What About Point-of-Care Ultrasound for Right Upper Quadrant Pain? What Do I Need to Know About Image Interpretation?

2019 ◽  
pp. 241-243
Author(s):  
Mark Collin ◽  
Thompson Kehrl
Keyword(s):  
Point Of Care ◽  
Image Interpretation ◽  
Point Of Care Ultrasound ◽  
Quadrant Pain

Telemedicine-guided point-of-care ultrasound can be feasible and effective in a life-threatening situation: The case of a field hospital during the COVID-19 pandemic (Preprint)

2020 ◽  
Author(s):  
Tarso Accorsi ◽  
Karine De Amicis Lima ◽  
Alexandra Brigido ◽  
Deborah Belfort ◽  
Fabio Habrum ◽  
...  
Keyword(s):  
Point Of Care ◽  
Image Interpretation ◽  
Acquisition Time ◽  
Point Of Care Ultrasound ◽  
Field Hospital ◽  
Portable Ultrasound ◽  
Local Staff ◽  
Assessment Protocol ◽  
Life Threatening ◽  
Threatening Situation

BACKGROUND Lightweight portable ultrasound is widely available, especially in inaccessible geographical areas. It demonstrates effectiveness and diagnosis improvement even in field conditions but no precise information about protocols, acquisition time, image interpretation, and the relevance in changing medical conduct exists. The COVID-19 pandemic implied many severe cases and the rapid construction of field hospitals with massive general practitioner (GP) recruitment. OBJECTIVE This prospective and descriptive study aimed to evaluate the feasibility of telemedicine guidance using a standardized multi-organ sonographic assessment protocol in untrained GPs during a COVID-19 emergency in a field hospital. METHODS Eleven COVID-19 in-patients presenting life-threatening complications, attended by local staff who spontaneously requested on-time teleconsultation, were enrolled. All untrained doctors successfully positioned the transducer and obtained key images guided by a remote doctor via telemedicine, with remote interpretation of the findings. RESULTS Only four (36%) general practitioners obtained the appropriate key heart image on the left parasternal long axis window, and three (27%) had an image interpreted remotely on-time. The evaluation time ranged from seven to 42 minutes, with a mean of 22.7 + 12. CONCLUSIONS Telemedicine is effective in guiding GPs to perform portable ultrasound in life-threatening situations, showing effectiveness in conducting decisions.

The abdomen

2019 ◽  
pp. 89-106
Author(s):  
Justin Bowra ◽  
Osama Loubani ◽  
Paul Atkinson
Keyword(s):  
Emergency Medicine ◽  
Bowel Obstruction ◽  
Peritoneal Fluid ◽  
Renal Colic ◽  
Point Of Care ◽  
Clinical Situation ◽  
Point Of Care Ultrasound ◽  
Quadrant Pain ◽  
Diagnosis And Management ◽  
Rule Out

Abdominal point-of-care ultrasound (PoCUS) for intra-peritoneal fluid in trauma is one of the earliest, and now most accepted, uses of PoCUS in emergency medicine and resuscitation. It is an essential part of the e-FAST (Extended Focused Assessment in Trauma) examination. Abdominal PoCUS can also guide diagnosis and management of right upper quadrant pain and renal colic. PoCUS can also ‘rule in’ (but not ‘rule out’) bowel obstruction and appendicitis. Regardless of the clinical situation, PoCUS is used to answer specific binary questions, rather than to perform an exhaustive survey of the abdomen.

Left upper quadrant pain: Diagnosis by point-of-care ultrasound

2020 ◽  
Vol 19 ◽  
pp. 100665
Author(s):  
Jeffrey R. Herrala ◽  
Denié Bernier ◽  
Heidi H. Kimberly
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Quadrant Pain ◽  
Pain Diagnosis

Ultrasound

2019 ◽  
pp. 1001-1028
Author(s):  
Matthew Lyon ◽  
W. Ted Kuhn
Keyword(s):  
Clinical Management ◽  
Point Of Care ◽  
Image Acquisition ◽  
Image Interpretation ◽  
Ultrasound Image ◽  
Point Of Care Ultrasound ◽  
Clinical Integration ◽  
Humanitarian Emergency ◽  
Emergency Situations ◽  
Essential Components

This chapter outlines how clinical management decisions in humanitarian emergency situations can be greatly enhanced by the utilization of point-of-care ultrasound. The chapter recognizes the advancing technology of point-of care ultrasound and its use in humanitarian missions, and provides guidance on the essential components of clinical ultrasound (image acquisition, image interpretation, and clinical integration).

scholarly journals Need of Integrating Sonoscopy in Undergraduate Medical Education in Developing Countries

2020 ◽  
Vol 18 (3) ◽  
pp. 556-559
Author(s):  
Amit Thapa
Keyword(s):  
Developing Countries ◽  
Medical Education ◽  
Undergraduate Medical Education ◽  
Medical Curriculum ◽  
Point Of Care ◽  
Image Interpretation ◽  
Point Of Care Ultrasound ◽  
Medical Specialities ◽  
Mind's Eye

Early exposure to technical knowledge improves dexterity and encourages ingenuity. We see the role of ultrasound as a “sonoscope”. Use of sonoscope improves anatomical understanding and improves virtual image interpretation (mind’s eye). Early sonoscope use does not interfere with learning physical examination rather it improves one’s sensitivity as one sees what lies underneath one’s hand. Sonoscope is being used by various medical specialities not only to make diagnosis, but also to monitor and guide interventions. Medical schools worldwide have realised the need and relevance of sonoscope in medical curriculum and hence this needs to be integrated in undergraduate medical education in developing countries. Keywords: Medical education; point of care ultrasound (POCUS); sonoscope

scholarly journals Ureteral Stone Mimics Appendicitis: A Point-of-care Ultrasound Case Report

2020 ◽  
Vol 4 (4) ◽  
pp. 555-558
Author(s):  
Cindy Shavor ◽  
Justine Pagenhardt ◽  
YuanYuan Sun ◽  
Clara Kraft ◽  
Bradley End ◽  
...  
Keyword(s):  
Case Report ◽  
Ureteral Stone ◽  
Point Of Care ◽  
Diagnostic Error ◽  
Point Of Care Ultrasound ◽  
Quadrant Pain ◽  
Lower Quadrant Pain ◽  
Lower Quadrant ◽  
Right Lower Quadrant Pain ◽  
Right Lower Quadrant

Introduction: Abdominal pain is a common complaint in the emergency department. Point-of-care ultrasound (POCUS) is a rapid modality to evaluate for the etiology. Case Report: A teenage male presented with symptoms concerning for appendicitis. POCUS revealed a non-peristalsing, non-compressible, tubular structure containing an echogenic stone. This was determined to be a ureteral stone within a dilated ureter, not appendicitis. Conclusion: We propose a syndromic sonographic approach to right lower quadrant pain (RLQ) that includes the gallbladder, right kidney, bladder, and right adnexa, in addition to RLQ landmarks. This case emphasizes the value of such an approach to avoid diagnostic error.

scholarly journals LO092: The educational impact of a formalized RUSH (Rapid Ultrasound in Shock) protocol in emergency medicine residency ultrasound training

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S61-S62
Author(s):  
C. Hrymak ◽  
E. Weldon ◽  
C. Pham
Keyword(s):  
Emergency Medicine ◽  
Point Of Care ◽  
Image Acquisition ◽  
Image Interpretation ◽  
Comfort Level ◽  
Point Of Care Ultrasound ◽  
Educational Impact ◽  
Hands On ◽  
Before And After ◽  
Junior Residents

Introduction: Point of care ultrasound for assessment of undifferentiated hypotension and shock is part of the clinical scope of Emergency Physicians in Canada. The RUSH Exam outlines a systematic approach to these patients. A RUSH Exam educational model using didactic and hands on practice was developed and implemented for Emergency Medicine (EM) residents. This study evaluated the effectiveness of the module in a simulated setting on the following endpoints: improvement in image acquisition, interpretation, speed, and subjective comfort level, among EM residents with basic ultrasound training. Methods: Approval was received from the institutional health research ethics board for this before and after simulation study. Residents in the -EM Program or CCFP-EM Program from July 2014 to July 2015 were eligible to consent. Participants were excluded if they were unable to complete all portions. All residents were educated to the same level of introductory ultrasound training based on the curriculum in place at our institution. The 8-hour intervention included RUSH didactic and hands on small group sessions. Testing before and after the intervention was performed with the SonoSim Livescan training platform. Two evaluators scored each resident on the accuracy of image acquisition, image interpretation, and time to scan completion. A before and after survey assessed resident comfort level with performing ultrasound on an emergency patient in shock, and basing decisions on ultrasound findings. Statistical analysis was performed using McNemar’s test for image acquisition and interpretation, a paired T test for time, and the Bahpkar test for the questionnaire. Results: 16 EM residents including 11 senior residents and 5 junior residents were enrolled. Improvement was achieved in the categories of IVC image acquisition and interpretation, as well as interpretation for B-lines, lung sliding, cardiac apical and parasternal long axis, and DVT (p<0.05). Subjective comfort level of performing ultrasound in shock and basing decisions on the findings was increased (p<0.0001). Among junior residents, there was an increased speed of image acquisition. Conclusion: With the introduction of the RUSH Exam educational module, EM residents showed improved image acquisition, image interpretation, speed, and comfort level when using ultrasound in critically ill patients.

Competency of Ultrasound Knowledge of Laos Emergency Medicine Residents during International Elective Rotation in Thailand

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S20-S24
Keyword(s):  
Emergency Medicine ◽  
Residency Program ◽  
Clinical Decision Making ◽  
Journal Club ◽  
Point Of Care ◽  
Image Interpretation ◽  
Clinical Decision ◽  
Point Of Care Ultrasound ◽  
International Elective ◽  
Before And After

Background: International rotations for EM residents are becoming increasingly popular. However, there is a dearth of evidence to demonstrate that these rotations can be performed utilizing the POCUS training and that residents have appropriate training, which could assist them in improving their point-of-care ultrasound (POCUS) knowledge. Objective: The researchers aimed at evaluating the POCUS knowledge of the international EM residents after the POCUS training during an international elective rotation. Materials and Methods: A curriculum was developed in the form of a 4-week rotation in the Laos EM residency program at the Department of Emergency Medicine at Khon Kaen University’s Srinagarind Hospital. It consisted of didactic lectures, bedside ultrasound trainings, the journal club, and the process of reviewing the images. Tools were developed, which included a knowledge exam, which was designed to test the residents’ image interpretation abilities and their clinical decision-making processes. The assessments were administered before and after each resident’s rotation. Results: Eight Laos EM residents completed their rotations and the tests. The average Pre-training scores and Post-training scores were 11.13+1.27 and 17.75+1.30, respectively. The average knowledge test score was found to have significantly improved from 55.63% to 88.75%. Conclusion: A POCUS training for the Laos EM residency program in the international elective rotation was able to be developed. Through participating in this training, the residents had been able to improve their basic POCUS knowledge, which will aid the emergency physicians to better care for their patients. Keywords: Ultrasound, POCUS, Emergency medicine, International cooperation

scholarly journals LO79: Climbing the learning curve teaching the pediatric emergency physician how to interpret point-of-care ultrasound images

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S35-S35
Author(s):  
C. Kwan ◽  
K. Weerdenburg ◽  
M. Pecarcic ◽  
M. Pusic ◽  
M. Tessaro ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Performance Metrics ◽  
Point Of Care ◽  
Image Interpretation ◽  
Deliberate Practice ◽  
Pediatric Emergency ◽  
Learning Curves ◽  
Point Of Care Ultrasound ◽  
On Line ◽  
On Line Learning

Introduction: Point-of-Care Ultrasound (POCUS) is rapidly being integrated into Pediatric Emergency Medicine (PEM), and image interpretation is an important component of this skill. Currently, PEM physicians often rely on case-by-case exposure and feedback by a POCUS expert physician to learn this skill; however, this may not be efficient, reliable or feasible. Thus, there is a pressing need to develop effective POCUS image interpretation learning and assessment tools. We developed an on-line learning platform that allowed for the deliberate practice of images in four POCUS applications [soft tissue, lung, cardiac and Focused Assessment Sonography for Trauma (FAST)], and determined the quantity of participant skill acquisition by deriving performance metrics and learning curves. Methods: This was a prospective cross-sectional study administered via an on-line learning and measurement platform. Images were acquired from a pediatric emergency department and each POCUS application contained 100 still/video images. Final diagnosis of each image was determined via the consensus of three PEM POCUS experts. PEM fellow and attending study participants were recruited from the USA and Canada and were required to complete the cases of at least one application. We aimed to enroll 200 participants who had to complete a minimum of 100 cases which, based on prior work, would provide sufficient raters for item analyses and comparisons between PEM attendings and fellows. To derive reference standard performance metrics and to validate image interpretations, a unique set of five PEM POCUS experts completed each application. Results: We enrolled 225 PEM physicians, 74 fellows and 151 attendings. For all applications, the Cohens d effect size was large at 0.87, and there was no difference between PEM attendings and fellows with respect to summary performance metrics (accuracy, p= 0.29; sensitivity, p=0.13; specificity, p=0.92). Final accuracy soft tissue, lung, cardiac, and FAST for all participants was 86.4%, 89.6%, 81.6%, 88.0%, respectively, and the corresponding accuracy of PEM POCUS experts for each application was 96.0%, 96.0%, 90.0%, and 93.0%. Learning curves show maximal learning gains (inflection point) up until 65 cases for soft tissue, 70 for FAST, 75 for lung, and 85 for cardiac. Conclusion: Deliberate practice of POCUS image interpretation was effective for ensuring broad domain coverage and predictable skill improvement. Specifically, there was a large learning effect after 100 case interpretations, and 65-85 case interpretations were needed to reach an accuracy threshold of approximately 85%.

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