scholarly journals Albumin Infusion in Patients with Cirrhosis: Time for POCUS-Enhanced Physical Examination

2021 ◽  
pp. 1-5
Author(s):  
Abhilash Koratala ◽  
Claudio Ronco ◽  
Amir Kazory
Keyword(s):  
Physical Examination ◽  
Hepatorenal Syndrome ◽  
Point Of Care ◽  
Objective Assessment ◽  
Objective Evaluation ◽  
Pulmonary Complications ◽  
Complex Disorders ◽  
Point Of Care Ultrasonography ◽  
The Impact

Objective assessment of fluid status is of utmost significance in the management of patients with complex disorders involving hemodynamics and multi-organ crosstalk such as cardiorenal or hepatorenal syndrome. The role of volume expansion using intravenous albumin in the setting of hepatorenal syndrome has been an everlasting debate among clinicians. With the accumulating evidence on the deleterious consequences of iatrogenic fluid overload, empiric albumin administration in these patients has been the focus of much attention, and the findings of recent studies suggest a higher incidence of pulmonary complications with albumin. Poor sensitivity of conventional physical examination has led to an interest in the utility of novel noninvasive bedside tools such as point-of-care ultrasonography (POCUS) to evaluate hemodynamics more precisely. Once confined to specialties such as obstetrics and emergency medicine, the scope of diagnostic POCUS is rapidly expanding in other fields including internal medicine and nephrology. Herein, we offer our perspective on the emerging role of POCUS for objective evaluation of patients with suspected hepatorenal physiology based on our experience. We propose that future clinical trials consider incorporating this strategy and explore the impact of POCUS-guided therapy on the outcomes.

scholarly journals Point of Care Ultrasonography for Objective Assessment of Heart Failure: Integration of Cardiac, Vascular, and Extravascular Determinants of Volume Status

2021 ◽  
pp. 1-13
Author(s):  
Abhilash Koratala ◽  
Amir Kazory
Keyword(s):  
Heart Failure ◽  
Point Of Care ◽  
Objective Assessment ◽  
Prognostic Significance ◽  
Volume Status ◽  
Lung Water ◽  
Ultrasound Evaluation ◽  
Reliable Assessment ◽  
Poor Outcomes ◽  
Point Of Care Ultrasonography

<b><i>Background:</i></b> Lingering congestion portends poor outcomes in patients with heart failure (HF) and is a key target in their management. Studies have shown that physical exam has low yield in this setting and conventional methods for more precise assessment and monitoring of volume status (e.g., body weight, natriuretic peptides, and chest radiography) have significant inherent shortcomings. <b><i>Summary:</i></b> Point of care ultrasonography (POCUS) is a noninvasive versatile bedside diagnostic tool that enhances the sensitivity of conventional physical examination to gauge congestion in these patients. It also aids in monitoring the efficacy of decongestive therapy and bears prognostic significance. In this narrative review, we discuss the role of focused sonographic assessment of the heart, venous system, and extravascular lung water/ascites (i.e., the pump, pipes, and the leaks) in objective assessment of fluid volume status. <b><i>Key Messages:</i></b> Since each of the discussed components of POCUS has its limitations, a combinational ultrasound evaluation guided by the main clinical features would be the key to reliable assessment and effective management of congestion in patients with HF.

scholarly journals Barriers to the implementation of point-of-care ultrasonography by physiotherapists in haemophilia treatment centres in Canada: a modified Delphi approach

2019 ◽  
Vol 6 (1) ◽  
pp. 29-41
Author(s):  
Karen Strike ◽  
Anthony Chan ◽  
Monica R. Maly ◽  
Patricia Solomon
Keyword(s):  
Physical Examination ◽  
Point Of Care ◽  
Healthcare Organisation ◽  
Knowledge To Action ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Treatment Centre ◽  
Diagnostic Modalities ◽  
Point Of Care Ultrasonography ◽  
Inner Setting

Abstract Background: In patients with haemophilia, evidence suggests that the physical examination alone is not sensitive enough to detect small amounts of blood within a joint. Attention has shifted to methods of improving the sensitivity of the physical examination through adding diagnostic modalities such as point-of-care ultrasonography (POC-US). Proficiency with the physical examination and understanding of the role of POC-US are important competencies for physiotherapists. Despite training, implementation of POC-US by physiotherapists in haemophilia treatment centres in Canada has been mixed. Aim: Using a theory-based approach, the aim of the current study is to achieve expert consensus regarding the barriers to physiotherapy performed POC-US in haemophilia treatment centres in Canada using a modified Delphi approach. Materials and Methods: Using the Knowledge-to-Action Framework and the Consolidated Framework for Implementation Research (CFIR), a modified Delphi approach was completed using the Modified BARRIERS Scale (MBS). Participants were blinded and consensus was reached over three rounds at the Canadian Hemophilia Society’s annual three-day conference. Results: Twenty-two physiotherapists participated; 20 participants completed Round 1, and 21 completed Rounds 2 and 3. Four items of the MBS reached consensus: 1) The physiotherapist does not have time to read research related to POC-US; 2) The physiotherapist is isolated from knowledgeable colleagues with whom to discuss POC-US; 3) Administration will not allow POC-US implementation; 4) There is insufficient time on the job to implement new ideas. All four consensus items can be mapped to one domain of the CFIR: the inner setting. Conclusion: The haemophilia treatment centre within a healthcare organisation appears to be an important target for addressing barriers to the implementation of physiotherapy performed POC-US.

scholarly journals Point-of-Care Tests for Bladder Cancer: The Influencing Role of Hematuria

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Joerg Hennenlotter ◽  
Severine Huber ◽  
Tilman Todenhöfer ◽  
Ursula Kuehs ◽  
David Schilling ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Diagnostic Yield ◽  
Point Of Care ◽  
False Positives ◽  
Two Systems ◽  
Reliable Interpretation ◽  
Point Of Care Tests ◽  
The Impact

Introduction. Several point-of-care tests (POCT) are available for the diagnosis of bladder cancer (BC). We evaluate the impact of HU (hematuria) on performance of POCTs.Materials and Methods. Urine from 10 donors was diluted with blood from 0.5 to 0.00625%. BladderCheckR, BTAstatR, BCMR, and BTARtests were applied. Tests were additionally conducted in 54 patients with HU. HU was stratified according to the amount of erythrocytes (RBC)/μL using two systems: (1) no HU; mild microscopic HU; severe microscopic HU; gross HU; (2) I <25 RBCs; <250 II; ≥250 III. Results were compared to HU status and histopathology.Results. Gross HU became evident between 2090 RBCs/μL and 1065/μL. Addition of blood led to default tests in all 4: BladderCheckR0.25%; BCM 0.025%, BioNexia 0.00625%, and BTAstat <0.00625%. Rates of false positives for BladderCheck, BTAstat, BCM, and BioNexia were 5.9, 11.8, 0, and 1.8% without HU and 0, 66.7, 44.4, and 66.7% with HU. BTAstat, BCM, and BioNexia were independently influenced by HU (P<0.0002).Conclusions. NMP22-BladderCheck was most resistant to blood. The diagnostic yield of all others was significantly influenced by HU. A well-defined HU grading helps to define limits of HU for a reliable interpretation of BC-POCTs.

scholarly journals POCUS for Nephrologists - Basic Principles and a General Approach

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0002482021
Author(s):  
Abhilash Koratala ◽  
Nathaniel Reisinger
Keyword(s):  
Physical Examination ◽  
Point Of Care ◽  
Basic Principles ◽  
Medical Specialties ◽  
Case Examples ◽  
Fluid Status ◽  
Valuable Adjunct ◽  
Point Of Care Ultrasonography ◽  
Fragmentation Of Care

Point of care ultrasonography (POCUS) has evolved as a valuable adjunct to physical examination in the recent past and various medical specialties have embraced it. However, POCUS training and scope of practice remain relatively undefined in nephrology. The utility of diagnostic POCUS beyond kidney and vascular access is under-recognized. Assessment of fluid status is a frequent dilemma faced by nephrologists in day-to-day practice where multi-organ POCUS can enhance the sensitivity of conventional physical examination. POCUS also reduces fragmentation of care, facilitates timely diagnosis, and expedites management. While the need for further imaging studies is obviated in selected cases, POCUS is not meant to serve as an alternative to consultative imaging. In addition, utility of POCUS depends on the skills and experience of the operator, which in turn depends on the quality of training. In this review, we discuss the rationale behind nephrologists performing POCUS, discuss case examples to illustrate the basic principles of focused ultrasonography, and share our experience-based opinion about developing a POCUS training program at the institutional level.

scholarly journals THE ROLE OF POINT-OF-CARE ULTRASONOGRAPHY IN THE INITIAL CHARACTERIZATION OF COVID-19 PATIENTS: RESULTS FROM A PROSPECTIVE MULTICENTRIC STUDY.

2020 ◽  
Author(s):  
yale tung chen ◽  
Rafael Llamas Fuentes ◽  
Pablo Rodriguez Fuertes
Keyword(s):  
Emergency Department ◽  
Troponin I ◽  
Point Of Care ◽  
Common Finding ◽  
Multicentric Study ◽  
X Ray ◽  
Therapeutic Decisions ◽  
Chest X Ray ◽  
Point Of Care Ultrasonography

INTRODUCTION: Coronavirus Disease 2019 (COVID-19) is a highly contagious illness caused by the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is growing evidence regarding the imaging findings of COVID-19, in Chest X-ray and CT scan, however their availability in this pandemic outbreak might be compromised. At this moment, the role of Point-of-care ultrasonography (POCUS) has yet to be explored. OBJECTIVES: The main purpose of this study is to describe the POCUS findings of the disease in COVID-19 patients admitted to the emergency department (ED). Determining the correlation of these parameters with vital signs, laboratory results and chest X-ray, as well as, therapeutic decisions and prognosis. METHODS: Prospective study carried out in the emergency department (ED) of two academic hospitals. High suspicion or confirmed COVID-19 patients were subjected to the ultrasonographic measurement of the inferior vena cava (IVC), focused cardiac ultrasound (FOCUS), and Lung Ultrasonography (Lung POCUS). RESULTS: Between March and April 2020, ninety-six patients were enrolled. The mean age was 68.2 years (SD 17.5). The most common finding in Lung POCUS was an irregular pleural line (63.2%) followed by bilateral confluent (55.2%) and isolated B-lines (53.1%), which was associated with a positive RT-PCR (OR 4.729, 95% CI: 1.989-11.246; p<0.001), and correlated with IL-6 levels (rho = 0.622; p = 0.002). The IVC moderately correlated with levels of pO2, expiratory (rho = -0.539; p =0.014) and inspiratory (rho = -0.527; p =0.017), with troponin I (rho = 0.509; p=0.03). After POCUS exam, almost 20% of the patients had an associated condition that required a change in the treatment or management. CONCLUSION: In this pandemic era, as the shortage of resources constitutes an undeniable public health threat, POCUS presents the potential to impact in diagnosis, management and prognosis of our confirmed or suspected COVID-19 patients.

Point-of-care ultrasound augments physical examination learning by undergraduate medical students

2020 ◽  
Vol 97 (1143) ◽  
pp. 10-15
Author(s):  
Chun Ka Wong ◽  
JoJo Hai ◽  
Kwong Yue Eric Chan ◽  
Ka Chun Un ◽  
Mi Zhou ◽  
...  
Keyword(s):  
Medical Students ◽  
Physical Examination ◽  
Medical Curriculum ◽  
Instant Messaging ◽  
Point Of Care ◽  
Group Discussion ◽  
Point Of Care Ultrasound ◽  
Undergraduate Medical Students ◽  
Significant Difference ◽  
The Impact

BackgroundLittle is known about the impact of the provision of handheld point-of-care ultrasound (POCUS) devices on physical examination skills of medical students.MethodsWe describe an educational initiative that comprised a POCUS workshop followed by allocation of a POCUS device to medical students for use over the subsequent 8 weeks. They were encouraged to scan patients and correlate their physical examination findings. A mobile instant messaging group discussion platform was set to provide feedback from instructors. Physical examination skills were assessed by means of clinical examination.Results210 final-year medical students from the University of Hong Kong participated in the programme. 46.3% completed the end of programme electronic survey: 74.6% enjoyed using the POCUS device, 50.0% found POCUS useful to validate physical examination findings and 47.7% agreed that POCUS increased their confidence with physical examination. 93.9% agreed that the programme should be incorporated into the medical curriculum and 81.9% would prefer keeping the device for longer time from 16 weeks (45.6%) to over 49 weeks (35.3%). Medical students who participated in the POCUS programme had a higher mean score for abdominal examination compared with those from the previous academic year with no POCUS programme (3.65±0.52 vs 3.21±0.80, p=0.014), but there was no statistically significant difference in their mean score for cardiovascular examination (3.62±0.64 vs 3.36±0.93, p=0.203).ConclusionThe POCUS programme that included provision of a personal handheld POCUS device improved students’ attitude, confidence and ability to perform a physical examination.

scholarly journals Impacted fish bone in buccal space associated with an abscess: Role of point-of-care ultrasonography in dental emergencies

2021 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
Santosh Palla ◽  
NarenKishore Rayudu ◽  
PhaniHimaja Devi Vaaka ◽  
DagillaPriyanka Rao
Keyword(s):  
Point Of Care ◽  
Fish Bone ◽  
Buccal Space ◽  
Point Of Care Ultrasonography

scholarly journals POCUS in cardiac arrest and its therapeutic implications – a case report

2021 ◽  
Vol 21 (84) ◽  
pp. e67-e69
Author(s):  
Wei Yang Lim ◽  
◽  
Kay Choong See ◽  
Keyword(s):  
Cardiac Arrest ◽  
Case Report ◽  
Critical Care Unit ◽  
Point Of Care ◽  
Definitive Treatment ◽  
Point Of Care Ultrasound ◽  
Prognostic Role ◽  
Therapeutic Implications ◽  
The Impact

Point of Care Ultrasound is an increasingly popular modality in the emergency department as well as in the critical care unit. Its applications are varied, centered on its role in diagnosis, thereby minimizing the time taken for the appropriate diagnosis to be made and hence incorporate definitive treatment. There are currently no international guidelines published with regards for point of care ultrasound in the context of cardiac arrest. We propose to delineate the impact of the role of point of care ultrasound in a patient with cardiac arrest, in the evaluation of the cause, its prognostic role, as well as possible implications for therapies based on a case report.

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