scholarly journals Hematocrit Sign Elucidates Cause of Abdominal Pain

POCUS Journal ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 8-9
Author(s):  
Jeffrey Lam ◽  
Steven Montague
Keyword(s):  
Point Of Care ◽  
Rectus Sheath ◽  
Point Of Care Ultrasound ◽  
Spontaneous Movement ◽  
Appropriate Care ◽  
Life Threatening ◽  
Catheter Site ◽  
Bedside Diagnosis ◽  
Threatening Situation ◽  
Rectus Sheath Hematoma

A 78-year-old male with chronic kidney disease on peritoneal dialysis developed unprovoked bilateral pulmonary embolisms. He was started on IV unfractionated heparin, but shortly thereafter developed severe pain and a small firm abdominal nodule near his dialysis catheter site. The diagnosis was unknown, and the initial plan was watchful waiting, until point-of-care ultrasound (POCUS) was used. POCUS revealed an ovoid mass with hyperdensity in the gravity dependent regions with spontaneous movement. This appearance was classic for the hematocrit sign. When combined with the clinical presentation, this was concerning for a rectus sheath hematoma. An urgent CT of the abdomen confirmed this several hours later. POCUS allowed for rapid bedside diagnosis, which expedited appropriate care in a potentially life-threatening situation.

Telemedicine-guided point-of-care ultrasound can be feasible and effective in a life-threatening situation: The case of a field hospital during the COVID-19 pandemic (Preprint)

2020 ◽  
Author(s):  
Tarso Accorsi ◽  
Karine De Amicis Lima ◽  
Alexandra Brigido ◽  
Deborah Belfort ◽  
Fabio Habrum ◽  
...  
Keyword(s):  
Point Of Care ◽  
Image Interpretation ◽  
Acquisition Time ◽  
Point Of Care Ultrasound ◽  
Field Hospital ◽  
Portable Ultrasound ◽  
Local Staff ◽  
Assessment Protocol ◽  
Life Threatening ◽  
Threatening Situation

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.

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 ◽  
2011 ◽  
Vol 19 (4) ◽  
pp. 236-241 ◽  
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.

scholarly journals Ultrasound Detection of the Aquarium Sign at the Bedside

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.

scholarly journals Point of care ultrasound in disaster triage

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.

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

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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