Gastric Ultrasound in the Management of Emergency Department Patients with Upper Gastrointestinal Bleeding: A Case Series and Sonographic Technique

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-01-01 DOI:10.1016/j.jemermed.2024.07.015

Robert James Adrian MD , Peter Alsharif MD , Hamid Shokoohi MD, MPH , Stephen Alerhand MD

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引用次数: 0

Abstract

Background

Gastrointestinal bleeding (GIB) is a common condition in the emergency department (ED) with high incidence and mortality.

Objectives

Very early risk stratification of GIB patients can sometimes be a challenge. The decision to intubate these patients is multifactorial and requires careful consideration.

Discussion

Gastric ultrasound (GUS) is an adjunct tool that may help make such decisions and is supported by anesthesiology society guidelines to assess aspiration risk.

Conclusion

In this manuscript, we present a case series of ED patients with upper GIB in whom emergency physicians (2 fellowship-trained attendings and 2 senior residents facile with point-of-care ultrasound) performed GUS. As a supplement to the clinical examination, this sonographic "lavage" (i.e., using GUS in patients with upper GIB) helped predict aspiration risk, support diagnostic reasoning, and expedite early goal-directed management and appropriate disposition. We also provide a step-by-step tutorial using high-quality media, as well as a novel algorithm for translation of this technique to the bedside for emergency physicians.

查看原文本刊更多论文

胃超声在急诊处理上消化道出血患者中的应用：一个病例系列和超声技术。

背景：胃肠道出血（GIB）是急诊科（ED）的常见病，具有较高的发病率和死亡率。目的：GIB患者的早期风险分层有时是一个挑战。对这些患者进行插管的决定是多方面的，需要仔细考虑。讨论：胃超声（GUS）是一种辅助工具，可以帮助做出此类决定，并得到麻醉学会指南的支持，以评估误吸风险。结论：在这篇文章中，我们介绍了一系列急诊医生（2名接受过奖学金培训的主治医生和2名熟练掌握即时超声的老年住院医生）对上GIB的ED患者进行GUS治疗的病例。作为临床检查的补充，超声“灌洗”（即在上GIB患者中使用GUS）有助于预测误吸风险，支持诊断推理，并加快早期目标导向的管理和适当的处置。我们还使用高质量的媒体提供一步一步的教程，以及一种新颖的算法，用于将该技术翻译到急诊医生的床边。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine