound is being used increasingly to diagnose pathological free fluid accumulation at the bedside. In addition to the detection of peritoneal and pericardial fluid, point-of-care ultrasound allows rapid bedside diagnosis of pleural fluid. FINDINGS: In this short report, we describe the sonographic observation of the vertebral or 'V-line' to help confirm the presence of pleural fluid in the supine patient. The V-line sign is a result of the fluid acting as an acoustic window to enable visualization of vertebral bodies and posterior thoracic wall, thus confirming the presence of pleural fluid. CONCLUSIONS: The V-line is a useful sonographic sign to aid the diagnosis of pleural free fluid.
Medical students benefit from the use of ultrasound when learning peripheral IV techniques.
Osborn SR, Borhart J, Antonis MS
Crit Ultrasound J · 2012 Mar · PMID 22883311 · Full text
BACKGROUND: Recent studies support high success rates after a short learning period of ultrasound IV technique, and increased patient and provider satisfaction when using ultrasound as an adjunct to peripheral IV placeme...
BACKGROUND: Recent studies support high success rates after a short learning period of ultrasound IV technique, and increased patient and provider satisfaction when using ultrasound as an adjunct to peripheral IV placement. No study to date has addressed the efficacy for instructing ultrasound-naive providers. We studied the introduction of ultrasound to the teaching technique of peripheral IV insertion on first- and second-year medical students. METHODS: This was a prospective, randomized, and controlled trial. A total of 69 medical students were randomly assigned to the control group with a classic, landmark-based approach (n = 36) or the real-time ultrasound-guided group (n = 33). Both groups observed a 20-min tutorial on IV placement using both techniques and then attempted vein cannulation. Students were given a survey to report their results and observations by a 10-cm visual analog scale. The survey response rate was 100%. RESULTS: In the two groups, 73.9% stated that they attempted an IV previously, and 63.7% of students had used an ultrasound machine prior to the study. None had used ultrasound for IV access prior to our session. The average number of attempts at cannulation was 1.42 in either group. There was no difference between the control and ultrasound groups in terms of number of attempts (p = 0.31). In both groups, 66.7% of learners were able to cannulate in one attempt, 21.7% in two attempts, and 11.6% in three attempts. The study group commented that they felt they gained more knowledge from the experience (p < 0.005) and that it was easier with ultrasound guidance (p < 0.005). CONCLUSION: Medical students feel they learn more when using ultrasound after a 20-min tutorial to place IVs and cannulation of the vein feels easier. Success rates are comparable between the traditional and ultrasound teaching approaches.
Bedside lung ultrasound in the critically ill patient with pulmonary pathology: different diagnoses with comparable chest X-ray opacification.
Koeze J, Nijsten MW, Lansink AO … +2 more , Droogh JM, Ismael F
Crit Ultrasound J · 2012 Mar · PMID 22883221 · Full text
The differential diagnosis and treatment of opacifications on the chest X-ray in critically ill patients may be challenging. This holds in particular the patient that suffers from respiratory failure with hemodynamic ins...
The differential diagnosis and treatment of opacifications on the chest X-ray in critically ill patients may be challenging. This holds in particular the patient that suffers from respiratory failure with hemodynamic instability. Opacification in the chest X-ray could be the result of hematothorax, pleural effusion, atelectasis, or consolidation. Physical examination of such patients may not always indicate what the cause of the opacification is and thus may not always help indicate the correct therapeutic approach. In such cases, bedside ultrasound may be very helpful. We present two cases with similar chest X-ray opacifications but different diagnoses established with the help of a bedside lung ultrasound. There is documented accuracy of ultrasound in differentiating pleural effusions from consolidation. Ultrasound is safe and may be an alternative for computed tomography scan in a hemodynamically or respiratory unstable intensive care patient.
Analysis of 777 cases with obstruction of the ureter or extrahepatic bile duct by ultrasonography after normal saline retention enema.
Tang C, Wu X, Fan Q … +1 more , Deng Z
Crit Ultrasound J · 2012 Apr · PMID 22871226 · Full text
BACKGROUND: Conventional transabdominal ultrasound usually fails to visualize parts of the ureter or extrahepatic bile duct covered by bowel gas. In this study, we propose a new method for gaining acoustic access to the...
BACKGROUND: Conventional transabdominal ultrasound usually fails to visualize parts of the ureter or extrahepatic bile duct covered by bowel gas. In this study, we propose a new method for gaining acoustic access to the ureters and extrahepatic bile duct to help determine the nature of obstruction to these structures when conventional transabdominal ultrasound fails. METHODS: The normal saline retention enema method, that is, using normal saline-filled colons to gain acoustic access to the bilateral ureters and extrahepatic bile duct and detecting the lesions with transabdominal ultrasonic diagnostic apparatus, was applied to 777 patients with obstructive lesions, including 603 with hydroureter and 174 with dilated common bile duct, which were not visualized by conventional ultrasonography. The follow-up data of all the patients were collected to verify the results obtained by this method. RESULTS: Of the 755 patients who successfully finished the examination after normal saline retention enema (the success rate of the enema is about 98%), the nature of obstruction in 718 patients was determined (the visualizing rate is approximately 95%), including 533 with ureteral calculus, 23 with ureteral stricture, 129 with extrahepatic bile duct calculus, and 33 with common bile duct tumor. CONCLUSIONS: Colons filled fully with normal saline can surely give acoustic access to the bilateral ureters and extrahepatic bile duct so as to determine the nature of obstruction of these structures when conventional transabdominal ultrasound fails.
Comparison of computerized tomography and ultrasound for diagnosing soft tissue abscesses.
Gaspari R, Dayno M, Briones J … +1 more , Blehar D
Crit Ultrasound J · 2012 Apr · PMID 22871216 · Full text
BACKGROUND: The diagnosis of a superficial abscess is usually obtained through history and physical exam but bedside ultrasound (US) and computerized tomography (CT) are sometimes used to assist in the diagnosis. It is u...
BACKGROUND: The diagnosis of a superficial abscess is usually obtained through history and physical exam but bedside ultrasound (US) and computerized tomography (CT) are sometimes used to assist in the diagnosis. It is unclear which imaging modality is superior for patients with superficial soft tissue infections. We compared the diagnostic accuracy of CT and US in patients with skin and soft tissue infections. METHODS: Patients presenting with a suspected skin abscess that underwent both US and CT imaging were eligible for inclusion. Two physicians blinded to patient characteristics and other imaging results prospectively reviewed the CT and US images for pre-defined image elements, and in circumstances where there was disagreement between these interpretations, a third physician adjudicated the findings. The presence or absence of an abscess cavity was noted on imaging. Imaging detail was summarized using a pre-specified 4-point scale based on the degree of visible detail with higher numbers corresponding to greater detail. The clinical presence of an abscess was defined by surgical evacuation of purulence. Sensitivity and specificity for both CT and US were calculated using Chi square analysis. Comparison between imaging detail was performed using a Student's T-test. Data are presented with (95% confidence intervals) unless otherwise noted. RESULTS: Over an 18 month period 612 patients received a soft tissue bedside ultrasound with 65 of those patients receiving a CT for the same complaint. 30 of these 65 patients had an abscess located in the head and neck (37%), buttock (17%), lower extremity (17%), upper extremity (13%), torso (13%), or hand (3%). US demonstrated a sensitivity and specificity for the diagnosis of abscess of 96.7% (87.0% to 99.4%) and 85.7% (77.4% to 88.0%) respectively. The overall sensitivity and specificity of CT for the diagnosis of an abscess was 76.7% (65.5% to 82.8%) and 91.4% (81.8% to 96.7%) respectively Overall image detail ratings were superior for US compared to CT (3.5 vs 2.3, p = 0.0001). CONCLUSION: US is more sensitive then CT, but CT is more specific for superficial soft tissue abscesses. US demonstrated more visible detail within the abscess cavity compared to CT.
Emergency department diagnosis of upper extremity deep venous thrombosis using bedside ultrasonography.
Rosen T, Chang B, Kaufman M … +2 more , Soderman M, Riley DC
Crit Ultrasound J · 2012 Apr · PMID 22871175 · Full text
A 27-year-old man presents to the emergency department with a 1-day history of severe right upper extremity pain and swelling. The patient's status is post open reduction internal fixation for a left tibial plateau fract...
A 27-year-old man presents to the emergency department with a 1-day history of severe right upper extremity pain and swelling. The patient's status is post open reduction internal fixation for a left tibial plateau fracture, which was complicated by methicillin-sensitive Staphylococcus aureus osteomyelitis. A peripherally inserted central catheter (PICC) line was subsequently placed for intravenous antibiotic therapy. Emergency department bedside ultrasound examination of both the right axillary vein and subclavian vein near the PICC line tip revealed deep venous thrombosis of both veins. Bedside upper extremity vascular ultrasonography can assist in the rapid diagnosis of upper extremity deep venous thrombosis in the emergency department.
Emergency department ultrasonography guided long-axis antecubital intravenous cannulation: How to do it.
Riley DC, Garcia S
Crit Ultrasound J · 2012 Apr · PMID 22871154 · Full text
An 85-year-old woman with a past medical history of severe peripheral vascular disease and right below knee amputation presented to the emergency department with a 1-day history of non-positional dizziness and weakness....
An 85-year-old woman with a past medical history of severe peripheral vascular disease and right below knee amputation presented to the emergency department with a 1-day history of non-positional dizziness and weakness. The patient required intravenous access to work up her dizziness and weakness. The patient had multiple failed blind ED peripheral IV attempts performed in the past. Emergency department bedside ultrasonography with a high frequency linear array vascular probe was used to guide antecubital brachial vein cannulation on the first attempt using the long-axis approach.
The sonographic digital portfolio: a longitudinal ultrasound image tracking program.
Hughes DR, Kube E, Gable BD … +2 more , Madore FE, Bahner DP
Crit Ultrasound J · 2012 Jul · PMID 22871130 · Full text
BACKGROUND: Ultrasonography (US) at the medical student level is developing. As clinical skills and simulation centers expand, US equipment miniaturizes, and more students are exposed to ultrasound; a digital portfolio c...
BACKGROUND: Ultrasonography (US) at the medical student level is developing. As clinical skills and simulation centers expand, US equipment miniaturizes, and more students are exposed to ultrasound; a digital portfolio comprised of US images and videos may be useful in demonstrating experience and possibly competency. METHODS: Medical students participated in US curricula consisting of didactics and hands-on training. From 1 July 2006 to 30 June 2008, student images and videos were saved. Total images and videos were evaluated and catalogued. RESULTS: A total of 10,074 images and 1,227 videos were saved during the 2-year period. For the academic year 2006 to 2007, 159 medical students obtained 3,641 of the images (84.9%) and 270 of the videos (86.0%). First year students obtained 778 images and 20 videos; second year students, 1,174 images and 64 videos; third year students, 211 images and 20 videos; and fourth year students, 1,478 images and 166 videos.For the academic year 2007 to 2008, 222 medical students obtained 4,340 images (75%) and 619 videos (67.8%). First year students obtained 624 images and 109 videos; second year students, 555 images and 81 videos; third year students, 132 images and 14 videos; and fourth year students, 3,029 images and 415 videos. CONCLUSIONS: The ultrasound digital portfolio allows medical students to collate and document their ultrasound experience. Currently, there is no requirement for ultrasound training, documentation of competency, or minimum numbers of US exams for medical education. The ultrasound digital portfolio may be a useful tool in documenting ultrasound proficiency.
Ultrasound-guided oblique approach for peripheral venous access in a phantom model.
Tassone HM, Tayal VS, Weekes AJ … +2 more , Garner CL, Norton JH
Crit Ultrasound J · 2012 Jun · PMID 22871109 · Full text
BACKGROUND: Ultrasound (US) vascular guidance is traditionally performed in transverse (T) and longitudinal (L) axes, each with drawbacks. We hypothesized that the introduction of a novel oblique (O) approach would impro...
BACKGROUND: Ultrasound (US) vascular guidance is traditionally performed in transverse (T) and longitudinal (L) axes, each with drawbacks. We hypothesized that the introduction of a novel oblique (O) approach would improve the success of US-guided peripheral venous access. We examined emergency physician (EP) performance using the O approach in a gel US phantom. METHODS: In a prospective, case control study, EPs were enrolled from four levels of physician experience including postgraduate years one to three (PGY1, PGY2, PGY3) and attending physicians. After a brief training session, each participant attempted vessel aspiration using a linear probe in T, L, and O axes on a gel US phantom. Time to aspiration and number of attempts to aspiration were recorded. The approach order was randomized, and descriptive statistics were used. RESULTS: Twenty-four physicians participated. The first-attempt success rate was lower for O, 45.83%, versus 70.83% for T (p = 0.03) and 83.33% for L (p = 0.01). The average time to aspiration was 12.5 s (O) compared with 9.47 s (T) and 9.74 s (L), respectively. There were no significant differences between all four groups in regard to total amount of time and number of aspiration attempts; however, a trend appeared revealing that PGY3 and attending physicians tended to aspirate in less time and by fewer attempts in all three orientations when compared with the PGY2 and PGY1 physicians. CONCLUSION: In this pilot study, US-guided simulated peripheral venous access using a phantom gel model in a mixed user group showed that the novel oblique approach was not initially more successful versus T and L techniques.
How to set up a low cost tele-ultrasound capable videoconferencing system with wide applicability.
Crawford I, McBeth PB, Mitchelson M … +3 more , Ferguson J, Tiruta C, Kirkpatrick AW
Crit Ultrasound J · 2012 May · PMID 22871099 · Full text
BACKGROUND: Worldwide ultrasound equipment accessibility is at an all-time high, as technology improves and costs decrease. Ensuring that patients benefit from more accurate resuscitation and diagnoses from a user-depend...
BACKGROUND: Worldwide ultrasound equipment accessibility is at an all-time high, as technology improves and costs decrease. Ensuring that patients benefit from more accurate resuscitation and diagnoses from a user-dependent technology, such as ultrasound, requires accurate examination, typically entailing significant training. Remote tele-mentored ultrasound (RTUS) examination is, however, a technique pioneered in space medicine that has increased applicability on earth. We, thus, sought to create and demonstrate a cost-minimal approach and system with potentially global applicability. METHODS: The cost-minimal RTUS system was constructed by utilizing a standard off-the-shelf laptop computer that connected to the internet through an internal wireless receiver and/or was tethered through a smartphone. A number of portable hand-held ultrasound devices were digitally streamed into the laptop utilizing a video converter. Both the ultrasound video and the output of a head-mounted video camera were transmitted over freely available Voice Over Internet Protocol (VOIP) software to remote experts who could receive and communicate using any mobile device (computer, tablet, or smartphone) that could access secure VOIP transmissions from the internet. RESULTS: The RTUS system allowed real-time mentored tele-ultrasound to be conducted from a variety of settings that were inside buildings, outside on mountainsides, and even within aircraft in flight all unified by the simple capability of receiving and transmitting VOIP transmissions. . Numerous types of ultrasound examinations were conducted such as abdominal and thoracic examinations with a variety of users mentored who had previous skills ranging from none to expert. Internet connectivity was rarely a limiting factor, with competing logistical and scheduling demands of the participants predominating. CONCLUSIONS: RTUS examinations can educate and guide point of care clinical providers to enhance their use of ultrasound. The scope of the examinations conducted is limited only by the time available and the criticality of the subject being examined. As internet connectivity will only improve worldwide, future developments need to focus on the human factors to optimize tele-sonographic interactions.
Derivation of a pediatric growth curve for inferior vena caval diameter in healthy pediatric patients: brief report of initial curve development.
Haines EJ, Chiricolo GC, Aralica K … +5 more , Briggs WM, Van Amerongen R, Laudenbach A, O'Rourke K, Melniker L
Crit Ultrasound J · 2012 May · PMID 22871083 · Full text
BACKGROUND: A validated tool has long been sought to provide clinicians with a uniform and accurate method to assess hydration status in the pediatric emergency medicine population. Outpatient clinicians use CDC height-...
BACKGROUND: A validated tool has long been sought to provide clinicians with a uniform and accurate method to assess hydration status in the pediatric emergency medicine population. Outpatient clinicians use CDC height- and weight-based curves for the assessment of physical development. In hospital, daily weights provide objective data; however, these are usually not available at presentation.One of the most promising techniques for the rapid assessment of volume is ultrasound (US) to obtain an indexed inferior vena cava diameter (IVCDi); as previously described. Prior studies have focused on IVCDi in dehydrated patients and have shown that it provides accurate estimates of right atrial pressure and volume status. The objective of this study is to derive an IVC growth curve in healthy pediatric patients. METHODS: Prospective cohort design enrolled healthy children between the ages of 4 weeks and 20 years. Patients presenting with fever, illnesses, or diagnoses known to affect the volume will be excluded. All eligible patients under 21, who have provided self or parental written consent, will undergo a brief ultrasound to obtain transverse and long images of both the IVC and the aorta; all scans will be digitally saved. Image quality will be subjectively rated as poor, fair, or good based on wall clarity. Poor quality images will be recorded but may be omitted from our analysis. Five clinicians completed a 1-h introduction to IVC-US and ten supervised scans prior to enrollment. Still images will be measured in order to determine IVCDi in both transverse and longitudinal planes. To assess inter-rater reliability, in 10% of cases, two clinicians will complete scans. All study scans will be over-read by a fellowship-trained sonologist.IVCDi will be plotted independently as functions of age, gender, BMI, and aortic diameter. Within each group, means with means or medians with 95% CIs will be calculated. Following uni- and bivariate analyses and assessment for colinearity, a variety of parametric and nonparametric regression procedures will be conducted. The smoothed curves will be approximated using a modified LMS estimation procedure. RESULTS: Data for the initial curve derivation includes 25 patients ranging from 13 months to 20 years (mean 102 months or 8.5 years). Sixty-five percent of patients were enrolled from the ED, while 35% were enrolled from well-child clinic visits. When evaluating the size of IVC as a function of time linear growth, increasing size was found to proportionately increase with age of patient in months. CONCLUSIONS: Data suggest a linear correlation between IVC size and age. Such data, when plotted as a new growth curve, may allow clinicians to plot a patient's sonographic measurements in order to assess hydration health.
Overview of ultrasound usage trends in orthopedic and sports physiotherapy.
de Brito Vieira WH, Aguiar KA, da Silva KM … +3 more , Canela PM, da Silva FS, Abreu BJ
Crit Ultrasound J · 2012 May · PMID 22871050 · Full text
BACKGROUND: The purpose of this study is to examine current beliefs about the use, the clinical importance, the theoretical fundamentals and the utilization criteria of therapeutic ultrasound (TUS) among physical therapi...
BACKGROUND: The purpose of this study is to examine current beliefs about the use, the clinical importance, the theoretical fundamentals and the utilization criteria of therapeutic ultrasound (TUS) among physical therapists on the clinical practice in orthopedic and sports physiotherapy in Brazil. METHODS: A brief survey was developed based on previous studies and was sent to 55 physical therapists with advanced competency in orthopedics and sports physiotherapy. The questions addressed general topics about the professional profile and ultrasound usage and dosage. RESULTS: Our data show the wide availability and frequent use of TUS in this sample of physical therapists. TUS is used in distinct musculoskeletal injuries and/or disorders in both acute and chronic conditions. Muscles, tendons and ligaments represented the major structures where TUS is used. Questions on the basic theory of TUS demonstrated a lack of knowledge of the ultrasound physiological effects as well as its interaction with biological tissues and TUS absolute contraindication. CONCLUSION: A Brazilian profile about the US usage and dosage in orthopedic and sports physiotherapy is presented and highlights the need for a continuous upgrading process and further research into its effects.
Case report and brief review of literature on sonographic detection of accidentally implanted wooden foreign body causing persistent sinus.
Borgohain B, Borgohain N, Handique A … +1 more , Gogoi PJ
Crit Ultrasound J · 2012 May · PMID 22871025 · Full text
Despite advances in imaging techniques, the detection of vegetative foreign bodies in soft tissues remains a difficult and sometimes even a challenging task. Clinical evaluation of such patient may present several months...
Despite advances in imaging techniques, the detection of vegetative foreign bodies in soft tissues remains a difficult and sometimes even a challenging task. Clinical evaluation of such patient may present several months or even years after the initial injury and clinician may fail to elicit an antecedent skin puncture. X-ray examination will miss radiolucent foreign bodies. A 15-year-old boy presented with a draining non-healing sinus at the lateral aspect of his right thigh for 9 months. Musculoskeletal ultrasonography was ordered after ruling out chronic osteomyelitis to detect possible lesions around the thigh. High-frequency linear ultrasonic probe readily detected an elongated foreign body within the vastus lateralis muscle. A long piece of wood was confirmed at surgery. Non-healing sinus with normal finding in radiograph following old trauma should raise the suspicion of implanted radiolucent foreign body/bodies. The role of diagnostic ultrasound as a valuable screening tool for the detection of foreign body is briefly reviewed.
Bedside ultrasound diagnosis of atraumatic bladder rupture in an alcohol-intoxicated patient: a case report.
Daignault MC, Saul T, Lewiss RE
Crit Ultrasound J · 2012 May · PMID 22870918 · Full text
Most commonly, patients who present to the emergency department with a history and physical examination suggestive of urinary bladder rupture report a preceding traumatic event. Spontaneous atraumatic bladder rupture is...
Most commonly, patients who present to the emergency department with a history and physical examination suggestive of urinary bladder rupture report a preceding traumatic event. Spontaneous atraumatic bladder rupture is relatively uncommon, but can occur in the context of a recent alcohol binge. The alcohol-intoxicated patient presents diagnostic and therapeutic challenges to the emergency physician (EP) that take on additional urgency given the high mortality of unrecognized bladder rupture. This case report reviews bladder anatomy, the unique physiological changes in the alcohol-intoxicated patient, and the high mortality rate of a ruptured urinary bladder. We review the historical diagnostic imaging options followed by a discussion of how bedside ultrasound could expedite diagnosis and management. We present the case of a patient with spontaneous atraumatic rupture of the urinary bladder after a recent alcohol binge. Bedside ultrasound was utilized by the EP to determine the need for emergent surgical consultation and intervention. We recommend that EPs consider bladder rupture in their initial evaluation of patients presenting with nonspecific abdominal pain in the context of recent alcohol intoxication. When using bedside ultrasound to evaluate the pelvis, the presence of anterior or posterior vesicular fluid collections, the loss of normal pelvic landmarks, or irregularities in the bladder wall may increase the EPs suspicion for this disease entity and expedite time-sensitive management.
Diastolic dysfunction and mortality in early severe sepsis and septic shock: a prospective, observational echocardiography study.
Brown SM, Pittman JE, Hirshberg EL … +5 more , Jones JP, Lanspa MJ, Kuttler KG, Litwin SE, Grissom CK
Crit Ultrasound J · 2012 May · PMID 22870900 · Full text
BACKGROUND: Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (T...
BACKGROUND: Patients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (TTE) predicts 28-day mortality. METHODS: In this prospective, observational study conducted in two intensive care units at a tertiary care hospital, 78 patients (age 53.2 ± 17.1 years; 51% females; mean APACHE II score 23.3 ± 7.4) with severe sepsis or septic shock underwent TTE within 6 h of ICU admission, after 18 to 32 h, and after resolution of shock. Left ventricular (LV) diastolic dysfunction was defined according to modified American Society of Echocardiography 2009 guidelines using E, A, and e' velocities; E/A and E/e'; and E deceleration time. Systolic dysfunction was defined as an ejection fraction < 45%. RESULTS: Twenty-seven patients (36.5%) had diastolic dysfunction on initial echocardiogram, while 47 patients (61.8%) had diastolic dysfunction on at least one echocardiogram. Total mortality was 16.5%. The highest mortality (37.5%) was observed among patients with grade I diastolic dysfunction, an effect that persisted after controlling for age and APACHE II score. At time of initial TTE, central venous pressure (CVP) (11+/- 5 mmHg) did not differ among grades I-III, although patients with grade I received less intravenous fluid. CONCLUSIONS: LV diastolic dysfunction is common in septic patients. Grade I diastolic dysfunction, but not grades II and III, was associated with increased mortality. This finding may reflect inadequate fluid resuscitation in early sepsis despite an elevated CVP, suggesting a possible role for TTE in sepsis resuscitation.
Supporting the early use of echocardiography in blunt chest trauma.
Jennings SB, Rice J
Crit Ultrasound J · 2012 May · PMID 22870886 · Full text
This case reports a very unusual mechanism of cardiac rupture following an episode of multiple blunt chest trauma. The patient, a professional jockey, was trampled by horses, and although shocked on hospital admission, h...
This case reports a very unusual mechanism of cardiac rupture following an episode of multiple blunt chest trauma. The patient, a professional jockey, was trampled by horses, and although shocked on hospital admission, he did not present with signs and symptoms that were consistent with cardiogenic shock. This case highlights the difficult and subjective nature of clinical examination in emergency situations when dealing with cases of acute cardiac tamponade. It further emphasises the lack of sensitivity of traditional trauma imaging and investigative approaches such as the standard anteroposterior chest X-ray and electrocardiogram. The diagnosis of acute cardiac tamponade was not made until tertiary-care-centre arrival, when ultrasound technology in the form of bedside echocardiography was used, facilitating emergency surgery to repair a ruptured left ventricle. It is hoped that the sharing of this case will alert fellow clinicians to this uncommon but possible mechanism of cardiac rupture and subsequent tamponade, encourage the early use of echocardiography at the bedside in hypotensive blunt chest trauma cases and reinforce the principles of the Advanced Trauma Life Support course in treating trauma victims.
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