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Point-of-care ultrasound (POCUS) is a useful diagnostic tool and has become an integral part of the care provided in the Emergency.
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- Ultrasound in Emergency Medicine – E-FAST procedure
- Emergency ultrasound - Wikipedia
More on the subject: emergency medicine POCT 99 ultrasound I'm interested in more information … Read all latest stories. Point-of-care Improving the safety and quality of pediatric emergency care with POC ultrasound Point-of-care ultrasound POCUS has become an important adjunct to clinical diagnosis and procedural guidance in the Pediatric Emergency Department PED , supported by literature demonstrating that….
World J Orthopedics ;1 1 — Kevin J. Knoop, Lawrence B. Stack, Alan B. McGraw-Hill Professional, Modern sonology and the bedside practitioner: Evolution of ultrasound from curious novelty to essential clinical tool.
Romolo Joseph Gaspari, J. Christian Fox, Paul R.
Mosby, Noncardiac point-of-care ultrasound by non-radiologist physicians: How widespread is it?. JACR ; 8 11 — The utility of handheld ultrasound in an austere medical setting in Guatemala after a natural disaster. Am J Disaster Med. Marzi I. Prehospital ultrasound imaging improves management of abdominal trauma.
Br J Surg ;93 2 : — AJEM; 19 4 — Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Critical Care Med. JASE ; 23 12 — Resuscitation ; — Relevance of lung ultrasound in the diagnosis of acute respiratory failure. Chest ; 1 — Outcome in cardiac arrest patients found to have cardiac standstill on bedside emergency department echocardiogram.
Acad Emerg Med. Echocardiographically guided pericardiocentesis — the gold standard for the management of pericardial effusion and cardiac tamponade. Can J Cardiol ;— Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure?
Ultrasound in Emergency Medicine – E-FAST procedure
J Trauma Acute Care Surg. Sonographic evaluation of intravascular volume status: Can internal jugular or femoral vein collapsibility be used in the absence of IVC visualization? Ann Thorac Med. Sonographic evaluation of intravascular volume status in the surgical intensive care unit: a prospective comparison of subclavian vein and inferior vena cava collapsibility index.
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J Surg Res. Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis: time course for resolution. Point-of-Care Ultrasonography. NEJM ; 8 — Ultrasonography-guided peripheral intravenous access versus traditional approaches in persons with difficult intravenous access. Journal of Emergency Medicine 31 4 — The use of POCUS in first-trimester pregnant patients has demonstrated decreased ED length-of-stay and time-to-ultrasound in the radiology department with a documented increase in patient satisfaction [ 28 ].
Pelvic ultrasound demonstrating signs of definitive intrauterine pregnancy. A Yolk sac within the gestational sac. B Fetal pole.
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C M-mode demonstrating the measurement of fetal heart rate. Like other applications of POCUS, cardiac ultrasound, too, aims to answer specific questions in ED patients presenting with hypotension, dyspnea, possible pericardial effusion, cardiac arrest, cardiac trauma, chest pain, and patients after cardiac surgery [ 29 ]. These questions are [ 30 ]: 1 Is there cardiac activity? Identifying the presence or absence of cardiac activity may help guide the resuscitation in cardiac arrest.
Patients with asystole and absent cardiac activity on ultrasound have a very low survival rate [ 31 ]. Emergency physicians can rapidly and accurately identify pericardial effusion and recognize sonographic signs of tamponade. A case of pulmonary embolism with signs of right ventricular strain. A Apical four chamber view illustrating right ventricular RV enlargement. B Parasternal short view illustrating D sign; D-shaped left ventricular LV due to flattening of the interventricular septum from the raised RV pressure.
Figure 8. Evaluation of the IVC along with the cardiac status can be used as an additional diagnostic tool to assess volume status and guide fluid resuscitation in patients with hypovolemic and septic shock.
Emergency ultrasound - Wikipedia
IVC imaged in M-mode. A Demonstrates small and collapsible IVC with respiratory variation. B Demonstrates plethoric IVC with minimal respiratory variation, which, in the right clinical setting, could suggest that the patient is volume overloaded. EPs, with adequate training, have been shown to be as adept as cardiologists at the performance and interpretation of cardiac ultrasound [ 32 , 33 ].
Its use in appropriate patients as mentioned above has consistently been shown to help narrow down differential diagnoses [ 34 ], diagnose and treat more accurately [ 35 , 36 , 37 , 38 ], and improve outcomes [ 39 ]. The use of POCUS to guide resuscitation in pulseless electrical activity PEA arrest has been proposed to help identify possible reversible causes such as cardiac tamponade and massive pulmonary embolism, and therefore, expedite management and improve survival [ 40 ]. In patients presenting to ED with abdominal, flank or back pain, an abdominal aortic aneurysm AAA is a diagnosis that no EP would want to miss.
To make matters worse, palpation on physical exam misses roughly one out of every three patients with an AAA [ 44 ]. A ruptured AAA must also be considered in patients with unexplained hypotension, particularly in the elderly [ 45 ]. A significant percentage of patients do not have clinically evident aortic aneurysms, and due to the time-dependent prognosis of the condition, ultrasound performed by the EP helps improve chances of survival [ 46 ].
In spite of these supportive statistics, it must be mentioned that bedside ultrasound is neither the gold standard nor the imaging modality of choice in ruptured aneurysms. The differential diagnosis in patients presenting with epigastric or right upper quadrant pain, jaundice or even undifferentiated sepsis is broad, and POCUS can easily recognize gallstones and acute cholecystitis Figure EPs have been shown to be as adept as trained sonographers in the identification of these conditions [ 51 , 52 ].
Bedside biliary ultrasound can avoid misdiagnosing patients with acute cholecystitis or biliary colic [ 53 ], decrease ED length-of-stay [ 54 ], and expedite further management [ 55 ]. Biliary ultrasound demonstrating gallstones in A and cholecystitis in B suggested by the thickened gallbladder wall and pericholecystic fluid.
ED visits for complaints secondary to urolithiasis are exceedingly common [ 56 , 57 ], and ultrasound is a highly useful and often underutilized tool in the evaluation of these patients [ 58 ]. In addition to the detection of hydronephrosis Figure 11 , urinary tract ultrasound can also be used to measure bladder volume, an element of particular importance in those with urinary retention.
Ultrasound can also be used in patients in whom urinary tract pathology may be on the list of differential diagnoses, such as those with abdominal pain, hematuria, back pain or groin pain [ 59 ]. Multiple studies have consistently demonstrated that in patients with suspected nephrolithiasis, there is a decreased need for subsequent CT scans with the use of ultrasound in the ED, resulting in decreased exposure to ionizing radiation.
A Normal renal ultrasound, B mild hydronephrosis only the renal pelvis is filled with fluid , C moderate hydronephrosis fluid-filled renal pelvis extending to the renal calyces , D severe hydronephrosis entire renal collecting system is dilated.
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DVT is suspected in patients presenting with leg swelling, pain, warmth, and erythema. In patients with suspected DVT, accurate diagnosis is essential to decrease the risk of propagation and development of PE that could lead to significant morbidity and mortality. With short training, EPs can use focused ultrasound protocol to accurately diagnose a proximal DVT in the highest probability areas Figure 12 in symptomatic outpatients [ 68 ]. Several studies have suggested that incorporating POCUS along with pretest probability scoring systems e.
All of these advantages make bedside ultrasound for DVT especially useful; however, it is important to understand its limitations. POCUS ultrasound demonstrates DVT of the left common femoral vein A and left popliteal vein B evident by the echogenic material within the lumen and non-compressible veins with graded compression. Ultrasound has a higher sensitivity than the traditional upright anteroposterior chest radiography for the detection of a pneumothorax [ 74 ]. Studies have shown that POCUS is a good diagnostic tool to diagnose acute cardiogenic pulmonary edema [ 76 , 77 ].
Case of acute cardiogenic pulmonary edema. Evident by B lines A , which are the vertical narrow-based lines arising from the pleural line to the edge of the ultrasound screen, which was present in both hemithoraces, and bilateral pleural effusion B. In addition, cardiac ultrasound showed decreased left ventricular systolic function not included in the figure which supports the diagnosis of acute cardiogenic pulmonary edema.