scholarly journals Point-of-care Lung Ultrasound Is Useful to Evaluate Emergency Department Patients for COVID-19

2020 ◽  
Vol 21 (6) ◽  
Author(s):  
Paul Walsh ◽  
Andrea Hankins ◽  
Heejung Bang
Keyword(s):  
Emergency Department ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Emergency Department Patients

scholarly journals Point of care lung ultrasound is useful when screening for CoVid-19 in Emergency Department patients.

2020 ◽  
Author(s):  
Andrea Hankins ◽  
Heejung Bang ◽  
Paul Walsh
Keyword(s):  
Emergency Department ◽  
Null Hypothesis ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Vital Signs ◽  
P Value ◽  
Inclusion Criteria ◽  
Upper Respiratory Infection ◽  
Life Threatening ◽  
Emergency Department Patients

Background CoVid-19 can be a life-threatening lung disease or a trivial upper respiratory infection depending on whether the alveoli are involved. Emergency department (ED) screening in symptomatic patients with normal vital signs is frequently limited to oro-nasopharyngeal swabs. We tested the null hypothesis that patients being screened for CoVid-19 in the ED with normal vital signs and without hypoxia would have a point-of-care lung ultrasound (LUS) consistent with CoVid-19 less than 2% of the time. Methods Subjects Subjects were identified from ED ultrasound logs. Inclusion criteria Age 14 years or older with symptoms prompting ED screening for CoVid-19. Exclusion criteria Known congestive heart failure or other chronic lung condition likely to cause excessive B lines on LUS. Intervention Structured blinded ultrasound review and chart review Analysis We used an exact hypothesis tests for binomial random variables. We also measured LUS diagnostic performance using computed tomography as the gold standard. Results We reviewed 77 charts; 62 met inclusion criteria. Vital signs were normal in 31 patients; 10 (32%) of these patients had LUS consistent with CoVid-19. We rejected the null hypothesis (p-value for bitest <0.001). The treating physicians' interpretation of their own point of care lung ultrasounds had a sensitivity of 100% (95% CI 75%, 100%) and specificity of 80% (95% CI 68%, 89%). Conclusion LUS has a meaningful detection rate for CoVid-19 in symptomatic emergency department patients with normal vital signs. We recommend at least LUS be used in addition to PCR testing when screening symptomatic ED patients for CoVid-19.

scholarly journals The Feasibility and Accuracy of Point-of-Care Lactate Measurement in Emergency Department Patients with Suspected Infection

2010 ◽  
Vol 39 (1) ◽  
pp. 89-94 ◽  
Author(s):  
Nathan I. Shapiro ◽  
Christopher Fisher ◽  
Michael Donnino ◽  
Lauren Cataldo ◽  
Aimee Tang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Point Of Care ◽  
Suspected Infection ◽  
Lactate Measurement ◽  
Emergency Department Patients

scholarly journals Early Multi-organ Point-of-Care Ultrasound Evaluation of Respiratory Distress During SARS-CoV-2 Outbreak: Case Report

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Robert Farrow ◽  
Graham Becherer-Bailey ◽  
Daniel Mantuani ◽  
Arun Nagdev
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Respiratory Distress ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Case Series ◽  
Disease Process ◽  
Point Of Care Ultrasound ◽  
Care Assessment

Introduction: Coronavirus disease 2019 (COVID-19) is caused by the virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several case series from Italy and China have highlighted the lung ultrasound findings of this disease process and may demonstrate its clinical utility during the current pandemic. Case Report: We present a case of a COVID-19 patient who presented to the emergency department twice within a 24-hour period with rapidly progressing illness. A multi-organ point-of-care ultrasound (POCUS) evaluation was used on the return visit and assisted clinical decision-making. Discussion: A multi-organ POCUS exam allows for quick assessment of acute dyspnea in the emergency department. As the lung involvement of COVID-19 is primarily a peripheral process it is readily identifiable via lung ultrasound. We believe that when applied efficiently and safely a POCUS exam can reduce clinical uncertainty and potentially limit the use of other imaging modalities when treating patients with COVID-19. Conclusion: This case highlights the utility of an early multiorgan point-of-care assessment for patients presenting with moderate respiratory distress during the severe SARS-CoV-2 pandemic.

scholarly journals Comparison between B·R·A·H·M·S PCT direct, a new sensitive point-of-care testing device for rapid quantification of procalcitonin in emergency department patients and established reference methods – a prospective multinational trial

2016 ◽  
Vol 54 (4) ◽  
Author(s):  
Alexander Kutz ◽  
Pierre Hausfater ◽  
Michael Oppert ◽  
Murat Alan ◽  
Eva Grolimund ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Whole Blood ◽  
Point Of Care ◽  
Venous Blood ◽  
Reference Method ◽  
Point Of Care Test ◽  
Emergency Department Patients ◽  
Work Up

AbstractProcalcitonin (PCT) is increasingly being used for the diagnostic and prognostic work up of patients with suspected infections in the emergency department (ED). Recently, B·R·A·H·M·S PCT direct, the first high sensitive point-of-care test (POCT), has been developed for fast PCT measurement on capillary or venous blood samples.This is a prospective, international comparison study conducted in three European EDs. Consecutive patients with suspicion of bacterial infection were included. Duplicate determination of PCT was performed in capillary (fingertip) and venous whole blood (EDTA), and compared to the reference method. The diagnostic accuracy was evaluated by correlation and concordance analyses.Three hundred and three patients were included over a 6-month period (60.4% male, median age 65.2 years). The correlation between capillary or venous whole blood and the reference method was excellent: rThis study found a high diagnostic accuracy and a faster time to result of B·R·A·H·M·S PCT direct in the ED setting, allowing shortening time to therapy and a more wide-spread use of PCT.

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

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.

scholarly journals Point of Care Ultrasound First: An Opportunity to Improve Efficiency for Uncomplicated Pregnancy in the Emergency Department

POCUS Journal ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 42-44
Author(s):  
Sara Urquhart ◽  
Kendall Stevens ◽  
Mariah Barnes ◽  
Matthew Flannigan
Keyword(s):  
Emergency Department ◽  
Random Sample ◽  
Medical Center ◽  
Point Of Care ◽  
Tertiary Care ◽  
Radiology Department ◽  
Point Of Care Ultrasound ◽  
Tertiary Care Medical Center ◽  
Time To Diagnosis ◽  
Emergency Department Patients

Introduction: Research suggests emergency providers using point-of-care ultrasound (POCUS) to confirm an uncomplicated intrauterine pregnancy (IUP) can decrease emergency department (ED) length of stay (LOS) compared to a radiology department ultrasound (RADUS). The objective of this study was to compare the time to diagnosis and LOS between POCUS and RADUS patients. Methods: This was a retrospective study at one urban medical center. A standardized tool was used to abstract data from a random sample of pregnant patients diagnosed with uncomplicated IUP between January 2016 and December 2017 at a single tertiary care medical center. Microsoft Excel 2010 software was used to measure time intervals, prepare descriptive statistics, and perform Mann-Whitney U tests to compare differences. Results: A random sample of 836 (36%) of the 2,346 emergency department patients diagnosed with an IUP between 8-20 weeks’ gestation during the study period was evaluated for inclusion. Three hundred sixty-six met inclusion criteria and were included in the final analysis. Patients were divided into 2 groups based on which type of ultrasound scan they received first: POCUS (n=165) and RADUS (n=201). Patients who received POCUS were found to have an IUP identified in an average of 48 minutes (95% CI, 43 to 53), while the RADUS group’s mean time to diagnosis was 120 minutes (95% CI 113 to 127) with a difference of 72 minutes (95% CI, 63 to 80; p<0.001). The mean LOS for patients who received POCUS was 132 minutes (95% CI, 122 to 142), while that of the RADUS group was 177 minutes (95% CI 170 to 184) with a difference of 45 minutes (95% CI 32 to 56; p<0.001). The study is limited by its single-center, retrospective design and by lack of blinding of data abstractors. Conclusion: Pregnant emergency department patients diagnosed with an uncomplicated IUP between 8-weeks and 20-weeks’ gestation had statistically significant reduction in time to diagnosis and disposition from the ED if assessed with POCUS as compared to RADUS.

Evaluation of the Prognostic Value of Lactate and Acid-base Status in Patients Presenting to the Emergency Department

2020 ◽  
Author(s):  
Ramiro D'Abrantes ◽  
Laura DUNN ◽  
Tim MCMILLAN ◽  
Ben CORNWELL ◽  
Ben BLOOM ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Point Of Care ◽  
Acid Base ◽  
Wide Range ◽  
Acid Base Status ◽  
Emergency Department Patients ◽  
Lactate Levels ◽  
High Lactate

Abstract IntroductionPoint-of-care metabolic screens are frequently used in the assessment of critical illness. Lactate levels predict mortality in a wide range of patients presenting to the Emergency Department but the effect of co-existing acidosis is unknown. We investigated the effect that acidosis has on in-hospital mortality for patients with hyperlactataemia. Methods This is a retrospective cohort study. The inclusion criteria were patients over 17 years of age who received a metabolic panel on arrival to the resuscitation area of the Emergency Department. The primary outcome was in-hospital mortality. The groups were normal lactate (0.0-2.0 mmol/L), intermediate lactate (2.1-4.0 mmol/L) and high lactate (>4.0 mmol/L), with and without acidosis. Odds ratios (OR) were calculated to assess the differences in mortality rates between groups stratified by lactate and acid-base status.Results 4107 metabolic panels were collected and 3238 were assessed. 510 (15.8%) & 784 (24.2%) patients had a normal lactate and acidosis or no acidosis respectively. 587 (18.1%) & 842 (26.0%) patients had intermediate lactate and acidosis or no acidosis respectively. 388 (12.0%) & 127 (3.9%) patients had high lactate and acidosis or no acidosis respectively. The overall mortality was 5%. In normal lactate group mortality was 4.3% and 0.6%, intermediate lactate mortality was 5.6% and 2.6%, and high lactate group mortality was 19.3% and 3.9%, with and without acidosis respectively. Combining base excess < -6 and lactate >4 mmol/L had a sensitivity of 39%, specificity of 96%, positive predictive value of 32% and a negative predictive value of 98% for in-hospital mortality, OR 14.0 (95% CI 9.77 – 20.11). Conclusion In an undifferentiated cohort of Emergency Department patients presenting to the resuscitation area lactaemia associated with acidosis is a more accurate predictor of in-hospital mortality than hyperlactataemia.

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