scholarly journals Point of care lung ultrasound is useful when screening for CoVid-19 in Emergency Department patients.

2020 ◽  
Author(s):  
Andrea Hankins ◽  
Heejung Bang ◽  
Paul Walsh
Keyword(s):  
Emergency Department ◽  
Null Hypothesis ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Vital Signs ◽  
P Value ◽  
Inclusion Criteria ◽  
Upper Respiratory Infection ◽  
Life Threatening ◽  
Emergency Department Patients

Background CoVid-19 can be a life-threatening lung disease or a trivial upper respiratory infection depending on whether the alveoli are involved. Emergency department (ED) screening in symptomatic patients with normal vital signs is frequently limited to oro-nasopharyngeal swabs. We tested the null hypothesis that patients being screened for CoVid-19 in the ED with normal vital signs and without hypoxia would have a point-of-care lung ultrasound (LUS) consistent with CoVid-19 less than 2% of the time. Methods Subjects Subjects were identified from ED ultrasound logs. Inclusion criteria Age 14 years or older with symptoms prompting ED screening for CoVid-19. Exclusion criteria Known congestive heart failure or other chronic lung condition likely to cause excessive B lines on LUS. Intervention Structured blinded ultrasound review and chart review Analysis We used an exact hypothesis tests for binomial random variables. We also measured LUS diagnostic performance using computed tomography as the gold standard. Results We reviewed 77 charts; 62 met inclusion criteria. Vital signs were normal in 31 patients; 10 (32%) of these patients had LUS consistent with CoVid-19. We rejected the null hypothesis (p-value for bitest <0.001). The treating physicians' interpretation of their own point of care lung ultrasounds had a sensitivity of 100% (95% CI 75%, 100%) and specificity of 80% (95% CI 68%, 89%). Conclusion LUS has a meaningful detection rate for CoVid-19 in symptomatic emergency department patients with normal vital signs. We recommend at least LUS be used in addition to PCR testing when screening symptomatic ED patients for CoVid-19.

scholarly journals Longitudinal remotely mentored self-performed lung ultrasound surveillance of paucisymptomatic Covid-19 patients at risk of disease progression

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Andrew W. Kirkpatrick ◽  
Jessica L. McKee ◽  
John M. Conly
Keyword(s):  
At Risk ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Human Life ◽  
Vital Signs ◽  
Home Monitoring ◽  
Cost Effective ◽  
Care Providers ◽  
Vital Signs Monitoring ◽  
Ultrasound Probes

AbstractCOVID-19 has impacted human life globally and threatens to overwhelm health-care resources. Infection rates are rapidly rising almost everywhere, and new approaches are required to both prevent transmission, but to also monitor and rescue infected and at-risk patients from severe complications. Point-of-care lung ultrasound has received intense attention as a cost-effective technology that can aid early diagnosis, triage, and longitudinal follow-up of lung health. Detecting pleural abnormalities in previously healthy lungs reveal the beginning of lung inflammation eventually requiring mechanical ventilation with sensitivities superior to chest radiographs or oxygen saturation monitoring. Using a paradigm first developed for space-medicine known as Remotely Telementored Self-Performed Ultrasound (RTSPUS), motivated patients with portable smartphone support ultrasound probes can be guided completely remotely by a remote lung imaging expert to longitudinally follow the health of their own lungs. Ultrasound probes can be couriered or even delivered by drone and can be easily sterilized or dedicated to one or a commonly exposed cohort of individuals. Using medical outreach supported by remote vital signs monitoring and lung ultrasound health surveillance would allow clinicians to follow and virtually lay hands upon many at-risk paucisymptomatic patients. Our initial experiences with such patients are presented, and we believe present a paradigm for an evolution in rich home-monitoring of the many patients expected to become infected and who threaten to overwhelm resources if they must all be assessed in person by at-risk care providers.

scholarly journals The Feasibility and Accuracy of Point-of-Care Lactate Measurement in Emergency Department Patients with Suspected Infection

2010 ◽  
Vol 39 (1) ◽  
pp. 89-94 ◽  
Author(s):  
Nathan I. Shapiro ◽  
Christopher Fisher ◽  
Michael Donnino ◽  
Lauren Cataldo ◽  
Aimee Tang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Point Of Care ◽  
Suspected Infection ◽  
Lactate Measurement ◽  
Emergency Department Patients

Determinants of pyelonephritis onset in patients with obstructive urolithiasis

2021 ◽  
pp. 039156032110352
Author(s):  
Georges Abi Tayeh ◽  
Ali Safa ◽  
Julien Sarkis ◽  
Marwan Alkassis ◽  
Nour Khalil ◽  
...  
Keyword(s):  
Emergency Department ◽  
Renal Colic ◽  
Demographic Data ◽  
Vital Signs ◽  
Kidney Injury ◽  
Stone Size ◽  
Positive Urine ◽  
Life Threatening ◽  
Fat Stranding ◽  
Obstructive Pyelonephritis

Background: Acute obstructive pyelonephritis due to urolithiasis represents a medico-surgical emergency that can lead to life-threatening complications. There are still no established factors that reliably predict progression toward acute pyelonephritis in patients presenting with a simple renal colic. Objective: To investigate clinical and paraclinical factors that are associated with the onset of acute obstructive pyelonephritis. Methods: Patients presenting to the emergency department for renal colic with obstructive urolithiasis on imaging were enrolled in the study. Demographic data, vital signs, medical comorbidities, blood test results, urinalysis, and radiological findings were recorded. Obstructive pyelonephritis was defined by the presence of two or more of the following criteria: fever, flank pain or costovertebral angle tenderness, and a positive urine culture. Results: Seventeen patients out of 120 presenting with renal colic, were diagnosed with acute obstructive pyelonephritis (14%). Parameters that were associated with the onset of obstructive pyelonephritis were: diabetes ( p = 0.03), elevated CRP ( p = 0.01), stone size (>5 mm) ( p = 0.03), dilatation of renal pelvis ( p = 0.01), peri-renal fat stranding ( p = 0.02), and positive nitrites on urinalysis ( p < 0.01). Hyperleukocytosis, acute kidney injury, multiple stones, pyuria (>10/mm3), hypertension, and were not associated with the onset of obstructive pyelonephritis. Conclusion: This study showed that known diabetic status, elevated CRP, positive urine nitrites, stone size (>5 mm), pyelic dilatation, and peri-renal fat stranding were associated with the onset of pyelonephritis in patients presenting to the emergency department with obstructive urolithiasis.

scholarly journals Diversity for diversity: A “fast track” nursing service model to complement conventional emergency medicine service in a busy urban area emergency department

2020 ◽  
pp. 102490792093170
Author(s):  
Ng Hing Yin ◽  
Fan Kin Ping ◽  
Lo Chor Man
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Fast Track ◽  
Waiting Times ◽  
Clinical Protocols ◽  
Service Model ◽  
Nursing Service ◽  
Life Threatening ◽  
Emergency Department Patients ◽  
High Level

Background: In a busy local emergency department, patients with certain non-life-threatening conditions which only require relatively quick and straightforward management may encounter long waiting times. A new service model called the “Fast Track” Nursing Service attempts to lessen the service load of the regular service queues and to improve patient outcomes. Objectives: This article reports the service outcomes of the Fast Track Nursing Service. Methods: Nurses at our department are selected and trained under clinical protocols specially developed for this service. Assessments and quality assurance audits ensure the quality of service. Results: This service resulted in comparatively shorter waiting times for patients included in predetermined clinical protocols. There was also a high level of patient satisfaction with this service. Conclusion: Our Fast Track Enhanced Nursing service is a model of tailored service diversification to shorten waiting times, thus improving patient satisfaction and outcome.

scholarly journals Early Multi-organ Point-of-Care Ultrasound Evaluation of Respiratory Distress During SARS-CoV-2 Outbreak: Case Report

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Robert Farrow ◽  
Graham Becherer-Bailey ◽  
Daniel Mantuani ◽  
Arun Nagdev
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Respiratory Distress ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Case Series ◽  
Disease Process ◽  
Point Of Care Ultrasound ◽  
Care Assessment

Introduction: Coronavirus disease 2019 (COVID-19) is caused by the virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several case series from Italy and China have highlighted the lung ultrasound findings of this disease process and may demonstrate its clinical utility during the current pandemic. Case Report: We present a case of a COVID-19 patient who presented to the emergency department twice within a 24-hour period with rapidly progressing illness. A multi-organ point-of-care ultrasound (POCUS) evaluation was used on the return visit and assisted clinical decision-making. Discussion: A multi-organ POCUS exam allows for quick assessment of acute dyspnea in the emergency department. As the lung involvement of COVID-19 is primarily a peripheral process it is readily identifiable via lung ultrasound. We believe that when applied efficiently and safely a POCUS exam can reduce clinical uncertainty and potentially limit the use of other imaging modalities when treating patients with COVID-19. Conclusion: This case highlights the utility of an early multiorgan point-of-care assessment for patients presenting with moderate respiratory distress during the severe SARS-CoV-2 pandemic.

scholarly journals Comparison between B·R·A·H·M·S PCT direct, a new sensitive point-of-care testing device for rapid quantification of procalcitonin in emergency department patients and established reference methods – a prospective multinational trial

2016 ◽  
Vol 54 (4) ◽  
Author(s):  
Alexander Kutz ◽  
Pierre Hausfater ◽  
Michael Oppert ◽  
Murat Alan ◽  
Eva Grolimund ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Whole Blood ◽  
Point Of Care ◽  
Venous Blood ◽  
Reference Method ◽  
Point Of Care Test ◽  
Emergency Department Patients ◽  
Work Up

AbstractProcalcitonin (PCT) is increasingly being used for the diagnostic and prognostic work up of patients with suspected infections in the emergency department (ED). Recently, B·R·A·H·M·S PCT direct, the first high sensitive point-of-care test (POCT), has been developed for fast PCT measurement on capillary or venous blood samples.This is a prospective, international comparison study conducted in three European EDs. Consecutive patients with suspicion of bacterial infection were included. Duplicate determination of PCT was performed in capillary (fingertip) and venous whole blood (EDTA), and compared to the reference method. The diagnostic accuracy was evaluated by correlation and concordance analyses.Three hundred and three patients were included over a 6-month period (60.4% male, median age 65.2 years). The correlation between capillary or venous whole blood and the reference method was excellent: rThis study found a high diagnostic accuracy and a faster time to result of B·R·A·H·M·S PCT direct in the ED setting, allowing shortening time to therapy and a more wide-spread use of PCT.

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