Critical Ultrasound Journal

OBJECTIVES: To show that medical students can evaluate the internal jugular vein (IJV) and its anatomical variations after rapid and focused training. We also aimed to evaluate the success rate of IJV puncture in simulation following traditional techniques (TTs) and monitored via ultrasound (US). MATERIALS AND METHODS: Six medical students without experience with US were given 4 h of theoretical-practical training in US, and then evaluated the IJV and common carotid artery (CCA) of 105 patients...

BACKGROUND: Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition. METHODS: PEM fellows performed and interpreted FOCUS on patients who also received cardiology service echocardiograms, the reference standard...

BACKGROUND: Fluid responsiveness is an important topic for clinicians. Aggressive hydration has been shown to lead to worse outcomes. The aim of this study was to investigate the sensitivity and specificity of mitral valve (MV) velocity time integral (VTI) as a non-invasive marker of volume responsiveness. METHODS: This was a prospective observational study conducted in a tertiary emergency department. End-stage renal disease patients presenting to the emergency department requiring emergent hemodialysis were enrolled...

BACKGROUND: Right iliac fossa abdominal pain is a common reason for emergency ward admissions, its etiology is difficult to diagnose. It can be facilitated by an imaging examination, such as a Computerized Tomography scan which exposes the patient to ionizing radiation and implies delays. A bedside ultrasound performed by emergency physicians could avoid these issues. The aim of our study was to assess the performance of ultrasound carried out at the patient's bedside by an emergency physician compared with a clinical-laboratory examination for the diagnosis of a surgical pathology in right iliac fossa pain...

Hypertensive emergency is a life-threatening state. End-organ damage affecting the heart accounts for up to 52% of hypertensive emergencies commonly encountered in the emergency department. Recent evidence indicates that strain echocardiography with computerized speckle-tracking is more sensitive at identifying hypertension induced changes in the left ventricle (LV) mechanical function than traditional 2-D echocardiography. We present a case demonstrating the use of emergency physician performed point-of-care strain echocardiography to identify and quantify LV mechanical dysfunction during a hypertensive crisis and to monitor improvement over 6 h...

Systolic anterior motion (SAM) after mitral valve repair (MVR) can adversely affect hemodynamics due to exacerbation of left ventricular outflow tract obstruction and mitral regurgitation. Intraoperative transient SAM after MVR can usually be managed with hemodynamic maneuvers under continuous monitoring by transesophageal echocardiography (TEE). However, during postoperative intensive care management, transient SAM is seldom diagnosed and the start of treatment may be delayed. We present a case of transient SAM after MVR with abrupt deterioration due to junctional rhythm in the intensive care unit (ICU)...

BACKGROUND: An accurate physical examination is essential in the care of critically ill and injured patients. However, to diagnose or exclude a pneumothorax, chest auscultation is unreliable compared to lung ultrasonography. In the dynamic prehospital environment, it is desirable to have the best possible ultrasound transducer readily available. The objective is to assess the difference between a linear-array, curved-array, and phased-array ultrasound transducer in the assessment for pneumothorax and to determine which is best...

BACKGROUND: Traditional landmark thoracostomy technique has a known complication rate up to 30%. The goal of this study is to determine whether novice providers could more accurately identify the appropriate intercostal site for thoracostomy by ultrasound guidance. METHODS: 33 emergency medicine residents and medical students volunteered to participate in this study during routine thoracostomy tube education. A healthy volunteer was used as the standardized patient for this study...

No abstract text is available yet for this article.

BACKGROUND: Point-of-care ultrasound (PoCUS) is spreading throughout Emergency Medicine, Critical Care and Pre-hospital Care. However, there is an underlying inherited conflict with the established specialties performing comprehensive examinations. It has been stated that PoCUS is disruptive innovation. If this is true the definition might open up for a new perspective on differentiating comprehensive ultrasound from PoCUS. PoCUS in the light of disruptive innovation is a different perspective on ultrasound that has not before been academically scrutinized...

When intracranial hypertension and severe lung damage coexist in the same clinical scenario, their management poses a difficult challenge, especially as concerns mechanical ventilation management. The needs of combined lung and brain protection from secondary damage may conflict, as ventilation strategies commonly used in patients with ARDS are potentially associated with an increased risk of intracranial hypertension. In particular, the use of positive end-expiratory pressure, recruitment maneuvers, prone positioning, and protective lung ventilation can have undesirable effects on cerebral physiology: they may positively or negatively affect intracranial pressure, based on the final repercussions on PaO2 and cerebral perfusion pressure (through changes in cardiac output, mean arterial pressure, venous return, PaO2 and PaCO2 ), also according to the baseline conditions of cerebral autoregulation...

BACKGROUND: Pre-hospital ultrasound is a new challenge and lung ultrasound could be an interesting opportunity in the pre-hospital medical service. The aim of our study was to evaluate the efficacy of lung ultrasound in out-of-hospital non-traumatic respiratory insufficiency. METHODS: We planned a case-controlled study in the ULSS 5 ovest vicentino area (Vicenza-Italy) enrolling subjects with severe dyspnea caused by cardiac heart failure or acute exacerbation of chronic obstructive pulmonary disease...

BACKGROUND: Clinical lung ultrasound examinations are widely used in the primary assessment or monitoring of patients with dyspnoea or respiratory failure. Despite being increasingly implemented, there is no international consensus on education, assessment of competencies, and certification. Today, training is usually based on the concept of mastery learning, but is often unstructured and limited by bustle in a clinical daily life. The aim of the systematic review is to provide an overview of published learning studies in clinical lung ultrasound, and to collect evidence for future recommendations in lung ultrasound education and certification...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Medical care in resource limited settings is challenging, particularly with limited access to diagnostic and imaging studies. The most portable and cost effective diagnostic imaging in these areas is ultrasound. Ultrasound is a very teachable skill with a short, single intensive training course and hands-on teaching; however, there are limited data on a longitudinal point-of-care ultrasound (POCUS) curriculum in resource limited settings. The goal of this intervention is to develop an effective longitudinal POCUS curriculum for local physicians working in rural clinics in the state of Chiapas, Mexico, and evaluate its effectiveness on patient care...

Prehospital point-of-care ultrasound used by nonradiologists in emergency medicine is gaining ground. It is feasible on-scene and during aeromedical transport and allows health-care professionals to detect or rule out potential harmful conditions. Consequently, it impacts decision-making in prioritizing care, selecting the best treatment, and the most suitable transport mode and destination. This increasing relevance of prehospital ultrasonography is due to advancements in ultrasound devices and related technology, and to a growing number of applications...

Thoracic ultrasound is a powerful diagnostic imaging technique for pleural space disorders. In addition to visualising pleural effusion, thoracic ultrasound also helps clinicians to identify the best puncture site and to guide the drainage insertion procedure. Thoracic ultrasound is essential during these invasive manoeuvres to increase safety and decrease potential life-threatening complications. This paper provides a technical description of pigtail-type drainage insertion using thoracic ultrasound, paying particular attention to indications, contraindications, ultrasound guidance, preparation/equipment, procedure and complications...

No abstract text is available yet for this article.

BACKGROUND: The use of point-of-care ultrasound (POCUS) has become increasingly important in resource-limited settings. It can rapidly diagnose both tropical infectious diseases and more common pathology at the bedside. In these practice settings, POCUS can have a significant impact on management strategies and patient care. Ultrasonography has been the gold standard for the diagnosis and staging of Echinococcus disease. However, even in the "classic" clinical scenario and setting, the clinician must maintain a broad differential diagnosis...