Maria A Pereda, Miguel A Chavez, Catherine C Hooper-Miele, Robert H Gilman, Mark C Steinhoff, Laura E Ellington, Margaret Gross, Carrie Price, James M Tielsch, William Checkley
BACKGROUND AND OBJECTIVE: Pneumonia is the leading cause of death of children. Diagnostic tools include chest radiography, but guidelines do not currently recommend the use of lung ultrasound (LUS) as a diagnostic method. We conducted a meta-analysis to summarize evidence on the diagnostic accuracy of LUS for childhood pneumonia. METHODS: We performed a systematic search in PubMed, Embase, the Cochrane Library, Scopus, Global Health, World Health Organization-Libraries, and Latin American and Caribbean Health Sciences Literature of studies comparing LUS diagnostic accuracy against a reference standard...
April 2015: Pediatrics
Federico Barbariol, Luigi Vetrugno, Livia Pompei, Adelisa De Flaviis, Giorgio Della Rocca
In some intensive care, nowadays, ultrasound diagnostics have become an extension of the physical examination (like a stethoscope). In this report, we discuss the case of an acute respiratory failure which arose immediately after the end of general anesthesia. An initial bedside ultrasound evaluation applying the 'BLUE protocol' showed no pathological changes capable of explaining the clinical picture; however, by evaluating also the right and left hemidiaphragms, we made a diagnosis of diaphragmatic dysfunction, which would probably have been difficult to diagnose without the aid of the diaphragm ultrasound...
2015: Critical Ultrasound Journal
Alessandro Squizzato, Luca Galli, Victor E A Gerdes
The best diagnostic strategy to confirm or exclude pulmonary embolism (PE) suspicion needs an appropriate combination of clinical assessment, plasma D-dimer measurement, and computed tomographic pulmonary angiography (CTPA). CTPA should be used with caution in some patient groups, such as patients with known allergy to contrast media, those with severe renal insufficiency, and pregnant women, and could be not immediately available in case of unstable patients. In the emergency setting, alternative diagnostic strategies should be implemented to overcome CTPA limitations...
2015: Critical Ultrasound Journal
Miguel Á Ibarra-Estrada, José A López-Pulgarín, Julio C Mijangos-Méndez, José L Díaz-Gómez, Guadalupe Aguirre-Avalos
BACKGROUND: The evaluation of fluid responsiveness in patients with hemodynamic instability remains to be challenging. This investigation aimed to determine whether respiratory variation in carotid Doppler peak velocity (ΔCDPV) predicts fluid responsiveness in patients with septic shock and lung protective mechanical ventilation with a tidal volume of 6 ml/kg. METHODS: We performed a prospective cohort study at an intensive care unit, studying the effect of 59 fluid challenges on 19 mechanically ventilated patients with septic shock...
December 2015: Critical Ultrasound Journal
Richard A Hoppmann, Victor V Rao, Floyd Bell, Mary Beth Poston, Duncan B Howe, Shaun Riffle, Stephen Harris, Ruth Riley, Carol McMahon, L Britt Wilson, Erika Blanck, Nancy A Richeson, Lynn K Thomas, Celia Hartman, Francis H Neuffer, Brian D Keisler, Kerry M Sims, Matthew D Garber, C Osborne Shuler, Michael Blaivas, Shawn A Chillag, Michael Wagner, Keith Barron, Danielle Davis, James R Wells, Donald J Kenney, Jeffrey W Hall, Paul H Bornemann, David Schrift, Patrick S Hunt, William B Owens, R Stephen Smith, Allison G Jackson, Kelsey Hagon, Steven P Wilson, Stanley D Fowler, James F Catroppo, Ali A Rizvi, Caroline K Powell, Thomas Cook, Eric Brown, Fernando A Navarro, Joshua Thornhill, Judith Burgis, William R Jennings, James B McCallum, James M Nottingham, James Kreiner, Robert Haddad, James R Augustine, Norman W Pedigo, Paul V Catalana
Interest in ultrasound education in medical schools has increased dramatically in recent years as reflected in a marked increase in publications on the topic and growing attendance at international meetings on ultrasound education. In 2006, the University of South Carolina School of Medicine introduced an integrated ultrasound curriculum (iUSC) across all years of medical school. That curriculum has evolved significantly over the 9 years. A review of the curriculum is presented, including curricular content, methods of delivery of the content, student assessment, and program assessment...
December 2015: Critical Ultrasound Journal
Becky J Riggs, Carmelina Trimboli-Heidler, Michael C Spaeder, Marijean M Miller, Nathan P Dean, Joanna S Cohen
Abusive head trauma includes any nonaccidental injury inflicted to a child's head and body. It is often characterized by, but not limited to, the repetitive acceleration-deceleration forces with or without blunt head impact. It has a mortality rate of 30%, and 80% of survivors experience permanent neurologic damage. In this case series, we hypothesize that bedside ultrasonography can be useful in the identification of retinal injuries that are consistent with abusive head trauma. Ocular manifestations of abusive head trauma are identified by dilated ophthalmic examination showing retinal hemorrhages that are too numerous to count, multilayered, and extending to the periphery...
May 2016: Annals of Emergency Medicine
David J Blehar, Bruce Barton, Romolo J Gaspari
OBJECTIVES: Proficiency in the use of bedside ultrasound (US) has become standard in emergency medicine residency training. While milestones have been established for this training, supporting data for minimum standard experience are lacking. The objective of this study was to characterize US learning curves to identify performance plateaus for both image acquisition and interpretation, as well as compare performance characteristics of learners to those of expert sonographers. METHODS: A retrospective review of an US database was conducted at a single academic institution...
May 2015: Academic Emergency Medicine
Arun Nagdev, Michael B Stone
Detection of pericardial effusions using point-of-care focused echocardiography is becoming a common application for clinicians who care for critical patients. Identification of tamponade physiology is of great utility, as these patients require urgent evaluation and management. We describe techniques that the point-of-care clinician sonographer can use to determine the presence or absence of echocardiographic evidence of cardiac tamponade.
June 2011: Resuscitation
Nalan Gökçe Çelebi Yamanoğlu, Adnan Yamanoğlu, İsmet Parlak, Pelin Pınar, Ali Tosun, Burak Erkuran, Gizem Aydınok, Fatih Torlak
OBJECTIVES: This study aims to determine the site of and the best sonographic method for measurement of inferior vena cava (IVC) diameter in volume status monitoring. METHODS: This observational before-and-after study was performed at the intensive care unit of the emergency department. It included hypotensive adult patients with suspected sepsis who were recommended to receive at least 20 mg/kg fluid replacement by the emergency physician. The patients were fluid replaced at a rate of 1000 mL/h, and maximum and minimum IVC diameters were measured and the Caval index calculated sonographically via both B-mode and M-mode...
March 2015: American Journal of Emergency Medicine
Mariantina Fragou, Andreas Gravvanis, Vasilios Dimitriou, Apostolos Papalois, Gregorios Kouraklis, Andreas Karabinis, Theodosios Saranteas, John Poularas, John Papanikolaou, Periklis Davlouros, Nicos Labropoulos, Dimitrios Karakitsos
OBJECTIVE: Subclavian vein catheterization may cause various complications. We compared the real-time ultrasound-guided subclavian vein cannulation vs. the landmark method in critical care patients. DESIGN: Prospective randomized study. SETTING: Medical intensive care unit of a tertiary medical center. PATIENTS: Four hundred sixty-three mechanically ventilated patients enrolled in a randomized controlled ISRCTN-registered trial (ISRCTN-61258470)...
July 2011: Critical Care Medicine
Sarah E Frasure, Joshua S Rempell, Vicki E Noble, Andrew S Liteplo
BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is an exaggerated response to ovulation induction therapy. It is a known complication of ovarian stimulation in patients undergoing treatment for infertility. As assisted reproductive technology and the use of ovulation induction agents expands, it is likely that there will be more cases of OHSS presenting to the Emergency Department (ED). OBJECTIVES: OHSS has a broad spectrum of clinical manifestations, from mild abdominal pain to severe cases where there is increased vascular permeability leading to significant fluid accumulation in body cavities and interstitial space...
August 2012: Journal of Emergency Medicine
Simon A Mahler, Greta Massey, Liliana Meskill, Hao Wang, Thomas C Arnold
BACKGROUND: Studies have shown that vein size is an important predictor of successful ultrasound-guided vascular access. The objective of this study is to evaluate maneuvers designed to increase basilic vein size, which could be used to facilitate ultrasound-guided peripheral intravenous access (USGPIV) in the Emergency Department (ED) setting. METHODS: This was a prospective non-randomized trial. Healthy volunteers aged 18-65 were enrolled. Basilic veins were identified and the cross-sectional area measured sonographically...
August 25, 2011: International Journal of Emergency Medicine
M Blaivas, M J Lambert, R A Harwood, J P Wood, J Konicki
UNLABELLED: Clinical diagnosis of lower-extremity (LE) deep venous thrombosis (DVT) requires confirmation by an imaging study before committing the patient to anticoagulation therapy. Studies have shown that demonstrating compressibility of leg veins under ultrasound is accurate for ruling out DVTs when performed by vascular specialists. Although LE Doppler has become the preferred test for diagnosing DVTs, it is not always available 24 hours per day. OBJECTIVES: To evaluate the accuracy and speed with which emergency physicians (EPs) could perform LE color duplex ultrasonography for the detection of DVT...
February 2000: Academic Emergency Medicine
G T Yusuf, P S Sidhu
Scrotal emergencies represent a small proportion of admissions to the emergency department; however, the intimate nature and potential for serious outcome often cause great anxiety. Rapid assessment is required to exclude fertility-threatening conditions and expedite surgical management. Ultrasound is an essential tool in acute scrotal assessment as it allows rapid, radiation-free, high-resolution imaging and, importantly, assessment of vascularity with colour Doppler imaging. In the presentation of the acute scrotum, the "on-call" practitioner will frequently be asked to exclude pathology requiring surgical management, in particular torsion of the spermatic cord...
September 4, 2013: Journal of Ultrasound
Thomas G Costantino, Jeremy F Kirtz, Wayne A Satz
BACKGROUND: Traditionally, Emergency Physicians (EPs) have used the external jugular (EJ) vein to gain vascular access in patients who have failed nursing attempts at peripheral access. Recently, some EPs have used ultrasound (USIV) to gain peripheral access. STUDY OBJECTIVE: This study seeks to determine which initial approach by EPs would lead to greater success. METHODS: This was a prospective, randomized study of all adult patients who presented to the Emergency Department (ED) between June and December 2007...
October 2010: Journal of Emergency Medicine
G Volpicelli, L A Melniker, L Cardinale, A Lamorte, M F Frascisco
Chronic heart failure is a complex clinical syndrome often characterised by recurrent episodes of acute decompensation. This is acknowledged as a major public health problem, leading to a steadily increasing number of hospitalisations in developed countries. In decompensated heart failure, the redistribution of fluids into the pulmonary vascular bed leads to respiratory failure, a common cause of presentation to the emergency department. The ability to diagnose, quantify and monitor pulmonary congestion is particularly important in managing the disease...
March 2013: La Radiologia Medica
Nathan A Teismann, Ronesha S Knight, Matthew Rehrer, Sachita Shah, Arun Nagdev, Michael Stone
BACKGROUND: Obtaining vascular access is difficult in certain patients. When routine peripheral venous catheterization is not possible, several alternatives may be considered, each with its own strengths and limitations. DISCUSSION: We describe a novel technique for establishing vascular access in Emergency Department (ED) patients: the placement of a standard catheter-over-needle device into the internal jugular vein using real-time ultrasound guidance. We present a series of patients for whom this procedure was performed after other attempts at vascular access were unsuccessful...
January 2013: Journal of Emergency Medicine
Fulvio Pomero, Francesco Dentali, Valentina Borretta, Matteo Bonzini, Remo Melchio, James D Douketis, Luigi Maria Fenoglio
Duplex ultrasound is the first-line diagnostic test for detecting lower limb deep-vein thrombosis (DVT) but it is time consuming, requires patient transport, and cannot be interpreted by most physicians. The accuracy of emergency physician-performed ultrasound (EPPU) for the diagnosis of DVT, when performed at the bedside, is unclear. We did a systematic review and meta-analysis of the literature, aiming to provide reliable data on the accuracy of EPPU in the diagnosis of DVT. The MEDLINE and EMBASE databases (up to August 2012) were systematically searched for studies evaluating the accuracy of EPPU compared to either colour-flow duplex ultrasound performed by a radiology department or vascular laboratory, or to angiography, in the diagnosis of DVT...
January 2013: Thrombosis and Haemostasis
Michael Blaivas, Larry Brannam, Daniel Theodoro
UNLABELLED: Questions have been raised regarding image quality (IQ) provided by portable ultrasound (US) machines. OBJECTIVES: To determine if a difference exists between images obtained with a common portable US machine and those obtained with a more expensive, larger US machine when comparing typical views used by emergency physicians. METHODS: The authors performed a cross-sectional, blinded comparison of images from similar sonographic windows obtained on healthy models using a SonoSite 180 Plus and a General Electric (GE) 400 US machine...
July 2004: Academic Emergency Medicine
B W Frazee, E R Snoey, A Levitt
Emergency Department (ED) patients with suspected deep vein thrombosis (DVT) require an objective vascular study such as ultrasound (US) to confirm the diagnosis prior to treatment or disposition. A simple compression US test of the common femoral vein and popliteal vein reliably detects proximal DVT in symptomatic patients. Application of compression US in the ED by Emergency Physicians (EPs) has been tested in a single previous study. We evaluated the ability of ED compression US, performed by EPs, to diagnose proximal DVT as compared to duplex US performed in a vascular laboratory...
February 2001: Journal of Emergency Medicine
2015-01-22 15:21:23
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