scholarly journals The use of critical care echocardiography in peri-arrest and cardiac arrest scenarios: Pros, cons and what the future holds

2020 ◽  
pp. 175114372093699 ◽  
Author(s):  
Luke Flower ◽  
Olusegun Olusanya ◽  
Pradeep R Madhivathanan
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Care ◽  
Core Competence ◽  
Point Of Care ◽  
Response To Treatment ◽  
Monitoring Tool ◽  
Critical Care Echocardiography ◽  
Focused Echocardiography

Echocardiography is being increasingly deployed as a diagnostic and monitoring tool in the critically ill. This rise in popularity has led to its recommendation as a core competence in intensive care, with several training routes available. In the peri-arrest and cardiac arrest population, point of care focused echocardiography has the potential to transform patient care and improve outcomes. Be it via diagnosis of shock aetiology and reversibility or assessing response to treatment and prognostication. This narrative review discusses current and future applications of echocardiography in this patient group and provides a structure with which one can approach such patients.

Cardiothoracic Surgery and Postoperative Intensive Care

2019 ◽  
pp. 417-423
Author(s):  
Juan G. Ripoll Sanz ◽  
Robert A. Ratzlaff
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Care ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Cardiothoracic Surgery ◽  
Open Heart ◽  
Postoperative Intensive Care ◽  
Main Factor

Cardiothoracic surgical (CTS) critical care responsibilities have progressively shifted away from surgeons and toward intensivists in the past several decades. CTS patients present unique challenges, and optimal patient care in the intensive care unit is a main factor for the prevention of deaths after any type of open heart surgery.

Acute and critical care echocardiography

2020 ◽  
pp. 387-416
Keyword(s):  
Critical Care ◽  
Cardiopulmonary Resuscitation ◽  
Patient Care ◽  
Fluid Responsiveness ◽  
Critically Ill Patient ◽  
Critical Care Echocardiography ◽  
Acute Diagnostics ◽  
Special Circumstances ◽  
Circulating Volume

This chapter covers the role of echocardiography in acute and critical care. This includes ‘front door’ echocardiography, the safeguarding of patient care, cardiopulmonary resuscitation, and acute diagnostics. The chapter then examines the circulating volume, fluid responsiveness, advanced haemodynamics, and special circumstances in the critically ill patient.

Current nursing practice of point-of-care laboratory diagnostic testing in critical care units

1995 ◽  
Vol 4 (6) ◽  
pp. 429-434 ◽  
Author(s):  
Lamb LSJr ◽  
RS Parrish ◽  
SF Goran ◽  
MH Biel
Keyword(s):  
Critical Care ◽  
Patient Care ◽  
Laboratory Testing ◽  
Point Of Care ◽  
Diagnostic Testing ◽  
Critical Care Nurses ◽  
Point Of Care Testing ◽  
Critical Care Units ◽  
In Vitro Diagnostic

BACKGROUND: The development of user-friendly laboratory analyzers, combined with the need for rapid assessment of critically ill patients, has led to the performance of in vitro diagnostic testing at the point of care by personnel without formal laboratory training. OBJECTIVES: To determine the range of laboratory testing performed by critical care nurses and their attitudes toward this role. METHODS: A survey of critical care nursing consultants was conducted, using a modified Likert scale, to assess objective measures of point-of-care testing practice in critical care units and to determine nurses' attitudes toward the practice of point-of-care testing. Statistical analysis was performed to determine significant trends in responses. RESULTS: Of the units responding to the survey, 35% used critical care nurses exclusively to perform point-of-care testing, 32.5% used laboratory technicians and critical care nurses, and 25% used other personnel. Of critical care nurses performing laboratory testing, 95.5% performed blood glucose analysis; 18.7%, arterial blood gas analysis; 4.5%, electrolyte analysis; 4.5%, hematology profiles; and 22.7%, other testing. Most agreed that stat tests were not reported promptly, thereby necessitating bedside testing. Respondents indicated that they would prefer that laboratory personnel operate in vitro diagnostic equipment and that requirements for critical care nurses to perform laboratory testing detracted from other patient care duties. CONCLUSIONS: Most nurses who perform point-of-care testing responded that it was necessary and helpful in patient management. However, they would prefer, because of their other patient care responsibilities, that laboratory personnel take this responsibility.

scholarly journals Impact of a 2-Day Critical Care Ultrasound Course during Fellowship Training: A Pilot Study

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Vi Am Dinh ◽  
Paresh C. Giri ◽  
Inimai Rathinavel ◽  
Emilie Nguyen ◽  
David Hecht ◽  
...  
Keyword(s):  
Critical Care ◽  
Point Of Care ◽  
Image Interpretation ◽  
Fellowship Training ◽  
Multiple Organ ◽  
Critical Care Echocardiography ◽  
Organ Systems ◽  
Critical Care Ultrasound ◽  
Written Test ◽  
The Impact

Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CCUS), standards establishing competency for its use are lacking. The purpose of this study was to evaluate the effectiveness of a 2-day CCUS course implementation on ultrasound-naïve critical care medicine (CCM) fellows.Methods. Prospective evaluation of the impact of a two-day CCUS course on eight CCM fellows’ attitudes, proficiency, and use of CCUS. Ultrasound competency on multiple organ systems was assessed including abdominal, pulmonary, vascular, and cardiac systems. Subjects served as self-controls and were assessed just prior to, within 1 week after, and 3 months after the course.Results. There was a significant improvement in CCM fellows’ written test scores, image acquisition ability, and pathologic image interpretation 1 week after the course and it was retained 3 months after the course. Fellows also had self-reported increased confidence and usage of CCUS applications after the course.Conclusions. Implementation of a 2-day critical care ultrasound course covering general CCUS and basic critical care echocardiography using a combination of didactics, live models, and ultrasound simulators is effective in improving critical care fellows’ proficiency and confidence with ultrasound use in both the short- and long-term settings.

scholarly journals Model Point-of-Care Ultrasound Curriculum in an Intensive Care Unit Fellowship Program and Its Impact on Patient Management

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Keith Killu ◽  
Victor Coba ◽  
Michael Mendez ◽  
Subhash Reddy ◽  
Tanja Adrzejewski ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Care ◽  
Patient Management ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Fellowship Program ◽  
Icu Patients ◽  
Surgical Icu ◽  
New Diagnosis

Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care.Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year.Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720). Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435).Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied.

scholarly journals Ultrasound in critical care

2020 ◽  
Author(s):  
Saima Rashid ◽  
Muhammad Faisal Khan ◽  
Rajkumar Rajendram
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
21St Century ◽  
Potential Role ◽  
Point Of Care ◽  
Narrative Review ◽  
Point Of Care Ultrasound ◽  
The 1950S

Ultrasound (US) was introduced in the 1950s and since then its use has increased exponentially. This has been facilitated by significant improvement in the probe technology, increasing access to portable machines and better understanding of lung, heart, abdominal and vascular US. Use of critical care US (CCUS) is now extremely common. It is important for frontline physicians who must make appropriate and timely decisions within seconds. It is safe, convenient and readily available in many centers. The concept of point of care ultrasound (POCUS) differs from US screening by a radiologist or sonographer. It is, rapid focused and goal-orientated. Despite its major limitation, e.g. operator dependence, bedside CCUS can be used for an ever-increasing range of indications. This narrative review will describe the potential role of CCUS as the replacement for the stethoscope in the 21st century and the limitations which must be overcome to achieve this. Received: 3 Nov 2018Reviewed & Accepted: 10 Nov 2018 Citation: Rashid S, Khan MF, Rajendram R. Ultrasound in critical care. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S160-S163

Critical Care Ultrasound (DRAFT)

2018 ◽  
Author(s):  
Christopher K. Schott
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Critically Ill Patients ◽  
Patient Management ◽  
Point Of Care ◽  
Rapid Response Team ◽  
Response To Treatment ◽  
Response Team ◽  
Critical Care Ultrasound ◽  
Point Of Care Ultrasonography

Point of care ultrasonography (POCUS) is a tool that can be used at the bedside to aid in the diagnosis and treatment of critically ill patients. The ability to directly visualize physiology, pathology, and response to treatment can add valuable information in patient management particularly in time sensitive situations with acutely decompensated patients as may occur in the context of rapid response team (RRT) events. Although most of the data on POCUS to guide resuscitations has been published through emergency medicine (EM) and pre-hospital studies, the same approach can be easily adapted for in-hospital RRT events. This chapter reviews validated POCUS protocols for the assessment of hypotensive, hypoxic, or arresting patients and the ways it can be incorporated into in-hospital RRTs.

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