Point-of-care ultrasound in a multiplace hyperbaric chamber

Historically, electronic devices have been generally prohibited during hyperbaric oxygen (HBO2) therapy due to risk of fire in a pressurized, oxygen-rich environment. Point-of-care ultrasound (POCUS), however, has emerged as a useful imaging modality in diverse clinical settings. Hyperbaric chambers treating critically ill patients would benefit from the application of POCUS at pressure to make real-time patient assessments. Thus far, POCUS during HBO2 therapy has been limited due to required equipment modifications to meet safety standards. Here we demonstrate proof of concept, safety, and successful performance of an off-the-shelf handheld POCUS system (SonoSite iViz) in a clinical hyperbaric environment without need for modification.

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The Accuracy of Point-of-Care Ultrasound in Detecting Small Bowel Obstruction in Emergency Department

Emergency Medicine International ◽

10.1155/2018/3684081 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

A. Pourmand ◽

U. Dimbil ◽

A. Drake ◽

H. Shokoohi

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Imaging Modality ◽

Point Of Care ◽

High Sensitivity ◽

Point Of Care Ultrasound ◽

Emergency Physicians ◽

Short Term ◽

Intestinal Peristalsis

Radiological imaging plays an essential role in the evaluation of a patient with suspected small bowel obstruction (SBO). In a few studies, point-of-care ultrasound (POCUS) has been utilized as a primary imaging modality in patients with suspected SBO. POCUS has been shown to be an accurate tool in the diagnosis of SBO with multiple research studies noting a consistent high sensitivity with a range of 94–100% and specificity of 81–100%. Specific sonographic findings that increase the likelihood of SBO include dilatation of small bowel loops > 25 mm, altered intestinal peristalsis, increased thickness of the bowel wall, and intraperitoneal fluid accumulation. Studies also reported that emergency physicians could apply this technique with limited and short-term ultrasound training. In this article, we aim to review the sensitivity and specificity of ultrasound examinations performed by emergency physicians in patients with suspected SBO.

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Paediatric ultrasound

Point of Care Ultrasound for Emergency Medicine and Resuscitation ◽

10.1093/med/9780198777540.003.0011 ◽

2019 ◽

pp. 217-224

Author(s):

Jason Fischer ◽

Lianne McLean

Keyword(s):

Critical Care ◽

Abdominal Pain ◽

Pyloric Stenosis ◽

Imaging Modality ◽

Point Of Care ◽

Adult Patients ◽

Point Of Care Ultrasound ◽

Lung Pathology ◽

Skull Fractures ◽

Body Habitus

This chapter highlights the increasing use of point-of-care ultrasound (PoCUS) in children. The size and body habitus of infants and children are often ideal for sonographic visualization and make PoCUS an ideal imaging modality for paediatric patients. PoCUS applications that have been traditionally used for adult patients are increasingly being adopted for the care of children. Paediatric-specific applications are also being developed for problems common and unique to paediatrics. Focused abdominal scans for appendicitis, intussusception, and pyloric stenosis are now frequently used in patients presenting with abdominal pain or vomiting. PoCUS can differentiate lung pathology and is helpful in the assessment of suspected skull fractures in non-verbal infants. Ongoing integration of PoCUS into shock, trauma, and triage algorithms support its increasing role in paediatric emergency and critical care.

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MP035: Point-of-care-ultrasound to diagnose appendicitis in a Canadian emergency department

CJEM ◽

10.1017/cem.2016.176 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S78-S78

Author(s):

S. Sharif ◽

S. Skitch ◽

D. Vlahaki ◽

A. Healey

Keyword(s):

Imaging Modality ◽

Point Of Care ◽

Retrospective Chart Review ◽

Fellowship Training ◽

Point Of Care Ultrasound ◽

Suspected Appendicitis ◽

Test Characteristics ◽

Resident Physicians ◽

Definitive Management ◽

Surgical Condition

Introduction: Appendicitis is a common surgical condition that frequently requires patients to undergo diagnostic imaging. Abdominal computed tomography is the gold standard imaging technique for the diagnosis of appendicitis, but exposes patients to radiation. Ultrasound offers an alternate radiation-free imaging modality for appendicitis. However, the availability of ultrasound during off-hours is limited in many Emergency departments (EDs). Clinician performed point-of-care ultrasound (POCUS) is increasingly used by emergency physicians as a bedside tool to evaluate suspected appendicitis. The purpose of this study is to evaluate the test characteristics of emergency physician performed POCUS to diagnose appendicitis in a Canadian ED. Methods: A pragmatic, retrospective chart review was performed on all patients for whom a POCUS was performed to diagnose appendicitis at St. Joseph’s Healthcare Hamilton in Ontario from December 1, 2010 to December 4, 2015. All POCUS scans were performed by physicians with Registered Diagnostic Medical Sonographer (RDMS) credentials or resident physicians undergoing POCUS fellowship training. All scans were over-read by RDMS credentialed faculty and subject to a rigorous quality assurance (QA) process. POCUS findings and patient outcomes were reported. Results: A total of 90 patients were included in the study. 24 patients were diagnosed with appendicitis on POCUS. Ultimately, 18 were diagnosed with appendicitis through formal imaging, laparoscopy, and pathology. The sensitivity and specificity for POCUS to diagnose appendicitis was found to be 69.2% (95% CI, 48.1%-84.9%) and 90.6% (95% CI, 80.0%-96.1%) respectively. Conclusion: Bedside ultrasound is a reliable imaging modality for ruling in acute appendicitis. In cases where POCUS is negative or indeterminate for appendicitis, further imaging should be obtained as clinical suspicion warrants. The use of POCUS has the potential to reduce patient exposure to ionizing radiation and decrease the costs of obtaining CT scans, while hastening the process of achieving definitive management through earlier surgical consultation.

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Empowering Your Presentation Skills

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1343 ◽

2014 ◽

Vol 8 (1) ◽

pp. 100-104

Author(s):

Hoi Ho ◽

Michael S Cardwell ◽

J Hector Aranda ◽

Rene Hernandez

Keyword(s):

Medical Education ◽

Medical Curriculum ◽

Imaging Modality ◽

Point Of Care ◽

Faculty Members ◽

Clinical Settings ◽

Web Based ◽

User Friendly ◽

And Training ◽

Selection Of

ABSTRACT As technology continues evolving, ultrasonography has become increasingly the imaging modality of choice in many different clinical settings including hospital, clinic and point of care. Similarly, the expansion of internet has revolutionized the medical curriculum and training of the entire medical education continuum: undergraduate medical education, graduate medical education and continuing medical education. More importantly, technology and internet have transformed the traditional teacher-dependent classroom-based teaching into the learneroriented web-based learning. To empower the presentation, whether classroom-based or web-based, it's essential that faculty members apply principles of adult learning throughout the session. Newer version of PowerPoint (PPT) is powerful and user-friendly. However, faculty members should be familiar with fundamental guidelines for appropriate selection of fonts, character sizes, background colors, charts, graphs, animation and multimedia. In general, PowerPoint presentations prepared on Windowsbased computers can be run on Mac computers; however, presenters should be aware of compatibility issues across platform such as fonts or multimedia formats. Faculty can also easily turn the PowerPoint presentation into a powerful and interactive teaching tool of ultrasonography for unlimited number of learners by following simple guidelines of using PowerPoint and having minimum resources and technical support for software of voice over presentation, such as Camtasia or Captivate. How to cite this article Cardwell MS, Aranda JH, Hernandez R, Ho H. Empowering Your Presentation Skills. Donald School J Ultrasound Obstet Gynecol 2014;8(1):100-104.

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Diaphragmatic Point-of-Care Ultrasound in COVID-19 Patients in the Emergency Department—A Proof-of-Concept Study

Journal of Clinical Medicine ◽

10.3390/jcm10225291 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5291

Author(s):

Emanuele Pivetta ◽

Irene Cara ◽

Giulia Paglietta ◽

Virginia Scategni ◽

Giulia Labarile ◽

...

Keyword(s):

Emergency Department ◽

Lung Ultrasound ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Proof Of Concept ◽

Additional Insight ◽

Concept Study ◽

Ultrasound Evaluation ◽

Diaphragmatic Motion ◽

Insight Into

Background: Lung Ultrasound Evaluation (LUS) is usefully applied in the Emergency Department (ED) to patients with suspected or confirmed COVID-19. Diaphragmatic Ultrasound (DUS) may provide additional insight into ventilatory function. This proof-of-concept study aimed to evaluate the feasibility of LUS and DUS in a third level ED during the COVID-19 pandemic. Methods: Adult patients presenting with COVID-19 symptoms were eligible. After the physical examination, both LUS and DUS (i.e., diaphragmatic motion and thickness) were performed. All patients were followed after 30 days to determine their need for ventilation, admission, and/or a new ED evaluation after discharge. The diagnostic accuracies of diaphragm measurements in assessing the risk of the 30-day outcome were calculated as well as the measurements’ usefulness. Bland–Altman plots were used for comparing bedside and off-line diaphragm measurements. Results: 118 patients were enrolled. Median thickness and motion were 1.7 mm (iqr 0.4) and 1.8 cm (iqr 0.7), respectively, with a mean difference of 0.009 mm (95% CI −0.037–0.056 mm) and −0.051 cm (95% CI −0.108–0.006 cm), respectively. The 30-day outcome was associated with an increase in thickness (OR 5.84, 95% CI 0.96–35.4), and a lower motion (OR 0.49, 95% CI 0.2–1.21). Conclusion: DUS seemed to be feasible and reliable in the ED in a population of patients presenting with symptoms related to COVID-19 infection.

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The Role and Challenges of Clinical Imaging During COVID-19 Outbreak

Journal of Diagnostic Medical Sonography ◽

10.1177/87564793211056903 ◽

2021 ◽

pp. 875647932110569

Author(s):

Mustafa Alhasan ◽

Mohamed Hasaneen

Keyword(s):

Infection Control ◽

Imaging Modality ◽

Point Of Care ◽

Limiting Factors ◽

Disease Stage ◽

Radiology Department ◽

Point Of Care Ultrasound ◽

Signal Loss ◽

Clinical Utilization ◽

Precautionary Measures

Objective: The Radiology department played a crucial role in detecting and following up with the COVID-19 disease during the pandemic. The purpose of this review was to highlight and discuss the role of each imaging modality, in the radiology department, that can help in the current pandemic and to determine the challenges faced by staff and how to overcome them. Materials and Methods: A literature search was performed using different databases, including PubMed, Google scholar, and the college electronic library to access 2020 published related articles. Results: A chest computed tomogram (CT) was found to be superior to a chest radiograph, with regards to the early detection of COVID-19. Utilizing lung point of care ultrasound (POCUS) with pediatric patients, demonstrated excellent sensitivity and specificity, compared to a chest radiography. In addition, lung ultrasound (LUS) showed a high correlation with the disease severity assessed with CT. However, magnetic resonance imaging (MRI) has some limiting factors with regard to its clinical utilization, due to signal loss. The reported challenges that the radiology department faced were mainly related to infection control, staff workload, and the training of students. Conclusion: The choice of an imaging modality to provide a COVID-19 diagnosis is debatable. It depends on several factors that should be carefully considered, such as disease stage, mobility of the patient, and ease of applying infection control procedures. The pros and cons of each imaging modality were highlighted, as part of this review. To control the spread of the infection, precautionary measures such as the use of portable radiographic equipment and the use of personal protective equipment (PPE) must be implemented.

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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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Identification of Hollow Viscus Injury with FAST Examination in Kurdistan, Iraq

Case Reports in Emergency Medicine ◽

10.1155/2018/5019415 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Ruj Al-Sindy ◽

Heleen Alaqrawy ◽

Mahmood Sh. Hafdullah ◽

Christine Butts

Keyword(s):

Imaging Modality ◽

Point Of Care ◽

Organ Injury ◽

Free Fluid ◽

Point Of Care Ultrasound ◽

Solid Organ ◽

Hollow Viscus ◽

Northern Iraq ◽

Hollow Viscus Injury ◽

Fast Exam

Point-of-care ultrasound has become indispensable in the evaluation of trauma, particularly in low resource areas, where it may be the only rapidly available imaging modality. The FAST (Focused Assessment with Sonography in Trauma) in particular can be lifesaving, by rapidly detecting signs of intra-abdominal hemorrhage. However, the FAST is primarily designed to identify free fluid associated with solid organ injury and is thought to have less sensitivity and power in identifying evidence of hollow viscus injury. We present a case of an unidentified man that presented to a hospital in the Kurdistan region of northern Iraq, a region of low resources, surrounded by war. The FAST exam proved to be the key to identifying this patient’s injuries.

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P041: Point-of-care ultrasound utilization and monetary outcomes (POCUMON) study

CJEM ◽

10.1017/cem.2020.248 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S79-S79

Author(s):

D. Rusiecki ◽

S. Douglas ◽

C. Bell

Keyword(s):

Health Care ◽

Health Care Costs ◽

Point Of Care ◽

Cost Savings ◽

Flank Pain ◽

Control Group ◽

Point Of Care Ultrasound ◽

Imaging Studies ◽

Patient Assessments ◽

Care Costs

Introduction: Point-of-care ultrasound (POCUS) is an integral tool in the modern emergency physician's toolkit. Evidence suggests many imaging and lab investigations are ordered without true medical indications; it is unknown how POCUS utilization impacts health care costs at a patient level. The purpose of this study was to assess whether POCUS use in the emergency department (ED) was associated with cost savings via decreased laboratory and radiographic testing. Methods: POCUMON is a single-center, prospective pilot study. The participants were a convenience sample of ED staff physicians and PGY-5 Emergency Medicine (EM) residents working in the ED from July-October 2019. Physicians who used POCUS as part of their assessment had the cost of their patient investigation plans compared with those proposed by a control group of ED physicians simultaneously on-shift. The control group was blinded to the POCUS findings but had access to the patient and medical record. The lab investigations and imaging studies ordered by both groups were recorded with respective costs. Data were analyzed using a paired T-test, with sub-group analyses. Ethics approval was obtained from the Queen's University HSREB (No.6026732). Results: 50 patient assessments using POCUS were captured in the study period. 76% of patient assessments were performed by EM staff physicians; 94% of control assessments were provided by EM staff physicians. Patient chief complaints included abdominal pain (7), chest pain/dyspnea (10), flank pain (3), pregnancy concerns (4), trauma (7), extremity complaints (4), back pain (3), and other (12). The POCUS group had a trend for lower number of laboratory tests (4.7 ± 0.44 vs 5.22 ± 0.39; p = 0.28) and imaging studies (0.94 ± 0.14 vs 1.1 ± 0.11; p = 0.33). Overall health care costs were similar in both groups, with a trend to cost savings in the POCUS group ($142.00 ± 15.44 vs $174.60 ± 17.00; p = 0.12). Subgrouping identified significant cost savings in the POCUS group for patients with a chief complaint of flank pain ($43.64 vs $248.82, p = 0.01). Conclusion: POCUS use was not associated with significant health care cost savings. ED POCUS usage did see a trend towards decreased laboratory and imaging investigations. Patients presenting with flank pain had significantly lower expenditures associated with their visit when POCUS was incorporated into their assessment. Large scale prospective studies are needed to investigate if POCUS is associated with cost-savings in ED patients.

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Stakeholder Perceptions of Point-of-Care Ultrasound Implementation in Resource-Limited Settings

Diagnostics ◽

10.3390/diagnostics9040153 ◽

2019 ◽

Vol 9 (4) ◽

pp. 153 ◽

Cited By ~ 3

Author(s):

Anna Maw ◽

Brittany Galvin ◽

Ricardo Henri ◽

Micheal Yao ◽

Bruno Exame ◽

...

Keyword(s):

Imaging Modality ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Structured Interviews ◽

Resource Limited Settings ◽

Resource Limited ◽

Point Of Care Diagnostics ◽

Key Stakeholders ◽

Imaging Point ◽

Study Participants

Background: Nearly half of the world lacks access to diagnostic imaging. Point of care ultrasound (POCUS) is a versatile and relatively affordable imaging modality that offers promise as a means of bridging the radiology gap and improving care in low resource settings. Methods: We performed semi-structured interviews of key stakeholders at two diverse hospitals where POCUS implementation programs had recently been conducted: one in a rural private hospital in Haiti and the other in a public referral hospital in Malawi. Questions regarding the clinical utility of POCUS, as well as barriers and facilitators of its implementation, were asked of study participants. Using the Framework Method, analysis of interview transcripts was guided by the WHO ASSURED criteria for point of care diagnostics. Results: Fifteen stakeholders with diverse roles in POCUS implementation were interviewed. Interviewees from both sites considered POCUS a valuable diagnostic tool that improved clinical decisions. They perceived barriers to adequate training as one of the most important remaining barriers to POCUS implementation. Conclusions: In spite of the increasing affordability and portability of ultrasounds devices, there are still important barriers to the implementation of POCUS in resource-limited settings.

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