Read by QxMD icon Read

Point of care ultrasound and emergency

Ying-Tai Shih, Chai-Hock Chua, Sheng-Wen Hou, Li-Wei Lin, Chee-Fah Chong
A 74-year-old male with chronic kidney disease presented to the emergency department with asystole. Mechanical chest compression was started immediately using a piston-type thumper device. The initial potassium level was 7.7 mEq/L and bedside point-of-care ultrasound (POCUS) revealed no pericardial fluid. With standard resuscitation and anti-hyperkalemia treatment, return of spontaneous circulation (ROSC) was achieved within 10 minutes of compressions. At 15 minutes post-ROSC, the patient went into pulseless electrical activity...
June 2018: Turkish Journal of Emergency Medicine
Maximilian Scharonow, Christian Weilbach
BACKGROUND: In the prehospital situation, the diagnostic armamentarium available to the rescue physician is limited. Emergency ultrasound has proven to be a useful diagnostic tool, providing crucial information for the management of critically ill and injured patients. The proportion of performed ultrasound scans in all patients attended to by the rescue service team, the quality of the findings and the ultrasound-related changes in management approach and patient transport were evaluated...
June 18, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Christopher Mallow, Warren Isakow
BACKGROUND: Point of care bedside ultrasound is widely utilized as a rapid technique to evaluate patients with acute pulmonary emergencies, including acute pneumothorax. The presence of a pneumothorax is a known cause of loss of lung sliding by ultrasound examination, but no other risk factors have been clearly identified. We attempted to identify demographic and patient characteristics that are risk factors for loss of ultrasonographic lung sliding in the absence of a pneumothorax. METHODS: Data were collected on 159 patients admitted to the medical intensive care unit with acute respiratory failure, undergoing routine admission lung ultrasound...
June 12, 2018: Journal of Bronchology & Interventional Pulmonology
Ping Wang, Larry J Kricka
BACKGROUND: Point-of-care technology (POCT)2 provides actionable information at the site of care to allow rapid clinical decision-making. With healthcare emphasis shifting toward precision medicine, population health, and chronic disease management, the potential impact of POCT continues to grow, and several prominent POCT trends have emerged or strengthened in the last decade. CONTENT: This review summarizes current and emerging trends in POCT, including technologies approved or cleared by the Food and Drug Administration or in development...
June 8, 2018: Clinical Chemistry
Claire Lissaman, Panida Kanjanauptom, Cyril Ong, Mark Tessaro, Elliot Long, Adam O'Brien
OBJECTIVES: The clinical diagnosis of pneumonia lacks specificity and may lead to antibiotic overuse, whereas radiological diagnoses can lack sensitivity. Point-of-care lung ultrasound is an emerging diagnostic tool. There are limited prospective data, however, on the accuracy of sonologists in the paediatric emergency department setting. We aimed to test the diagnostic accuracy of lung ultrasound for pneumonia using chest radiograph (CR) as the reference standard. METHODS: This prospective observational cohort study in a paediatric emergency department enrolled children aged 1 month to <18 years, who had a CR ordered for possible pneumonia...
June 7, 2018: Archives of Disease in Childhood
Brunhild M Halm, Tina A Leone, Lindsey T Chaudoin, Kenneth W McKinley, Carrie Ruzal-Shapiro, Adrian A Franke, Daniel S Tsze
OBJECTIVES: The identification of hydrocephalus in infants by pediatric emergency medicine (PEM) physicians using cranial point-of-care ultrasound (POCUS) has not been evaluated. We aimed to conduct a pilot/proof-of-concept study to evaluate whether PEM physicians can identify hydrocephalus (anterior horn width >5 mm) in 15 infants (mean 69 ± 42 days old) from the neonatal intensive care unit using POCUS. Our exploratory aims were to determine the test characteristics of cranial POCUS performed by PEM physicians for diagnosing hydrocephalus and the interrater reliability between measurements made by the PEM physicians and the radiologist...
June 5, 2018: Pediatric Emergency Care
Hamid Shokoohi, Ali Pourmand, Keith Boniface, Rebecca Allen, Bruno Petinaux, Babak Sarani, James P Phillips
As terrorist actors revise their tactics to outmaneuver increasing counter-terrorism security measures, a recent trend toward less-sophisticated attack methods has emerged. Most notable of these "low tech" trends are the Targeted Automobile Ramming MAss Casualty (TARMAC) attacks. Between 2014 and November 2017, 18 TARMAC attacks were reported worldwide, resulting in 181 deaths and 679 injuries. TARMAC attack-related injuries are unique compared to accidental pedestrian trauma and other causes of mass casualty incidents (MCI), and therefore they require special consideration...
May 29, 2018: American Journal of Emergency Medicine
Clara Kraft, Benjamin Lasure, Melinda Sharon, Paulina Patel, Joseph Minardi
The diagnosis of lung abscess can be difficult to make and often requires imaging beyond plain chest x-ray. The decision to further image with computed tomography should be weighed against the risks of radiation exposure, especially in pediatric patients. In addition, the cost and potential impact on length of stay from obtaining computed tomography scans should be considered. In this report, we describe a case of lung abscess made immediately using point-of-care ultrasound in the emergency department. To our knowledge, there are no previous cases describing lung abscess diagnosed by point-of-care ultrasound...
June 2018: Pediatric Emergency Care
Anna Dominguez, Heloisa A Gaspar, Marcela Preto, Fernanda E Ejzenberg
Ultrasound techniques have been developed since the past century and are becoming more useful in different areas of medical knowledge. More recently, lung ultrasound gained importance throughout artefacts analysis to help clinical evaluation at bedside and became subject of interest in the paediatric intensive care and emergency department settings for both procedural and diagnostic purposes. The normal pattern of lung ultrasound is defined by the presence of lung sliding associated with A-lines whereas B-lines may be representative of pathologic findings...
May 31, 2018: Journal of Paediatrics and Child Health
A Pourmand, U Dimbil, A Drake, H Shokoohi
Radiological imaging plays an essential role in the evaluation of a patient with suspected small bowel obstruction (SBO). In a few studies, point-of-care ultrasound (POCUS) has been utilized as a primary imaging modality in patients with suspected SBO. POCUS has been shown to be an accurate tool in the diagnosis of SBO with multiple research studies noting a consistent high sensitivity with a range of 94-100% and specificity of 81-100%. Specific sonographic findings that increase the likelihood of SBO include dilatation of small bowel loops > 25 mm, altered intestinal peristalsis, increased thickness of the bowel wall, and intraperitoneal fluid accumulation...
2018: Emergency Medicine International
Vigil James, Jade Seguin, Charisse W Kwan
Irreducible umbilical swelling in infants is considered a surgical emergency because a delay in surgical intervention for an incarcerated umbilical hernia can lead to bowel ischemia and necrosis. We report two patients who presented to a pediatric emergency department with history and symptoms of irreducible umbilical mass suggestive of umbilical hernia. Point-of-care ultrasound was used at the bedside to demonstrate the presence of urachal cyst remnants and accurately guided the care of these children.
November 2017: Clinical practice and cases in emergency medicine
Robert Ellspermann, Caroline Sirhari, Ethan Chapin, Mathew Nelson
We present a case of a 12-year-old female with a history of congenital solitary kidney presenting to an academic pediatric emergency department (ED) in acute abdominal pain. Using ultrasound as the initial diagnostic modality, the patient was found to have Herlyn-Werner-Wunderlich syndrome (HWWS), an abnormal development of the Müllerian system during embryogenesis resulting in obstructed hemivagina with resulting hematometrocolpos. The patient presented with undifferentiated abdominopelvic pain, and in the course of the ED workup was diagnosed with a disorder infrequently encountered by emergency physicians...
November 2017: Clinical practice and cases in emergency medicine
Khai Pin Lee, Vigil James, Gene Y Ong
Idiopathic pediatric pneumoparotitis, being rare, is often misdiagnosed in acute care settings, resulting in inappropriate initial management and emergency department (ED) disposition. We report the case of a previously well 11-year-old boy who presented to our ED with acute left cheek swelling and pain. He was diagnosed with pneumoparotitis with cervicofacial subcutaneous emphysema with the aid of point-of-care ultrasound (POCUS) and radiographs. Despite appropriate initial ED and inpatient management, he developed bilateral involvement and pneumomediastinum...
November 2017: Clinical practice and cases in emergency medicine
Nicole Dorinzi, Justine Pagenhardt, Melinda Sharon, Kristine Robinson, Erin Setzer, Nicolas Denne, Joseph Minardi
A 15-day-old male who was born at term presented with non-bilious projectile vomiting. He was nontoxic and his abdomen was benign without masses. Point-of-care ultrasound (POCUS) showed hypertrophic pyloric stenosis (HPS). Typical findings include target sign; pyloric muscle thickness greater than three millimeters (mm); channel length greater than 15-18 mm; and lack of gastric emptying. The patient was admitted; consultative ultrasound (US) was negative, but repeated 48 hours later for persistent vomiting...
November 2017: Clinical practice and cases in emergency medicine
Haleigh C Kotter, Daniel Weingrow, Caleb P Canders
Hematometrocolpos is a rare congenital abnormality of the female urogenital system that leads to an imperforate hymen and subsequent retrograde menstruation. We present the case of a 14-year-old female patient who presented to the emergency department with amenorrhea and abdominal pain, and was found to have an imperforate hymen and hematometrocolpos on trans-abdominal point-of-care ultrasound. It is important for emergency physicians to consider this diagnosis in pubescent female patients presenting with abdominal pain, as missed diagnosis can lead to infertility and other complications...
August 2017: Clinical practice and cases in emergency medicine
Tyler L Holliday, Kristine S Robinson, Nicole Dorinzi, Andrew W Vucelik, Erin L Setzer, Debra L Williams, Melinda J Sharon, Joseph J Minardi
Blunt scrotal injury represents a diagnostic dilemma for emergency physicians (EP). Consequently, point-of-care ultrasound (POCUS) has emerged as a tool for early investigation of the acute scrotum in the emergency department. We describe a case where an EP used scrotal POCUS to immediately visualize the loss of testicular contour and underlying heterogeneous parenchyma to rapidly make the diagnosis of testicular rupture in a young male presenting with scrotal trauma. The use of POCUS in this case expedited therapy, likely improving the patient's outcome...
August 2017: Clinical practice and cases in emergency medicine
Benjamin Thomas, Edward Durant, Sophie Barbant, Arun Nagdev
We report a case of a 52-year-old man who presented to the emergency department (ED) in extremis (hypotensive with an altered sensorium) with subsequent cardiac arrest after a motor vehicle collision. The initial trauma evaluation did not reveal a source of the hemodynamic compromise. A point-of-care ultrasound revealed severe mitral regurgitation secondary to an anterolateral papillary muscle rupture. Patient underwent successful emergent mitral valve replacement after initial resuscitative efforts and intraaortic balloon pump placement...
August 2017: Clinical practice and cases in emergency medicine
Allison Cohen, Mark Foster, Brendon Stankard, Maxine Owusu, Mathew Nelson
Gastric outlet obstruction (GOO) is a rare condition occurring as a consequence of numerous processes that prevent gastric emptying. Presenting symptoms of GOO are non-specific and include nausea, vomiting, epigastric discomfort and decreased appetite. The diagnosis of GOO is often challenging. Emergency physicians must have a heightened awareness of GOO to ensure proper diagnosis and rapid treatment. Although the gold standard for diagnoses of GOO is endoscopy, many patients are identified by computerized tomography imaging...
February 2018: Clinical practice and cases in emergency medicine
Roopa Avula, Michael Niemann, Nicole Dorinzi, Kristine Robinson, Melinda Sharon, Joseph Minardi
Isolated pelvic deep vein thromboses (DVT) are rare and difficult to diagnose, but they are more common in pregnant women and carry an increased risk of embolization. Pulmonary embolism is the most common non-obstetric cause of death in pregnancy. Compression ultrasound is the first-line imaging test for suspected lower extremity DVT, but it cannot usually aid in directly visualizing or easily diagnosing isolated pelvic DVT. Nonetheless, point-of-care ultrasound (POCUS) may provide valuable clues to help rule in pelvic DVT and expedite initiation of anticoagulant therapy...
August 2017: Clinical practice and cases in emergency medicine
Kristin Meigh, Madison Caja, Melinda Sharon, Allison Tadros, Shane Dragan, David Henkel, Joseph Minardi
Takotsubo cardiomyopathy (TCM) is an important condition for the emergency physician to consider in patients with cardiovascular symptoms. A 70-year-old woman presented with chest pain and nausea following emotional trauma. She had an elevated troponin and a normal electrocardiogram with no history of previous cardiac disease. Point-of-care focused cardiac ultrasound (FOCUS) showed reduced left ventricular systolic function with mid to apical hypokinesis. Cardiac catheterization revealed clean coronary arteries and confirmed the suspected diagnosis of TCM...
May 2018: Clinical practice and cases in emergency medicine
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"