Ultrasound and emergency medicine

Situs inversus totalis (SIT) is a rare medical condition characterized by a complete mirror-image reversal of the normal positioning of the internal organs. Aristotle initially described situs inversus in animals, while Fabricius first characterized it in humans. Although the specific cause is uncertain, there is evidence of autosomal recessive and X-linked inheritance. Before seeking treatment for an unrelated ailment, many people with SIT are unaware of their distinct anatomy, as in our case. The presented case is a 30-year-old female patient from Central Ethiopia, presented to Hakim Gizaw Teaching Hospital outpatient department of medicine with the complaint of right-sided anterior chest pain for five days...

BACKGROUND: Transvaginal (TVUS) and transabdominal ultrasound (TAUS) are both utilized in the evaluation of early pregnancy patients. While many practitioners using point of care ultrasound (POCUS) will generally not pursue TVUS in cases where an intrauterine pregnancy (IUP) is visualized on TAUS, this may not be true in Radiology performed ultrasound. OBJECTIVES: To evaluate for differences in transvaginal ultrasound (TVUS) utilization between Radiology performed (RP) ultrasound and point of care ultrasound (POCUS) by Emergency Department (ED) physicians in early pregnancy patients...

STUDY OBJECTIVE: We propose a novel method of evaluating right ventricular (RV) dysfunction in the emergency department (ED) using RV "bubble time"-the duration of time bubbles from a saline solution flush are visualized in the RV on echocardiography. The objective was to identify the optimal cutoff value for RV bubble time that differentiates patients with RV dysfunction and report on its diagnostic test characteristics. METHODS: This prospective diagnostic accuracy study enrolled a convenience sample of hemodynamically stable patients in the ED...

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INTRODUCTION: Point-of-care ultrasound (POCUS) performed by emergency physicians (EP) has emerged as an effective alternative to radiology department ultrasounds for the diagnosis of lower extremity deep vein thrombosis (DVT). Systematic reviews suggested good sensitivity and specificity overall for EP-performed POCUS for DVT diagnosis, yet high levels of heterogeneity were reported. METHODS: In this systematic review and meta-analysis, we aimed to provide the most up-to-date estimates of the accuracy of EP-performed POCUS for diagnosis of DVT and to explore potential correlations with test performance...

Space travel has transformed in the past several years. Given the burgeoning market for space tourism, in-flight medical emergencies are likely to be expected. Ultrasound is one of the few diagnostic and therapeutic modalities available for astronauts in space. However, while point-of-care ultrasound (POCUS) is available, there is no current standard of training for astronaut preparation. We suggest an organized and structured methodology by which astronauts should best prepare for space with the medical equipment available on board...

INTRODUCTION: Numerous studies have demonstrated the accuracy of point-of-care ultrasound (POCUS). Portable, handheld devices have expanded the clinical scope of POCUS at a fraction of the cost of traditional, cart-based models. There is a paucity of data assessing the diagnostic accuracy of portable devices. Our objective in this study was to compare the diagnostic accuracy of a portable device with a cart-based model. METHODS: This was an institutional review board-approved, observational, prospective, randomized clinical trial (NCT05196776) of a convenience sample of adult patients who presented to a university-based health system...

INTRODUCTION: The use of a reliable scoring system for quality assessment (QA) is imperative to limit inconsistencies in measuring ultrasound acquisition skills. The current grading scale used for QA endorsed by the American College of Emergency Physicians (ACEP) is non-specific, applies irrespective of the type of study performed, and has not been rigorously validated. Our goal in this study was to determine whether a succinct, organ-specific grading scale designed for lung-specific QA would be more precise with better interobserver agreement...

PURPOSE: Using point-of-care ultrasound (POCUS) to diagnose abdominal aortic aneurysm (AAA) is an essential skill in emergency medicine (EM). While simulation-based POCUS education is commonly used, the translation to performance in the emergency department (ED) is unknown. We investigated whether adding case-based simulation to an EM residency curriculum was associated with changes in the quantity and quality of aorta POCUS performed by residents in the ED. METHODS: A case-based simulation was introduced to resident didactics at our academic, Level I trauma center...

Radiological and nuclear medicine methods play a fundamental role in the diagnosis and staging of patients with lung cancer. Imaging is essential in the detection, characterisation, staging and follow-up of lung cancer. Due to the increasing evidence, low-dose chest computed tomography (CT) screening for the early detection of lung cancer is being introduced to the clinical routine in several countries. Radiomics and radiogenomics are emerging fields reliant on artificial intelligence to improve diagnosis and personalised risk stratification...

An echocardiogram is a sophisticated ultrasound imaging technique employed to diagnose heart conditions. The transthoracic echocardiogram, one of the most prevalent types, is instrumental in evaluating significant cardiac diseases. However, interpreting its results heavily relies on the clinician's expertise. In this context, artificial intelligence has emerged as a vital tool for helping clinicians. This study critically analyzes key state-of-the-art research that uses deep learning techniques to automate transthoracic echocardiogram analysis and support clinical judgments...

Hypertension is a primary contributor to cardiovascular disease, and the leading risk factor for loss of quality adjusted life years. Up to 50% of the cases of hypertension in the US remain uncontrolled. Additionally, 8-18% of the hypertensive population have resistant hypertension, uncontrolled pressure despite three different anti-hypertensive agents. Recently, catheter-based, percutaneous renal denervation emerged as a method for ablating renal sympathetic nerves for difficult to control hypertension. Initial randomized (non-sham) trials and registry analyses showed impressive benefit, but the first sham-controlled randomized controlled trial (RCT) using monopolar radiofrequency ablation showed limited benefit...

OBJECTIVES: Clinical practice guidelines are essential for promoting evidence-based healthcare. While diversification of panel members can reduce disparities in care, processes for panel selection lack transparency. We aim to share our approach in forming a diverse expert panel for the updated Adult Critical Care Ultrasound Guidelines. DESIGN: This process evaluation aims to understand whether the implementation of a transparent and intentional approach to guideline panel selection would result in the creation of a diverse expert guideline panel...

BACKGROUND: Ultrasound has established utility within pediatric emergency medicine and has an added benefit of avoiding excessive radiation exposure. The serial focused assessment with sonography in trauma (sFAST) examination is a potential alternative to improve pediatric trauma evaluation. We sought to evaluate the accuracy of sFAST in pediatric patients with blunt abdominal trauma. METHODS: We performed a multicenter, retrospective observational study of electronic medical records, trauma registry data, and image archiving records of previous sFAST examinations...

Introduction Point-of-care ultrasound (POCUS) has become integral across medical specialties globally, addressing clinical queries, guiding procedures, and bridging the gap between physical examination and advanced imaging. Early ultrasound training for medical students enhances clinical decision-making and reduces diagnostic errors. Aims To evaluate the knowledge and attitude of senior medical students towards POCUS and to assess knowledge gaps and difficulties encountered by senior medical students to assist in the development of future curricula...

OBJECTIVE: This study aims to investigate the expression levels of soluble CD40L (sCD40L), matrix metalloproteinase 2 (MMP2), and matrix metalloproteinase 9 (MMP9) in the serum of patients experiencing recurrent abortion and their impact on uterine artery blood flow. METHODS: A cohort of 200 patients with recurrent abortion was selected for this investigation. The levels of sCD40L, MMP2, and MMP9 in serum were assessed using ELISA, while ultrasound was employed to measure the pulsatility index (PI) and resistance index (RI) in uterine artery blood flow...

BACKGROUND: Atherosclerotic coronary heart disease (CHD) stands as a paramount cardiovascular concern and the primary cause of mortality. To underscore the significance of our study, it is crucial to highlight the existing gaps in current diagnostic methods and prognostic assessments of CHD. By addressing these gaps, our research aims to contribute valuable insights and advancements in the understanding and management of this prevalent cardiovascular condition. OBJECTIVE: The primary objective of this study is to investigate the correlation between carotid ultrasound, the Atherogenic Index of Plasma (AIP), and the severity of CHD...

OBJECTIVES: Early diagnosis of relative afferent pupillary defects (RAPDs) in patients with ocular trauma is crucial for timely management and improved outcomes. However, clinical examination can be challenging for patients with periorbital ecchymosis. This study aimed to compare the diagnostic accuracy of point-of-care ultrasound (POCUS) and clinical examination by emergency physicians for detecting RAPD in adult ocular trauma patients and to evaluate the proportion of RAPD in patients with ocular trauma who presented to the ED...

This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety...

An electrical storm also known as a ventricular tachycardia storm (VT storm) tends to recur and form a vicious cycle, eventually leading to a refractory electrical storm, refractory to electrical and pharmacological cardioversion. The treatment of refractory VT storm is challenging. Here we discuss the case of a middle-aged gentleman who presented to our emergency department 6 months apart with a refractory VT storm. When all the anti-arrhythmic agents and multiple cardioversion attempts failed in terminating the storm, we attempted ultrasound-guided stellate ganglion block...