Definitive Advantages of Point-of-Care Ultrasound: A Case Series.
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ABSTRACT:
SUBMITTER: Lanspa MJ
PROVIDER: S-EPMC9399626 | biostudies-literature | 2022 Aug
REPOSITORIES: biostudies-literature
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Definitive Advantages of Point-of-Care Ultrasound: A Case Series.
Lanspa Michael J MJ Fox Steven W SW Sohn Jaqueline J Dugar Siddharth S Klick John C JC Diaz-Gomez Jose J Liu Rachel R Panebianco Nova N
CASE (Philadelphia, Pa.) 20220815 6
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Project description:Graphical abstract Highlights • Integration of POCUS findings in the clinical context is crucial.• Valvular abnormalities may not be identified by POCUS.• Valvular disease should not be excluded based solely on a POCUS.• Careful review of POCUS studies in real time may help mitigate some POCUS pitfalls.
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Project description:Lower abdominal pain in females of reproductive age continues to be a diagnostic dilemma for the emergency physician (EP). Point-of-care ultrasound (US) allows for rapid, accurate, and safe evaluation of abdominal and pelvic pain in both the pregnant and non-pregnant patient. We present 3 cases of females presenting with right lower quadrant and adnexal tenderness where transvaginal ultrasonography revealed acute appendicitis. The discussion focuses on the use of EP- performed transvaginal US in gynecologic and intra-abdominal pathology and discusses the use of a staged approach to evaluation using US and computed tomography, as indicated.
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Project description:IntroductionFirst detected in December 2019, the severe acute respiratory syndrome coronavirus 2 pandemic upended the global community in a few short months. Diagnostic testing is currently limited in availability, accuracy, and efficiency. Imaging modalities such as chest radiograph (CXR), computed tomography, and lung ultrasound each demonstrate characteristic findings of coronavirus disease 2019 (COVID-19). Lung ultrasound offers benefits over other imaging modalities including portability, cost, reduced exposure of healthcare workers as well as decreased contamination of equipment such as computed tomography scanners.Case seriesHere we present a case series describing consistent lung ultrasound findings in patients with confirmed COVID-19 despite variable clinical presentations and CXR findings. We discuss a triage algorithm for clinical applicability and utility of lung point-of-care ultrasound in the setting of COVID-19 and advocate for judicious and targeted use of this tool.ConclusionLung point-of-care ultrasound can provide valuable data supporting diagnostic and triage decisions surrounding suspected cases of COVID-19. Prospective studies validating our proposed triage algorithm are warranted.
| S-EPMC7434229 | biostudies-literature
Project description:Graphical abstract Highlights • POCUS is increasingly being used in the evaluation of critically ill patients.• POCUS can shorten pulse check duration and prognosticate outcomes in cardiac arrest.• POCUS can identify the etiology of cardiac arrest after the first image.• POCUS can be used without delay or interrupting treatment.
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Project description:PurposeForeign body (FB) ingestions represent a common problem in children. History and physical examination are commonly not enough to diagnose a foreign body ingestion; therefore, conventional radiography is routinely used to detect them. Point-of-care ultrasound is widely used in the emergency department for several diagnostic applications but there are few articles describing the possibility to use point-of-care ultrasound to detect ingested foreign bodies, and the necessary training to get competent in this application. The main objective of this paper is to illustrate the use of point-of-care ultrasound (POCUS) to detect ingested foreign bodies. The secondary objective is to describe a limited training, necessary for emergency pediatricians, to obtain this skill.MethodsThis is a case series of eight pediatric patients who presented to the pediatric Emergency Department (ED), with suspected ingestion of FB, and were assessed with POCUS. Physician sonographers were two pediatricians and three residents in pediatrics working in two Italian Pediatric EDs. All sonographers participated in a 2-day POCUS workshop which included the most common pediatric POCUS applications.ResultsPOCUS, performed by emergency pediatricians who participated to a limited training, allowed to always identify the foreign bodies ingested.ConclusionsWe demonstrate that an appropriate and limited training allows pediatric emergency physicians to correctly identify foreign body in the esophagus or stomach. Point-of-care ultrasound in foreign body ingestion in the Emergency Department may allow to prioritize the escalation of care in children and it can contribute to reduce the time to endoscopic management when needed.
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Project description:IntroductionAbdominal pain is a common complaint in the emergency department. Point-of-care ultrasound (POCUS) is a rapid modality to evaluate for the etiology.Case reportA teenage male presented with symptoms concerning for appendicitis. POCUS revealed a non-peristalsing, non-compressible, tubular structure containing an echogenic stone. This was determined to be a ureteral stone within a dilated ureter, not appendicitis.ConclusionWe propose a syndromic sonographic approach to right lower quadrant pain (RLQ) that includes the gallbladder, right kidney, bladder, and right adnexa, in addition to RLQ landmarks. This case emphasizes the value of such an approach to avoid diagnostic error.
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Project description:Molar pregnancies are rare complications that can have potentially devastating effects, including neoplastic disease. Given the potential for malignant conversion, proper diagnosis of molar pregnancy is crucial. This case demonstrates the utility of point-of-care ultrasound (POCUS) for molar pregnancy in the emergency department (ED). The patient was a 43-year-old G8P1, 8-week-pregnant female who presented to the emergency department for evaluation of abdominal pain. Her physical exam was notable for abdominal tenderness and a normal pelvic exam. Evaluation included basic labs with a quantitative serum beta human chorionic gonadotropin (βhCG), urinalysis, and vaginal wet mount. Her results were unremarkable with the exception of elevated βhCG to 83,000 mIU/mL. A transabdominal POCUS was performed which showed a heterogeneous mass with several anechoic areas, concerning for a molar pregnancy. Patient was seen by obstetrics and gynecology (OB-GYN) and a transvaginal ultrasound showed similar findings. Dilation and evacuation were performed approximately 5 hours after initial diagnosis on POCUS. Use of POCUS was crucial for expedient diagnosis and appropriate treatment in this patient, highlighting the utility of POCUS for pregnant patients in the ED.TopicsMolar pregnancy, gestational trophoblastic disease, hydatidiform mole, point of care ultrasound.
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Project description:A 68-year-old man presented with one week of vague abdominal symptoms and was found to have new ascites and pulmonary embolism for which a heparin drip was initiated. We report a case diagnosing hemoperitoneum with point of care ultrasound (POCUS). Identifying hemoperitoneum can be challenging, but POCUS can be a useful tool for its diagnosis. There is limited literature on the sonographic characteristics of hemoperitoneum. Echogenicity of fluid is not a reliable distinguisher between exudative and transudative effusions. The diagnosis of hemoperitoneum in this case was suggested by the progression of POCUS findings over time rather than sonographic characteristics by themselves.
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Project description:Venous air embolism (VAE) is an uncommon event consistent in the entrainment of air from any communication between the environment and the venous vasculature that could occur during central venous catheter (CVC) manipulation, and might trigger circulatory shock within minutes depending on the amount of air embolized. We present a case of a critical care patient who presented sudden clinical hemodynamic deterioration after the removal of central venous catheter. Hemodynamic evaluation with point-of-care ultrasound (POCUS) showed bubbles in both right and left heart cavities wherewith air embolism facilitated by heart septal defect was suspected. Therefore, the patient was reintubated, supported with vasopressors and a new CVC was inserted to proceed with air aspiration. Shortly after, the patient's hemodynamic status improved in terms of vital signs stabilization. 6 h after the event with optimal perfusion markers and diminished sedation, the patient showed left hemiparesis therefore a cerebral magnetic resonance (MRI) was also performed showing hyperintensity in the right precentral gyrus, so ischemic stroke without hemorrhagic transformation diagnosis was made, because of paradoxical embolism. This case report demonstrates the value of POCUS application as a diagnostic tool in the hemodynamically unstable patient.
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