scholarly journals Perioperative Point-of-Care Ultrasound in Children

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 213
Author(s):  
Karen Boretsky
Keyword(s):  
Point Of Care ◽  
Perioperative Period ◽  
Central Line ◽  
Hydration Status ◽  
Point Of Care Ultrasound ◽  
Global Cardiac Function ◽  
Block Placement ◽  
Portable Ultrasonography ◽  
Point Of Care Ultrasonography ◽  
Endotracheal Tube Size

Anesthesiologists and other acute care physicians perform and interpret portable ultrasonography—point-of-care ultrasound (POCUS)—at a child’s bedside, in the perioperative period. In addition to the established procedural use for central line and nerve block placement, POCUS is being used to guide critical clinical decisions in real-time. Diagnostic point-of-care applications most relevant to the pediatric anesthesiologist include lung ultrasound for assessment of endotracheal tube size and position, pneumothorax, pleural effusion, pneumonia, and atelectasis; cardiac ultrasound for global cardiac function and hydration status, and gastric ultrasound for aspiration risk stratification. This article reviews and discusses select literature regarding the use of various applications of point-of-care ultrasonography in the perioperative period.

scholarly journals Non-Invasive Intracranial Pressure Evaluation in an Emergency Room – Point-of-Care Ultrasonography

2016 ◽  
Vol 38 (04) ◽  
pp. 279-283
Author(s):  
Daniel Damiani ◽  
Durval Damiani
Keyword(s):  
Intracranial Pressure ◽  
Randomized Trials ◽  
Point Of Care ◽  
Current Data ◽  
Point Of Care Ultrasound ◽  
Medical Specialties ◽  
Non Invasive ◽  
Nerve Sheath ◽  
Invasive Method ◽  
Point Of Care Ultrasonography

AbstractPoint-of-care ultrasound is modifying conducts in emergency care. The various medical specialties, in addition to traditional indications in cases of multiple trauma, are using this technique for rapid diagnosis at the bedside without patient mobilization and without radiation. Point-of-care ultrasound in neurocritical patients, through its transorbital window, can estimate the intracranial pressure by a non-invasive method. Through the measurement of the diameter of the optic nerve sheath 3 mm posterior to the retina, the intracranial pressure is estimated if the value of the diameter is > 5 mm, as it has been verified in other studies. The present article describes the most current data on this topic, and it also highlights the need for more multicentric and randomized trials to determine the correct cut-off points that represent the high sensibility and specificity of the method.

Diagnostic accuracy of point-of-care knee ultrasound for evaluation of meniscus and collateral ligaments pathology in comparison with MRI

2021 ◽  
pp. 028418512110582
Author(s):  
Ahmed Elshimy ◽  
Ahmed M Osman ◽  
Mohamed El Sayed Awad ◽  
Mohamed M Abdel Aziz
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Point Of Care ◽  
Operative Procedure ◽  
Point Of Care Ultrasound ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Diagnostic Modality ◽  
Cross Sectional ◽  
Portable Ultrasonography

Background Although magnetic resonance imaging (MRI) is often the “gold standard” for diagnosing knee problems, it has many limitations. Therefore, ultrasonography has been suggested as an effective rapid alternative in many knee abnormalities, especially after injuries of the meniscus and collateral ligaments. Purpose To determine the diagnostic accuracy of point-of-care ultrasound (POCUS) in detecting injuries of the meniscus and collateral ligament compared to MRI. Material and Methods An observational cross-sectional blinded study was conducted of 60 patients with clinically suspicious meniscus and collateral ligament injuries who were planned for an arthroscopy and or operative procedure. These patients underwent both blinded POCUS and MRI of the knees before the intervention procedure and results of both imaging modalities were compared according to the operative and arthroscopic findings. Results The preoperative reliability of POCUS compared to MRI for the assessment of meniscus injuries was sensitivity (92.9% vs. 90.5%), specificity (88.9% vs. 83.3%), positive predictive value (PPV; 95.1% vs. 92.7%), negative predictive value (NPV; 84.2% vs. 79%), and overall accuracy (91.7% vs. 88.3%). However, for diagnosing collateral ligament injures, POCUS versus MRI assessed sensitivity (92.3% vs. 88.5%), specificity (100% vs. 97.1%), PPV (100% vs. 95.8%), NPV (94.4% vs. 91.7%), and overall accuracy (96.7% vs. 93.3%). Conclusion Ultrasonography is a useful screening tool for the initial diagnosis of meniscal and collateral ligament pathology compared to or even with potential advantages over MRI, especially when MRI is unavailable or contraindicated. As newly advanced portable ultrasonography becomes available, it could be considered as a point-of-injury diagnostic modality.

scholarly journals Uveal Melanoma Identified as Ocular Mass on Point-of-care Ultrasound

2021 ◽  
Vol 5 (3) ◽  
pp. 367-368
Author(s):  
Hannah Spungen ◽  
Daniel Weingrow
Keyword(s):  
Emergency Department ◽  
Retinal Detachment ◽  
Uveal Melanoma ◽  
Vision Loss ◽  
Point Of Care ◽  
Black Spot ◽  
Distant Metastases ◽  
Posterior Chamber ◽  
Point Of Care Ultrasound ◽  
Point Of Care Ultrasonography

Case Presentation: A 41-year-old man presented to the emergency department with five months of progressive monocular vision loss in his right eye, which he described as a gradually descending and enlarging black spot. He had no light perception in his right eye with elevated intraocular pressure and an afferent pupillary defect, while his left eye visual acuity and pupillary exam was normal. Point-of-care ultrasound demonstrated a hyperechoic, pedunculated mass in the posterior chamber of his right eye, consistent with a diagnosis of ocular melanoma. Ophthalmology scheduled the patient for an elective, right eye enucleation the following week, after which a diagnosis of uveal melanoma (UM) was confirmed on histopathology. Discussion: Uveal melanoma is an uncommon diagnosis that requires prompt intervention and surveillance due to the possibility of distant metastases arising in up to 50% of patients. Emergency department diagnosis of UM may be confounded by features of other intraocular pathology, such as increased ocular pressure or the finding of retinal detachment on fundoscopy. When emergency providers encounter glaucoma or retinal detachment on physical exam, point-of-care ultrasonography represents a key adjunct in the timely diagnosis and referral of this potentially vision- and life-threatening malignancy.

scholarly journals A131 POINT OF CARE ULTRASOUND CHANGES THE NEEDLE INSERTION LOCATION FROM AN ANATOMICALLY LANDMARKED SITE DURING BEDSIDE PARACENTESIS.

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 114-115
Author(s):  
D Rodrigues ◽  
A Kundra ◽  
L Hookey ◽  
S Montague
Keyword(s):  
Point Of Care ◽  
Demographic Data ◽  
Insertion Site ◽  
Central Line ◽  
Needle Insertion ◽  
Point Of Care Ultrasound ◽  
Anatomic Site ◽  
Perceived Safety ◽  
Central Line Insertion ◽  
General Internal

Abstract Background Paracentesis is a bedside procedure to obtain ascitic fluid from the peritoneum. It is traditionally performed using anatomic landmarking and percussion to ascertain a safe drainage site. The serious complication rate has been reported as less than 2%. Point-of-care ultrasound (POCUS) has been adopted into education and clinical use and has been shown to improve the safety of certain procedures such as central line insertion and thoracentesis. However, the evidence supporting its use is limited. Aims We aimed to assess if POCUS would yield a user-preferred site for needle insertion compared to conventional landmarking, defined as a >5cm change in location. Methods Adult patients under the care of gastroenterology or general internal medicine at Kingston Health Sciences Centre undergoing paracentesis were consecutively enrolled between January and September of 2020. Physicians performing the procedure were enrolled based on availability. An anatomic site was selected 4cm superiorly and 2-4cm medially to the anterior superior ileac spine and confirmed with dullness to percussion. POCUS was then employed to determine if there was an alternative user-preferred site. Patient and operator demographic data and procedure-related information were collected. Results A total of 30 individual patients and 24 operators were enrolled, comprising 45 unique procedure combinations. Operators were primarily in their PGY 1 and 2 years of training (33% and 31% respectively). Per procedure, patients mean age was 61, and most of the ascites was due to cirrhosis (84%) predominantly due to EtOH (47%) and NAFLD (34%). As per indication, 29% of procedures were for diagnostic purposes alone. In total, users primarily preferred the POCUS site which resulted in a change in needle insertion site >5cm from the anatomic site in 69% of cases. The average depth of fluid was greater at the POCUS site vs. the anatomic site (5.4cm+/-2.8 vs 3.0cm+/-2.5, p<0.005). On average, POCUS deflected the needle insertion site superiorly and laterally to the anatomic site. Operators listed that per procedure the POCUS site was chosen to avoid adjacent organs (38%), optimize fluid pocket (61%) and due to abdominal wall issues (primarily issues with pannus; 11.5%). Importantly 6 cases were aborted due to a lack of an appropriate fluid pocket, despite clinical and/or prior radiographic evidence of ascites. Conclusions Overall, POCUS changes the needle insertion site from the conventional anatomic site for most procedures, due to user-perceived safety concerns. POCUS also prevented an attempt at paracentesis in 6 cases that were deemed unsafe. Therefore, POCUS plays an important role in bedside paracentesis. This research supports the use of POCUS in paracentesis and argues for continued training with POCUS throughout medical school and residency. Funding Agencies None

scholarly journals Point-of-Care Ultrasound in Undergraduate Medical Education: a Probe into its Feasibility

2018 ◽  
Vol 8 (2) ◽  
pp. 23-24
Author(s):  
John MacIsaac
Keyword(s):  
Medical Education ◽  
Residency Training ◽  
Undergraduate Medical Education ◽  
Training Programs ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Medical Specialties ◽  
Undergraduate Level ◽  
Medical Undergraduate ◽  
Point Of Care Ultrasonography

Point of care ultrasonography (POCUS) has had its applications expand rapidly over recent years and across several medical specialties. Enough so that is has become an essential skill in most residency training programs across Canada. Despite this, there is little to no structured POCUS training at the medical undergraduate level. The goal of this commentary is to briefly introduce the value of POCUS in medical education; the feasibility of its integration; current barriers to its introduction; and the potential for students to be a possible solution until faculty can introduce a formal undergraduate POCUS curriculum.

scholarly journals Development of Core Contents of Point-of-Care Ultrasound Curriculum for Pediatric Emergency Medicine Physician Training: A Modified Delphi Survey

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 757
Author(s):  
Jae-Hyun Kwon ◽  
Jin-Hee Lee ◽  
Young-Rock Ha ◽  
June-Dong Park ◽  
Keyword(s):  
Emergency Medicine ◽  
Point Of Care ◽  
Pediatric Emergency ◽  
Point Of Care Ultrasound ◽  
Pediatric Emergency Medicine ◽  
Modified Delphi ◽  
Experience Teaching ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Point Of Care Ultrasonography

Background: As the frequency of ultrasound use in pediatric emergency departments increases, it is necessary to train pediatric emergency medicine (PEM) physicians on pediatric point-of-care ultrasonography (POCUS). We discussed the core content of POCUS applications and proposed a POCUS training curriculum for PEM physicians in South Korea. Methods: Twenty-three experts were included if had performed over 1500 POCUS scans, had at least three years of experience teaching POCUS to physicians, were POCUS instructors or had completed a certified pediatric POCUS program. Experts rated 61 possible POCUS applications in terms of the importance of their inclusion in a PEM POCUS curriculum using the modified Delphi technique. Results: In round one, twelve (52.2%) out of 23 experts responded to the email. Eleven experts satisfied the inclusion criteria. Eleven experts participated in round one of a survey and agreed on 27 (44.3%) out of a total of 61 items. In round two, all 11 experts participated in the survey; they agreed on two (5.9%) of the remaining 34 items, and no items were excluded. Conclusion: Using the Delphi method, 61 applications were discussed, and a consensus was reached on 29 core applications.

Ultrasound application in point of care by palliative medicine physicians: Initial experience of oncology palliative medicine consultation in two rural area hospitals in Costa Rica.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 254-254
Author(s):  
Karol Villalobos
Keyword(s):  
Costa Rica ◽  
Rural Areas ◽  
Palliative Medicine ◽  
Point Of Care ◽  
Limited Resources ◽  
Point Of Care Ultrasound ◽  
Resource Limited Settings ◽  
Portable Ultrasound ◽  
Resource Limited ◽  
Point Of Care Ultrasonography

254 Background: Point of care Ultrasonography (POCUS)—that is ultrasonography performed and interpreted by the clinician at the bedside—is a method of clinical focused evaluation assisted by ultrasound equipment which gives the health provider in limited resources conditions, a prompt and accurate diagnosis for a limited number of pathologies. Development of portable ultrasound equipment with accessible technologies in terms of health investment, allows developing such practice in non-conventional resource-limited settings as patient homes. Our proposal is to show point of care ultrasonography (POCUS) experiences by two Palliative Care specialist doctors with in government-managed Social Security service (CCSS) in rural areas in Costa Rica. Methods: Limited diagnosis examinations were performed both at the hospital as well as at out of hospital sites in rural areas of Turrialba, and San Carlos, Costa Rica. Percutaneous procedures took place at the hospital following monitoring and aseptic standards, using two different units (Contec CMS600P2B, Phillips Clearvue 550). Results: Each brief case presented in this article shows effective Point of Care Ultrasound uses for patients with life-limiting conditions in resource-limited settings. Use of this technology by palliative medicine specialists in these cases helped patients and their families by accelerating right diagnosis, limiting unnecessary hospital transportation or by helping making safer procedures. Conclusions: Point of care ultrasound usage by palliative medicine specialists is an innovation breaking paradigms that has shown in our case to be a successful help as an evaluation strategy in a limited-resources rural environment, with a frail population.

scholarly journals The Master Clinician’s Elective: Integrating Evidence-Based Physical Examination and Point of Care Ultrasonography in Modern Clinical Medicine

POCUS Journal ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 13-19
Author(s):  
Maria Gabriela Frank MD ◽  
Cason Pierce MD ◽  
Noelle Northcutt MD ◽  
Joseph Walker Keach MD ◽  
Gerard Salame MD ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Physical Examination ◽  
Clinical Medicine ◽  
Point Of Care ◽  
Physical Exam ◽  
Inpatient Setting ◽  
Point Of Care Ultrasound ◽  
Evidence Based ◽  
Post Test ◽  
Point Of Care Ultrasonography

Background: Many internal medicine residency programs have incorporated ultrasonography into their curriculum; however, its integration with physical examination skills teaching at a graduate medical level is scarce. The program’s aim is to create a reproducible elective that combines physical exam and bedside ultrasound as a method for augmenting residents’ knowledge and competence in these techniques with the ultimate goal of improving patient care. Methods: We designed and implemented a two-week elective rotation for senior internal medicine residents, combining evidence-based physical examination with diagnostic bedside ultrasonography. The rotation took place in an inpatient setting at Denver Health Hospital. Program evaluation data was collected data between February 2016 to March 2019. IRB approval was waived. Results: Since its inception in 2016, 19 residents completed the rotation. Residents performed a pre-test and a post-test under direct observation by course faculty. Each resident was measured on the ability to perform pre-determined physical exam and point-of-care ultrasound (POCUS) skills. In the pre-test, participants correctly performed an average of 40% of expected physical exam maneuvers and 32% of expected POCUS skills. At elective conclusion, all participants were effectively able to demonstrate the highest yield physical exam and ultrasound maneuvers. Discussion and Conclusion: An elective designed specifically to integrate POCUS and physical exam modalities improves the ability of resident physicians to utilize both diagnostic modalities.

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