Cardiac point-of-care ultrasound reveals unexpected, life-threatening findings in two children

BACKGROUND Lightweight portable ultrasound is widely available, especially in inaccessible geographical areas. It demonstrates effectiveness and diagnosis improvement even in field conditions but no precise information about protocols, acquisition time, image interpretation, and the relevance in changing medical conduct exists. The COVID-19 pandemic implied many severe cases and the rapid construction of field hospitals with massive general practitioner (GP) recruitment. OBJECTIVE This prospective and descriptive study aimed to evaluate the feasibility of telemedicine guidance using a standardized multi-organ sonographic assessment protocol in untrained GPs during a COVID-19 emergency in a field hospital. METHODS Eleven COVID-19 in-patients presenting life-threatening complications, attended by local staff who spontaneously requested on-time teleconsultation, were enrolled. All untrained doctors successfully positioned the transducer and obtained key images guided by a remote doctor via telemedicine, with remote interpretation of the findings. RESULTS Only four (36%) general practitioners obtained the appropriate key heart image on the left parasternal long axis window, and three (27%) had an image interpreted remotely on-time. The evaluation time ranged from seven to 42 minutes, with a mean of 22.7 + 12. CONCLUSIONS Telemedicine is effective in guiding GPs to perform portable ultrasound in life-threatening situations, showing effectiveness in conducting decisions.

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Ultrasound Detection of the Aquarium Sign at the Bedside

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_002047 ◽

2020 ◽

Author(s):

Mihiro Kaga ◽

Emi Yamashita ◽

Takeshi Ueda

Keyword(s):

Point Of Care ◽

Point Of Care Ultrasound ◽

Test Results ◽

Mesenteric Ischaemia ◽

Contrast Enhanced ◽

Life Threatening ◽

Hepatic Portal ◽

The Right ◽

Enhanced Computed Tomography ◽

The Relationship

Objectives: The aquarium sign is the name given to a large quantity of bubble-like echoes that suggests the presence of hepatic portal venous gas (HPVG). Few studies in the literature have addressed the relationship between the aquarium sign and HPVG. In some cases, HPVG can only be detected using ultrasonography. HPVG can be observed in a variety of conditions, including those that require emergency surgery, such as acute mesenteric ischaemia (AMI). Therefore, it is important to identify the presence of HPVG as soon as possible. Materials and methods: We report a case of the aquarium sign, where bubble-like echoes flowed from the right atrium towards the right ventricle, which was identified using bedside cardiac ultrasonography as part of a point-of-care ultrasound test. Results: This aquarium sign finding led to the diagnosis of AMI, which was confirmed using contrast-enhanced computed tomography (CT). Conclusion: The aquarium sign is a useful finding suggestive of HPVG and mesenteric ischaemia, which can be rapidly and easily observed using bedside cardiac ultrasonography. However, there are very few reports on the aquarium sign. The inability of other more cumbersome diagnostic imaging modalities, such as CT and magnetic resonance imaging, to detect HPVG emphasizes the utility and convenience of detecting the aquarium sign using bedside ultrasonography. This technique can lead to early detection of life-threatening diseases as well as improve the prognosis for patients. The diagnostic implications of the aquarium sign for HPVG are still unclear and require further research.

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Point of care ultrasound in disaster triage

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v86i1.2165 ◽

2017 ◽

Vol 86 (1) ◽

pp. 38-39

Author(s):

Brandon Chau ◽

Gayathri Sivakumar

Keyword(s):

Imaging Modality ◽

Point Of Care ◽

Accurate Method ◽

Point Of Care Ultrasound ◽

Life Threatening ◽

Intraperitoneal Bleeding ◽

Ultrasound Technology ◽

Fast Exam ◽

Disaster Scenario ◽

The Military

Ultrasound technology has rapidly progressed over the past decades to emerge as a portable, versatile imaging modality to complement the physical exam. It has been shown to be superior to clinical exam and equivalent to computed-tomography in detecting many life-threatening conditions, and thus is used in a variety of resuscitative settings, including the front lines of the military. A variety of imaging protocols exist for ultrasound, but in resource-deplete settings such as a disaster scenario, the focused assessment with sonography for trauma (FAST) exam is a rapid and accurate method of determining acute intraperitoneal bleeding. With improving portability, as well as the ability to transmit images to a centralized command hub, it can become a key component of the first responder’s toolkit.

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Use of Point-of-Care Ultrasound to Facilitate Guidance and Intrauterine Placement of a Foley Urinary Catheter to Tamponade Life-Threatening Postprocedure Hemorrhage Caused by Disseminated Intravascular Coagulation

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2019.11.033 ◽

2020 ◽

Vol 58 (2) ◽

pp. e75-e78

Author(s):

Allison Cohen ◽

Andrew Jersey ◽

Mathew Nelson

Keyword(s):

Disseminated Intravascular Coagulation ◽

Urinary Catheter ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Intravascular Coagulation ◽

Life Threatening

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A Case Report of Acute Heart Failure Due to Infective Aortic Endocarditis Diagnosed by Point-of-care Ultrasound

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.3.45002 ◽

2020 ◽

Vol 4 (2) ◽

pp. 193-196

Author(s):

Ryan Gallagher ◽

Michelle Wilson ◽

Pamela Hite ◽

Bradley Jackson

Keyword(s):

Heart Failure ◽

Case Report ◽

Aortic Valve ◽

Acute Heart Failure ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Complication Rates ◽

Threatening Condition ◽

Valve Insufficiency ◽

Life Threatening

Introduction: Infective endocarditis (IE) is a life-threatening condition with significant morbidity and mortality, and can require surgical repair. Case Report: A 36-year-old man presented to the emergency department for worsening dyspnea and chest pain. Point-of-care echocardiography demonstrated a mobile oscillating mass on the aortic valve with poor approximation of the valve leaflets, suggesting aortic valve insufficiency secondary to IE as the cause of acute heart failure. The patient underwent emergent aortic valve replacement within 24 hours. Discussion: While point-of-care echocardiography has been well documented in identifying tricuspid vegetations, aortic valve involvement and subsequent heart failure is less well described. Earlier recognition of aortic valve vegetations and insufficiency can expedite surgical intervention, with decreased complication rates linked to earlier antimicrobial therapy. Conclusion: This case report highlights the ability of point-of-care ultrasound to identify aortic vegetations, allowing for the earlier diagnosis and therapy.

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My Patient Has No Blood Pressure: Have They Got an Abdominal Aortic Aneurysm? Point-Of-Care Ultrasound of the Abdominal Aorta in Hypotensive Patients

Ultrasound ◽

10.1258/ult.2011.010048 ◽

2011 ◽

Vol 19 (4) ◽

pp. 236-241 ◽

Cited By ~ 2

Author(s):

Audra Gedmintas ◽

Matthew Grabove ◽

Paul Atkinson

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Point Of Care ◽

Abdominal Mass ◽

Sudden Onset ◽

Point Of Care Ultrasound ◽

Mass Detection ◽

Abdominal Aortic ◽

Life Threatening ◽

Threatening Situation

Among patients presenting to the emergency department (ED) with undifferentiated hypotension, how can point-of-care ultrasound (PoCUS) help identify abdominal aortic aneurysm (AAA) as the cause of the hypotension? Many hypotensive patients in the ED are critically ill, with only minutes available to find the cause of the hypotension and treat it before the patient decompensates. While the classic description of the presentation of a ruptured AAA is of collapse with sudden onset abdominal pain and a palpable, pulsatile abdominal mass, detection of AAA by palpation is notoriously unreliable, and many patients are unaware of their underlying condition. This life-threatening situation is made even more difficult by virtue of the fact that the patient is often too unstable to travel for traditional diagnostics such as computed tomography. This article will address the use of PoCUS for the detection of AAA in the evaluation of the hypotensive patient.

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

POCUS Journal ◽

10.24908/pocus.v6i1.14756 ◽

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.

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Left ventricular outflow tract pseudoaneurysm diagnosed with point-of-care ultrasound in the emergency department

CJEM ◽

10.1017/cem.2018.20 ◽

2018 ◽

Vol 20 (5) ◽

pp. 798-801 ◽

Cited By ~ 1

Author(s):

Puneet Kapur ◽

Melanie Baimel ◽

Jordan Chenkin

Keyword(s):

Left Ventricular Outflow Tract ◽

Point Of Care ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Point Of Care Ultrasound ◽

Exertional Dyspnea ◽

Extrinsic Compression ◽

Left Ventricular Outflow ◽

Life Threatening

AbstractLeft ventricular outflow tract pseudoaneurysms are a rare but life-threatening disorder, often caused by complications of cardiac surgery or myocardial infarction. We present a case report of a patient with no prior risk factors who presented with a six-month history of progressive exertional dyspnea, bilateral leg swelling and cough. Point-of-care ultrasound revealed an unexpected outpouching of the left ventricle. He was diagnosed with a left ventricular outflow tract pseudoaneurysm and subsequently went into cardiogenic shock secondary to extension of pseudoaneurysm causing extrinsic compression of the coronary arteries. The patient underwent successful emergency surgical repair and made a full recovery.

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Point-of-care ultrasound in obstetrics and gynecology

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-05972-5 ◽

2021 ◽

Vol 303 (4) ◽

pp. 871-876

Author(s):

Florian Recker ◽

Eva Weber ◽

Brigitte Strizek ◽

Ulrich Gembruch ◽

Susan Campbell Westerway ◽

...

Keyword(s):

Real Time ◽

Point Of Care ◽

General Medicine ◽

Obstetrics And Gynecology ◽

Point Of Care Ultrasound ◽

Emergency Physicians ◽

Medical Office ◽

Life Threatening ◽

Teaching Programs ◽

Time Critical

Abstract Background The rapid technical development and portability of ultrasound systems over recent years has had a profound impact on the area of point-of-care-ultrasound (POCUS), both in general medicine and in obstetrics and gynecology. The use of POCUS enables the clinician to perform the ultrasound scan either at the medical office or the patient’s bedside and used as an extension of the physical examination. Real-time images can immediately be correlated with the patient’s symptoms, and any changes in a (critical) patient’s condition can be more rapidly detected. POCUS in OBGYN POCUS is also suitable for time-critical scenarios, and depending on the situation and its dynamics, the course and results of any therapy may be observed in real time. POCUS should be considered to be a routine extension of practice for most OB/GYN clinicians as it can give immediate answers to what could be life-threatening situations for the mother and/or baby. With its proven usefulness, the applications and use of POCUS should be incorporated in teaching programs for medical students, OBGYN residents and emergency physicians.

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The Double Gut Point: A Novel Sonographic Sign of Pneumoperitoneum

10.21203/rs.3.rs-1253423/v1 ◽

2022 ◽

Author(s):

Yale Tung Chen ◽

Tomas Villén Villegas ◽

Elmo Pereira

Keyword(s):

Point Of Care ◽

Critically Ill Patient ◽

Point Of Care Ultrasound ◽

Sudden Increase ◽

Urgent Surgery ◽

Free Air ◽

Linear Probe ◽

Threatening Condition ◽

Life Threatening ◽

Upper Abdominal

Abstract Pneumoperitoneum is a life-threatening condition, caused by hollow organ perforation. The diagnosis is often difficult, and Point-of-care ultrasound can be useful to distinguish from different conditions, and early set the indication of urgent surgery. We report a critically ill patient presented to the Emergency Department with sudden increase in upper abdominal pain and distension with a diagnosis of small bowel obstruction on ultrasound using a curvilinear probe. After repeating the ultrasound using a linear probe, two dynamic points at mesogastrium very similar to the “double lung point” seen in thoracic ultrasound was detected. This “double gut point” due to bowel ischemia and perforation was confirmed on a computed tomography scan. In this case, the finding of an abdominal “double gut point” allowed us to diagnose pneumoperitoneum, being a novel sign not previously described, that could aid to diagnose small amounts of free air in the peritoneal cavity.

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