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Bedside Echocardiography

Amer M Johri, Joshua Durbin, Joseph Newbigging, Robert Tanzola, Ryan Chow, Sabe De, James Tam
The development of small, user friendly, handheld ultrasound devices has stimulated the growth of cardiac point-of-care ultrasound (POCUS) for the purpose of rapid, bedside cardiac assessment. Medical schools have begun integrating cardiac POCUS into their curricula. In this review the authors summarize the variable approaches taken by several medical training programs with respect to duration of POCUS training, prerequisite knowledge, and methods of delivering these skills (including e-learning, hands-on training, and simulation)...
March 14, 2018: Journal of the American Society of Echocardiography
Jasper M Smit, Reinder Raadsen, Michiel J Blans, Manfred Petjak, Peter M Van de Ven, Pieter R Tuinman
BACKGROUND: Insertion of a central venous catheter (CVC) is common practice in critical care medicine. Complications arising from CVC placement are mostly due to a pneumothorax or malposition. Correct position is currently confirmed by chest x-ray, while ultrasonography might be a more suitable option. We performed a meta-analysis of the available studies with the primary aim of synthesizing information regarding detection of CVC-related complications and misplacement using ultrasound (US)...
March 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
Thomas Uray, Andrew Lamade, Jonathan Elmer, Tomas Drabek, Jason P Stezoski, Amalea Missé, Keri Janesko-Feldman, Robert H Garman, Niel Chen, Patrick M Kochanek, Cameron Dezfulian
OBJECTIVES: Cardiac arrest etiology may be an important source of between-patient heterogeneity, but the impact of etiology on organ injury is unknown. We tested the hypothesis that asphyxial cardiac arrest results in greater neurologic injury than cardiac etiology cardiac arrest (ventricular fibrillation cardiac arrest), whereas ventricular fibrillation cardiac arrest results in greater cardiovascular dysfunction after return of spontaneous circulation. DESIGN: Prospective observational human and randomized animal study...
March 10, 2018: Critical Care Medicine
Takeshi Yamamoto
High-risk pulmonary embolism (PE) is a life-threatening disorder associated with high mortality and morbidity. Most deaths in patients with shock occur within the first few hours after presentation, and rapid diagnosis and treatment is therefore essential to save patients' lives. The main manifestations of major PE are acute right ventricular (RV) failure and hypoxia. RV pressure overload is predominantly related to the interaction between the mechanical pulmonary vascular obstruction and the underlying cardiopulmonary status...
2018: Journal of Intensive Care
John Bates McCutcheon, Pascha Schaffer, Matthew Lyon, Richard Gordon
Bedside ultrasound is often used as a part of the evaluation of patients who are critically ill. The McConnell sign is an important echocardiographic finding in some critically ill patients with pulmonary embolism and an acute right ventricular infarct. We present 3 critically ill patients with confirmed acute chest syndrome who showed the McConnell sign on echocardiography. In patients with sickle cell disease presenting with chest pain and shortness of breath, the presence of the McConnell sign does not narrow the differential diagnosis between pulmonary embolism, an acute right ventricular infarct, and acute chest syndrome...
March 2, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Hong Li, Yi-Dan Li, Wei-Wei Zhu, Ling-Yun Kong, Xiao-Guang Ye, Qi-Zhe Cai, Lan-Lan Sun, Xiu-Zhang Lu
Ultrasound lung comets (ULCs) are a nonionizing bedside approach to assess extravascular lung water. We evaluated a protocol for grading ULC score to estimate pulmonary congestion in heart failure patients and investigated clinical and echocardiographic correlates of the ULC score. Ninety-three patients with congestive heart failure, admitted to the emergency department, underwent pulmonary ultrasound and echocardiography. A ULC score was obtained by summing the ULC scores of 7 zones of anterolateral chest scans...
2018: BioMed Research International
Gregory Milligan, John C Moscona
Coronary sinus thrombosis is a rare and often overlooked diagnosis that can have fatal consequences. We report a case of acute coronary sinus thrombosis in a patient with systolic heart failure who had undergone recent right-heart catheterization. The patient presented with recurrent presyncope, syncope, and shortness of breath. An echogenic focus consistent with a coronary sinus thrombus was visualized on transthoracic echocardiography that had not been seen previously on recent imaging. The patient was managed on oral anticoagulation...
February 12, 2018: Journal of Clinical Ultrasound: JCU
Rouven Kubicki, René Höhn, Jochen Grohmann, Thilo Fleck, Katja Reineker, Johannes Kroll, Matthias Siepe, Christoph Benk, Rolf Klemm, Frank Humburger, Brigitte Stiller
Extracorporeal life support (ECLS) weaning is a complex interdisciplinary process with no clear guidelines. To assess ventricular and pulmonary function as well as hemodynamics including end-organ recovery during ECLS weaning, we developed a standardized weaning protocol. We reviewed our experience 2 years later to assess its feasibility and efficacy. In 2015 we established an inter-professional, standardized, stepwise protocol for weaning from ECLS. If the patient did not require further surgery, weaning was conducted bedside in the intensive care unit (ICU)...
February 8, 2018: Artificial Organs
Delphine Georges, Hugues de Courson, Romain Lanchon, Musa Sesay, Karine Nouette-Gaulain, Matthieu Biais
BACKGROUND: In mechanically ventilated patients, an increase in cardiac index during an end-expiratory-occlusion test predicts fluid responsiveness. To identify this rapid increase in cardiac index, continuous and instantaneous cardiac index monitoring is necessary, decreasing its feasibility at the bedside. Our study was designed to investigate whether changes in velocity time integral and in peak velocity obtained using transthoracic echocardiography during an end-expiratory-occlusion maneuver could predict fluid responsiveness...
February 8, 2018: Critical Care: the Official Journal of the Critical Care Forum
Yogen Singh, Anup C Katheria, Farha Vora
Shock in newborn infants has unique etiopathologic origins that require careful assessment to direct specific interventions. Early diagnosis is key to successful management. Unlike adults and pediatric patients, shock in newborn infants is often recognized in the uncompensated phase by the presence of hypotension, which may be too late. The routine methods of evaluation used in the adult and pediatric population are often invasive and less feasible. We aim to discuss the pathophysiology in shock in newborn infants, including the transitional changes at birth and unique features that contribute to the challenges in early identification...
2018: Frontiers in Pediatrics
Linda Sarah Ross, Markus Bettin, Simon Kochhäuser, Martin Ritter, Jens Minnerup, Lars Eckardt, Florian Reinke, Ralf Dittrich
BACKGROUND: Atrial fibrillation (AF) is an important cause of stroke. Continuous electrocardiography (ECG) monitoring with software-based analysis algorithms has been suggested to enhance the AF detection rate. We investigated the ability of stroke risk analysis (SRA) in the detection of AF in acute stroke patients. METHODS: Consecutive stroke patients numbering 1,153 were screened. Patients with cardioembolic stroke related to AF (n = 296, paroxysmal n = 63, persistent n = 233) and patients with cryptogenic stroke (n = 309) after standard diagnostic work-up (bedside ECG monitoring, ultrasound, transesophageal echocardiography, 24 h Holter ECG) received SRA during their stay at the Stroke Unit...
January 17, 2018: Cerebrovascular Diseases
Marina Del Rios, Joseph Colla, Pavitra Kotini-Shah, Joan Briller, Ben Gerber, Heather Prendergast
INTRODUCTION: This study evaluates the agreement between emergency physician (EP) assessment of diastolic dysfunction (DD) by a simplified approach using average peak mitral excursion velocity (e'A ) and an independent cardiologist's diagnosis of DD by estimating left atrial (LA) pressure using American Society of Echocardiography (ASE) guidelines. METHODS: This was a secondary analysis of 48 limited bedside echocardiograms (LBE) performed as a part of a research study of patients presenting to the Emergency Department (ED) with elevated blood pressure but without decompensated heart failure...
January 25, 2018: Critical Ultrasound Journal
Nan Gai, Ronit Lavi, Philip M Jones, Hwa Lee, Douglas Naudie, Daniel Bainbridge
PURPOSE: Hip and knee arthroplasty surgeries are associated with embolism of materials such as air, cement, and fat. Patent foramen ovale (PFO) is a common congenital cardiac condition that has been reported to lead to paradoxical embolism. This observational study aimed to investigate if the presence of a PFO was associated with an increased risk of postoperative delirium in patients undergoing primary elective hip or knee arthroplasties. METHOD: This was a prospective cohort study at a tertiary teaching hospital...
January 24, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Shinichi Minagoe
The three EBMs in the title refer to the following concepts: evidence-based medicine, experience-based medicine, and echo-based medicine. Evidence-based medicine: I have carried out the following clinical research using transthoracic Doppler echocardiography: (1) noninvasive pulsed-wave Doppler echocardiographic detection of the direction of shunt flow in patients with atrial septal defect: usefulness of the right parasternal approach (1985), (2) significance of laminar systolic regurgitant flow in patients with tricuspid regurgitation: a combined pulsed-wave, continuous-wave, and two-dimensional echocardiography (1990), (3) obstruction of the inferior vena caval orifice by the giant left atrium in patients with mitral stenosis: a Doppler echocardiographic study from the right parasternal approach (1992), and (4) demonstration of a localized acceleration flow signal in the transmural penetrating coronary artery using transthoracic color and pulsed-wave Doppler echocardiography in patients with hypertrophic cardiomyopathy (1996-2017)...
January 22, 2018: Journal of Echocardiography
Maeng Real Park, Mun Ki Min, Ji Ho Ryu, Dae Sub Lee, Kang Ho Lee
Coronary artery dissection and intramural hematoma after blunt chest trauma are rare, but life-threatening, complications. Coronary intramural hematoma extension is even rarer. A 31-year-old man was transferred to our hospital for worsening left chest pain during while he was admitted at a nearby hospital due to blunt chest trauma. Bedside echocardiography showed akinesis of the left ventricular apex and anterior wall as well as hypokinesis of the mid-to-basal anteroseptal wall and mid-to-basal lateral and posterior walls of the left ventricle...
January 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Fabio Guarracino, Pietro Bertini, Michael R Pinsky
Hemodynamic monitoring is essential during the treatment of the critically ill in order to address the hemodynamic alterations and assess the response to treatment. Traditionally classified causes of shock and underlying pathophysiological mechanisms are often neglected by resuscitative strategies included in the guidelines. Most of hemodynamic management focuses on the ability to early recognise patients susceptible to increase cardiac output (CO) and mean arterial pressure (MAP) after a defined fluid challenge by eliciting Starling's law of the heart, and less is known of the ones presenting in shock and not volume responsive...
January 16, 2018: Minerva Anestesiologica
Benjamin M Bussmann, Shrey Sharma, David Mcgregor, William Hulme, Tim Harris
OBJECTIVES: Bedside ultrasound is increasingly being used to guide fluid management in shocked patients. Little data exist on the inter-rater reliability of techniques used, especially when performed by nonexpert trainee doctors. The primary aim of this study is to measure the inter-rater reliability of five ultrasound techniques commonly used to guide fluid management: inferior vena cava collapsibility index (IVCCI), transthoracic echocardiography (TTE)-derived stroke volumes, ultrasound cardiac output monitor (USCOM) derived stroke volume and carotid artery blood flow and corrected flow time measurements...
January 8, 2018: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Mahmut Kalem, Hakan Kocaoğlu, Ercan Şahin, Merve H Kocaoğlu, Kerem Başarır, Hakan Kınık
OBJECTIVE: The aim of this study was to analyze the effects of preoperative echocardiography on patient survival, timing of surgery in length of hospital stay in patients who will undergo hip nailing for an intertrochanteric fracture. METHODS: The clinical records of the patients who were admitted to a tertiary university hospital with an intertrochanteric femur fracture were retrospectively analyzed. The age, gender, American Society of Anesthesiologists (ASA) score, days to surgery, total hospital stay, cardiac drug prescription/modification, cardiac intervention and presence of an echocardiography assessment including detailed findings were reviewed...
January 2, 2018: Acta Orthopaedica et Traumatologica Turcica
Sudha P Jayaraman, Rahul J Anand, Jonathan H DeAntonio, Martin Mangino, Michel B Aboutanos, Vigneshwar Kasirajan, Rao Ivatury, Alex B Valadka, Olena Glushakova, Ronald L Hayes, Lorin M Bachmann, Gretchen M Brophy, Daniel Contaifer, Urszula O Warncke, Donald F Brophy, Dayanjan S Wijesinghe
Trauma is a major problem in the United States. Mortality from trauma is the number one cause of death under the age of 45 in the US and is the third leading cause of death for all age groups. There are nearly 200,000 deaths per year due to trauma in the US at a cost of over $671 billion in combined health care costs and lost productivity. Unsurprisingly, trauma accounts for about 30% of all life-years lost in the US. Due to immense development of trauma systems, a large majority of trauma patients survive the injury but then go on to die from complications arising from the injury...
December 26, 2017: Shock
Yasbanoo Moayedi, Juan G Duero Posada, Gillian C Nesbitt, Heather J Ross, Chaim Bell, Paul Dorian, Matthew Sibbald
Clinicians have strong opinions about whether they should be provided the clinical history before or after bedside testing. We hypothesized that diagnostic accuracy is improved when a concordant clinical history is provided before a diagnostic test. To investigate whether the timing (before or after) and the consistency (concordant vs discordant) of the clinical history in the setting of focused bedside echocardiography affects clinician diagnostic accuracy and management decisions. Thirty-two cardiology residents were asked to perform a bedside echocardiogram on a Vimedix 3D mannequin...
January 2018: Canadian Journal of Cardiology
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