Point of care ultrasound versus CT pulmonary angiogram in suspected pulmonary embolus

2017 ◽  
Vol 34 (7) ◽  
pp. 487.2-489
Author(s):  
Joseph Bacani Bacani ◽  
Kerstin De Wit
Keyword(s):  
Pulmonary Embolus ◽  
Point Of Care ◽  
Clinical Suspicion ◽  
Point Of Care Ultrasound ◽  
Clinical Question ◽  
Non Invasive ◽  
Pulmonary Angiogram ◽  
Definitive Statement ◽  
Ct Pulmonary Angiogram ◽  
Study Type

A short cut review was carried out to establish whether non-invasive, multi-organ point of care ultrasound could reduce the need for CTPA in adult patients presenting with clinical suspicion of pulmonary embolus. 3 papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that multi-organ POCUS shows promise but that more data is needed to make a definitive statement regarding validity in clinical practice.

scholarly journals Non-Invasive Intracranial Pressure Evaluation in an Emergency Room – Point-of-Care Ultrasonography

2016 ◽  
Vol 38 (04) ◽  
pp. 279-283
Author(s):  
Daniel Damiani ◽  
Durval Damiani
Keyword(s):  
Intracranial Pressure ◽  
Randomized Trials ◽  
Point Of Care ◽  
Current Data ◽  
Point Of Care Ultrasound ◽  
Medical Specialties ◽  
Non Invasive ◽  
Nerve Sheath ◽  
Invasive Method ◽  
Point Of Care Ultrasonography

AbstractPoint-of-care ultrasound is modifying conducts in emergency care. The various medical specialties, in addition to traditional indications in cases of multiple trauma, are using this technique for rapid diagnosis at the bedside without patient mobilization and without radiation. Point-of-care ultrasound in neurocritical patients, through its transorbital window, can estimate the intracranial pressure by a non-invasive method. Through the measurement of the diameter of the optic nerve sheath 3 mm posterior to the retina, the intracranial pressure is estimated if the value of the diameter is > 5 mm, as it has been verified in other studies. The present article describes the most current data on this topic, and it also highlights the need for more multicentric and randomized trials to determine the correct cut-off points that represent the high sensibility and specificity of the method.

scholarly journals Fluid Therapy in Pulmonary Disease: How Careful Do We Need to Be?

2021 ◽  
Vol 8 ◽  
Author(s):  
Sophie Adamantos
Keyword(s):  
Fluid Therapy ◽  
Fluid Overload ◽  
Point Of Care ◽  
Pulmonary Complications ◽  
Point Of Care Ultrasound ◽  
Protective Mechanisms ◽  
Non Invasive ◽  
Life Saving ◽  
Severe Hemorrhage ◽  
Healthy Dogs

Intravenous fluid therapy is a vital and life-saving therapeutic in veterinary medicine. In the absence of heart or lung disease, trauma or sepsis there is limited evidence that fluid therapy will have a detrimental effect on lung function. In healthy dogs there is a reasonable level of experimental evidence that supraphysiologic rates of fluid are required before signs of fluid overload are made evident. In cats, however, this may not be the case. There are higher rates of asymptomatic myocardial disease, but even in the absence of that it seems that some cats may be susceptible to fluid overload. Where systemic inflammation already exists the careful homeostatic and protective mechanisms within the lung are deranged and increases in hydrostatic pressure are more likely to result in fluid movement into the lung tissues. Strategies including restricting the use of intravenous crystalloid fluid administration and using blood products for management of severe hemorrhage are of increasing importance in human trauma and seem to be associated with fewer pulmonary complications, and lower mortality. Managing dogs and cats with sepsis and acute respiratory distress syndrome is already challenging, but ensuring adequate vascular expansion needs to be balanced with avoiding excessive volume administration which may negatively impact pulmonary function. While fluids remain crucial to management of these conditions, there will be an ongoing requirement to balance need without providing excess. The use of point of care ultrasound may provide clinicians with a non-invasive and accessible way to do this.

Point-of-care contrast enhanced lung ultrasound and COVID-19

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110479
Author(s):  
Alice Tee ◽  
Gibran Timothy Yusuf ◽  
Adrian Wong ◽  
Deepak Rao ◽  
Sa Tran ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Contrast Enhanced Ultrasound ◽  
Cross Sectional ◽  
Patient Demographics ◽  
Pulmonary Angiogram ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Ct Pulmonary Angiogram

Objectives Bedside lung ultrasound has been indispensable during the coronavirus disease 2019 (COVID-19) pandemic, allowing us to rapidly assess critically unwell patients. We demonstrate the unique application of contrast-enhanced ultrasound with the aim of further understanding this disease. Methods Patient demographics were recorded alongside recent cross-sectional imaging and inflammatory markers. Ultrasound was conducted by experienced operators in a portable setting. Conventional six-point lung ultrasound method was used to evaluate B-lines, small (subpleural) consolidation and the pleura. Areas of small consolidation were targeted after intravenous administration of ultrasound contrast. Results The areas of small consolidations, a potential sign of pneumonia on B-mode lung ultrasound, usually enhance on contrast-enhanced ultrasound. Our study revealed these areas to be avascular, indicating an underlying thrombotic/infarction process. Findings were present in 100% of the patients we examined. We have also shown that the degree of infarction correlates with CT severity (r = 0.4) and inflammatory markers, and that these areas improve as patients recover. Conclusions We confirmed the theory of immune thrombus by identifying the presence of microthrombi in the lungs of 100% of our patients, despite 79% having had a recent negative CT pulmonary angiogram study. contrast-enhanced ultrasound can be utilised to add confidence to an uncertain COVID-19 diagnosis and for prognosticating and monitoring progress in confirmed COVID-19 patients. Contrast-enhanced ultrasound is clearly very different to CT, the gold standard, and while there are specific pathologies that can only be detected on CT, contrast-enhanced ultrasound has many advantages, most notability the ability to pick up microthrombi at the periphery of the lungs.

scholarly journals Diagnosing Early Cardiac Tamponade in Patient with JAK2+ Myeloproliferative Syndrome with Point of Care Ultrasound

POCUS Journal ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 13-15
Author(s):  
Evan Cameron ◽  
Lawrence Istrail
Keyword(s):  
User Interface ◽  
Cardiac Tamponade ◽  
Point Of Care ◽  
Handheld Devices ◽  
Point Of Care Ultrasound ◽  
Diagnostic Modality ◽  
Non Invasive ◽  
Myeloproliferative Syndrome ◽  
Life Threatening ◽  
New Diagnosis

Point of care ultrasound (POCUS) is a diagnostic modality growing in popularity and use in medicine in both the acute and chronic management settings. Its utility lies in its non-invasive application, direct user interface, and portability, especially in handheld devices, allowing for quick assessment and triage. Herein is a case of POCUS diagnosing life threatening cardiac tamponade in a patient with a new diagnosis of JAK2+ myeloproliferative syndrome prompting urgent intervention with pericardiocentesis. This case illustrates the utility of POCUS through its ability to serve as a quick diagnostic tool that can hasten intervention for potentially life-threatening conditions.   

scholarly journals P056: Non-invasive measurement of the central venous pressure using near-infrared spectroscopy versus point-of-care ultrasound

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S76-S77
Author(s):  
N. Goumeniouk ◽  
J. Newbigging ◽  
M. McDonnell ◽  
M.L.A. Sivilotti
Keyword(s):  
Emergency Department ◽  
Infrared Spectroscopy ◽  
Near Infrared ◽  
Point Of Care ◽  
Venous Pressure ◽  
Point Of Care Ultrasound ◽  
Central Venous ◽  
Non Invasive ◽  
Secondary Outcomes ◽  
Invasive Measurement

Introduction: A fundamental hemodynamic parameter, the central venous pressure (CVP) is rarely available in the emergency patient due the delay and risks inherent to central vein cannulation. Recently, two non-invasive strategies have emerged: a) point-of-care ultrasound to supplement traditional inspection the internal jugular waveform ; or b) near-infrared spectroscopy (NIRS) of the external jugular vein. Methods: Five medical students underwent standardized training on both NIRS device (Venus 2000 CVP; Mespere Life Sciences, Waterloo ON) and ultrasound-assisted CVP assessment. During prescheduled, randomly permuted and balanced shifts, a pair of students obtained blinded independent measurements using each device within 10 minutes of each other. High priority subjects likely to have abnormal CVP (e.g. vomiting, dehydrated, heart failure, sepsis) were approached preferentially, followed by a convenience sample of other eligible patients in the emergency department. Secondary outcomes were stopwatch-recorded time from device ready to stable measurement, as well as operator ease, operator confidence and patient discomfort. The blinded treating physician rated each subjects volume status on an ordered scale: depleted, neutral and overloaded. Results: We enrolled 104 patients (median [IQR] age 68 [53, 78] years; 50% male; BMI 27.6 [17.0, 47.7] kg/m2; admission rate 27%) in June-August 2017. Treating physicians classified 17 as volume depleted and 12 overloaded. CVP measurements differed widely between techniques: ultrasound 8 [7, 9] cmH2O (3 cases unobtainable) vs NIRS 12 [8, 17] cmH2O (13 unobtainable). Agreement and correlation between the two devices was extremely low (R2=0.04). While neither technique demonstrated a strong association with the treating physicians estimate of volume status, only the ultrasound values increased monotonically with physician estimate. With regards to secondary outcomes, ultrasound measurements took less time (paired difference 50 seconds [95% CI 7, 93]), and operators were more confident (0.63 [0.02, 1.23] out of 10) and at ease (0.78, [0.13, 1.43]) with ultrasound; patients rated discomfort equally (-0.06 [-0.30, 0.18]). Conclusion: Non-invasive measurement of CVP remains a challenge in the emergency department. The external jugular pressure by NIRS has very high variability and poor agreement with ultrasound-enhanced inspection of the internal jugular, suggesting that this technique is not yet practical for use by non-experts.

Point-of-care ultrasound (POCUS) as the keystone investigation in undifferentiated dyspnoea

2020 ◽  
Vol 13 (6) ◽  
pp. e234602
Author(s):  
Sara Montemerani ◽  
Valeria Donati ◽  
Nicola Di Pietra ◽  
Giovanni Iannelli
Keyword(s):  
Respiratory Failure ◽  
Point Of Care ◽  
High Rate ◽  
Chronic Obstructive ◽  
Subjective Perception ◽  
Point Of Care Ultrasound ◽  
Obstructive Pulmonary Disease ◽  
Require Time ◽  
Non Invasive ◽  
Common Causes

Dyspnoea is defined as a subjective perception of laboured breathing. It is a common cause of access to the emergency department (ED), it has a high rate of intensive care unit admission and a high mortality. The most common causes of dyspnoea in the adult include pneumonia, heart failure, chronic obstructive pulmonary disease, pulmonary embolism and asthma. Due to the high variety of dyspnoea’s causes, the need for a rapid and accurate diagnosis puts the emergency physician in trouble. Moreover, standard tests such as chest radiography, B-type natriuretic peptide and d-dimer require time and may be less useful in patients with respiratory failure who require urgent therapy. Point-of-care ultrasound (POCUS) is rapid, non-invasive, repeatable and a useful tool in evaluating patients with acute and severe dyspnoea. This case report demonstrates the usefulness of POCUS in a patient with undifferentiated respiratory failure presenting to the ED.

scholarly journals Abdominal wall mass

2018 ◽  
Vol 25 (6) ◽  
pp. 374-375
Author(s):  
Pei-Yi Zhang ◽  
Wei-Jing Lee
Keyword(s):  
High Frequency ◽  
Linear Array ◽  
Point Of Care ◽  
Abdominal Mass ◽  
Vascular Lesion ◽  
Point Of Care Ultrasound ◽  
Tumor Mass ◽  
Non Invasive ◽  
Array Transducer ◽  
Wall Mass

A 52-year-old man presented to the emergency department due to progressive periumbilical pain for 3 days. Point-of-care ultrasound was performed by using high-frequency linear-array transducer. Point-of-care ultrasound is a useful and non-invasive tool that can be used to evaluate the characteristics of superficial abdominal mass whether it is a hernia, tumor mass, hematoma, abscess, or vascular lesion.

scholarly journals Use of point-of-care ultrasound in the management of patients presenting with shock: the treatment implications of an early bedside diagnosis of pulmonary embolism

2020 ◽  
Vol 13 (3) ◽  
pp. e233670
Author(s):  
Fiqry Fadhlillah ◽  
Maiyuran Ratneswaran
Keyword(s):  
Pulmonary Embolism ◽  
Systolic Function ◽  
Point Of Care ◽  
Pulmonary Arteries ◽  
Left Ventricular ◽  
Haemodynamic Instability ◽  
Point Of Care Ultrasound ◽  
Systemic Thrombolysis ◽  
Pulmonary Angiogram ◽  
Bedside Diagnosis

Point-of-care ultrasound has been used to identify real-time indicators of acute obstruction to right ventricular outflow and aid appropriate diagnosis and management of patients presenting with extensive pulmonary embolism in whom haemodynamic instability permits only bedside investigation. We present the case of a 70-year-old woman who presented with shock. A focused bedside echocardiography was performed and showed left ventricular septal wall flattening and a severely dilated right ventricle with impaired systolic function. The right atrium was dilated with a floating thrombus visible on the sub-xiphoid view. The patient was treated with intravenous systemic thrombolysis (alteplase) prior to undergoing CT pulmonary angiogram. This showed saddle pulmonary embolus, with extensive thrombus in the main and all lobar pulmonary arteries bilaterally, with evidence of right heart strain.

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