Point-of-care ultrasound evaluation of pericardial effusions: Does this patient have cardiac tamponade?

We present a case of a patient who underwent ultrasound evaluation for potential blunt ocular trauma. She was found to have multiple, freely mobile, scintillating hyperechoic opacities within the vitreous that was diagnosed as asteroid hyalosis, a rare but benign condition easily confused with vitreous hemorrhage, retinal detachment, lens dislocation, or foreign body on ocular ultrasound.

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Large pleural and pericardial effusions seen with point-of-care ultrasound in the setting of new onset lymphoma

Visual Journal of Emergency Medicine ◽

10.1016/j.visj.2020.100847 ◽

2020 ◽

Vol 21 ◽

pp. 100847

Author(s):

Denver Rogalla ◽

Casey Wilson

Keyword(s):

Point Of Care ◽

Point Of Care Ultrasound ◽

Pericardial Effusions ◽

New Onset

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Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department—A Proof-of-Concept Study

Journal of Clinical Medicine ◽

10.3390/jcm10225291 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5291

Author(s):

Emanuele Pivetta ◽

Irene Cara ◽

Giulia Paglietta ◽

Virginia Scategni ◽

Giulia Labarile ◽

...

Keyword(s):

Emergency Department ◽

Lung Ultrasound ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Proof Of Concept ◽

Additional Insight ◽

Concept Study ◽

Ultrasound Evaluation ◽

Diaphragmatic Motion ◽

Insight Into

Background: Lung Ultrasound Evaluation (LUS) is usefully applied in the Emergency Department (ED) to patients with suspected or confirmed COVID-19. Diaphragmatic Ultrasound (DUS) may provide additional insight into ventilatory function. This proof-of-concept study aimed to evaluate the feasibility of LUS and DUS in a third level ED during the COVID-19 pandemic. Methods: Adult patients presenting with COVID-19 symptoms were eligible. After the physical examination, both LUS and DUS (i.e., diaphragmatic motion and thickness) were performed. All patients were followed after 30 days to determine their need for ventilation, admission, and/or a new ED evaluation after discharge. The diagnostic accuracies of diaphragm measurements in assessing the risk of the 30-day outcome were calculated as well as the measurements’ usefulness. Bland–Altman plots were used for comparing bedside and off-line diaphragm measurements. Results: 118 patients were enrolled. Median thickness and motion were 1.7 mm (iqr 0.4) and 1.8 cm (iqr 0.7), respectively, with a mean difference of 0.009 mm (95% CI −0.037–0.056 mm) and −0.051 cm (95% CI −0.108–0.006 cm), respectively. The 30-day outcome was associated with an increase in thickness (OR 5.84, 95% CI 0.96–35.4), and a lower motion (OR 0.49, 95% CI 0.2–1.21). Conclusion: DUS seemed to be feasible and reliable in the ED in a population of patients presenting with symptoms related to COVID-19 infection.

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Cardiac Tamponade Diagnosed by Point-of-Care Ultrasound

Pediatric Emergency Care ◽

10.1097/pec.0000000000001024 ◽

2017 ◽

Vol 33 (2) ◽

pp. 132-134 ◽

Cited By ~ 5

Author(s):

Austin T. Smith ◽

Caroline Watnick ◽

Robinson M. Ferre

Keyword(s):

Cardiac Tamponade ◽

Point Of Care ◽

Point Of Care Ultrasound

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Pericardial Tamponade After Systemic Alteplase in Stroke and Emergent Reversal With Tranexamic Acid

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.10.44369 ◽

2019 ◽

Vol 4 (1) ◽

pp. 55-58

Author(s):

Cynthia Romero ◽

Samuel Shartar ◽

Michael Carr

Keyword(s):

Ischemic Stroke ◽

Tranexamic Acid ◽

Acute Ischemic Stroke ◽

Cardiac Tamponade ◽

Major Bleeding ◽

Point Of Care ◽

Pericardial Tamponade ◽

Point Of Care Ultrasound ◽

Blood Products ◽

Tissue Plasminogen

Alteplase, or tissue plasminogen activator (tPA), lyses clots by enhancing activation of plasminogen to plasmin. Conversely, tranexamic acid (TXA) functions by inhibiting the conversion of plasminogen to plasmin, which inhibits fibrinolysis. TXA has proven safe and effective in major bleeding with various etiologies. A 76-year-old male developed acute ischemic stroke symptoms. Systemic alteplase was administered and he showed clinical improvement. Shortly thereafter, the patient became hypotensive and lost pulses. Point-of-care ultrasound revealed cardiac tamponade. TXA was immediately given to inhibit fibrinolysis since cryoprecipitate and blood products were not immediately available. Pericardiocentesis was performed and successfully removed 200 milliliters of blood with return of pulses. Clinicians must consider TXA as a rapidly accessible antagonist of tPA’s fibrinolytic effects.

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Gastric point-of-care ultrasound evaluation in pediatric emergency department procedural sedation patients; is the stomach empty at the point of scheduled revisit?

10.22514/sv.2021.109 ◽

2021 ◽

Keyword(s):

Emergency Department ◽

Point Of Care ◽

Stomach Contents ◽

Final Analysis ◽

Gastric Antrum ◽

Empty Stomach ◽

Procedural Sedation ◽

Point Of Care Ultrasound ◽

Ultrasound Evaluation ◽

Fasting Time

Objectives: This study aimed to use gastric point of care ultrasound (POCUS) to estimate the prevalence of an “empty stomach” among patients undergoing procedural sedation and analgesia (PSA) in the emergency department (ED) after observing the requisite fasting time at home. Methods: A prospective observational study was conducted with children with facial lacerations who made a scheduled revisit to the ED after completion of the recommended fasting time. Their stomach contents were assessed with a sagittal view of the gastric antrum by POCUS in the right lateral decubitus position. The characteristics of gastric contents were described as empty, solid, and liquid with an estimated gastric volume. “Empty stomach” was defined as a collapsed gastric antrum or calculated a gastric fluid volume of less than or equal to 1.25 mL/kg on POCUS. Results: Gastric POCUS was performed in 125 patients, and the final analysis included 122 patients. For 95 patients who had followed the recommended fasting time, the median fasting time was 7 hours for solids and 6 hours for liquids, and 78 (82%) patients had an empty stomach. Conversely, seven of 27 patients (26%) who did not have an adequate fasting time had an empty stomach. The optimal cut-off value of fasting time to predict an empty stomach was 6.5 hours based on a receiver operating characteristic (ROC) analysis (sensitivity = 0.767, specificity = 0.811). Conclusions: Most scheduled revisiting children had an “empty stomach” at the time of sedation after the recommended fasting. However, providers should be aware that one in five children still had stomach residue, although they had more than 6 hours of fasting.

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