POCUS journal最新文献

{"title":"Dengue Cardiomyopathy Treatment Strategy Optimisation by Integrating Point of Care Ultrasound (POCUS) with VExUS.","authors":"Wei Ven Chin, Mae Jane Khaw","doi":"10.24908/pocus.v9i2.17706","DOIUrl":"10.24908/pocus.v9i2.17706","url":null,"abstract":"<p><p>Dengue fever is an arthropod-borne viral disease that is widespread throughout the world. We report a case of dengue cardiomyopathy that was detected and treated to best effect using point of care ultrasound (POCUS) and the VExUS score. A 75-year-old lady with no known comorbidities presented with a ten-day history of fever, vomiting, loose stool, and poor appetite. Upon arrival, she was febrile and hypotensive. POCUS examination showed reduced left ventricular systolic function, inferior vena cava measuring 2.27 cm and VExUS grading of 2 to 3. Dengue serology IgM and IgG were positive and NT-proBNP was raised at 12500 pg/ml. Instead of fluid resuscitation, diuretic and inotropes were initiated along the line of cardiogenic shock secondary to dengue cardiomyopathy. Serial normal cardiac enzymes and electrocardiogram excluded acute coronary syndrome. She was discharged well, and repeated echocardiography one-month post discharge showed normal left ventricular systolic function with no clinical signs or symptoms of heart failure.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"42-45"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-Guided Nerve Blocks for Flexor Tenosynovitis.","authors":"John M Bowling, Erick Zoumberakis","doi":"10.24908/pocus.v9i2.17395","DOIUrl":"10.24908/pocus.v9i2.17395","url":null,"abstract":"<p><p>Performing an ultrasound-guided nerve block (UGNB) is now common practice in many emergency departments (EDs) and is considered a core skill according to the American College of Emergency Physicians (ACEP). Nerve blocks are mostly utilized for fractures and laceration repairs, however, these blocks have many other applications. We present a case of utilizing an ulnar UGNB in a patient with flexor tenosynovitis and a history of intravenous drug use (IVDU) when parental opiates proved to be ineffective.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"12-14"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inside the November 2024 Issue.","authors":"Benjamin T Galen","doi":"10.24908/pocus.v9i2.18344","DOIUrl":"https://doi.org/10.24908/pocus.v9i2.18344","url":null,"abstract":"","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare Cause of Pediatric Abdominal Pain Diagnosed on Point of Care Ultrasound (POCUS).","authors":"Courtney Owens, Lindsey Chaudoin","doi":"10.24908/pocus.v9i2.17451","DOIUrl":"10.24908/pocus.v9i2.17451","url":null,"abstract":"<p><p>An 11-year-old postmenarchal female presented to the pediatric emergency department (ED) with 2 days of periumbilical and right lower abdominal pain. Radiology-performed ultrasound (RADUS) did not visualize the appendix, and there was a plan for surgical consultation to decide between serial abdominal exams versus computed tomography (CT) scan. While awaiting consultation and to help further narrow the differential diagnosis, the emergency provider performed a point of care ultrasound (POCUS) of the urinary tract. This revealed several anomalies including a solitary left kidney with hydronephrosis, and a well-circumscribed, fluid-filled structure with mixed echogenicity posterior to the bladder and inferior to the uterus. Given these findings on POCUS, further imaging was pursued, including a RADUS of the pelvis followed by a magnetic resonance imaging (MRI) of the abdomen. Further imaging ultimately diagnosed a bicornuate uterus, septate vagina with hematocolpos and solitary left kidney consistent with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome. This case is an illustration of how POCUS is an invaluable tool to narrow the differential diagnosis and guide advanced imaging or consultation for both common and rare causes of pediatric abdominal pain.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"32-34"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of a Stress Fracture Of a Metatarsal Bone with Point of Care Ultrasound (POCUS).","authors":"Alfred Doblinger","doi":"10.24908/pocus.v9i2.17393","DOIUrl":"10.24908/pocus.v9i2.17393","url":null,"abstract":"<p><p>The early diagnosis of stress fractures is a challenge in daily primary care practice. Point of care ultrasound (POCUS) can be helpful in the diagnosis of early signs of an incipient stress fracture. A 52-year-old woman presented with a history of chronic overuse in the left forefoot. A sonographic examination in the area of the reported pain point on the third metatarsal (consistent with a marching fracture) showed a clear accumulation of fluid, corresponding to subperiosteal hematoma. After only two weeks of resting the forefoot, a repeat examination using POCUS showed clear callus formation. This confirmed the suspected diagnosis of an early stage stress fracture. This case shows a sensible and easy-to-learn way of using POCUS in general practice. POCUS in combination with clinical examination and anamnesis is a cost-effective and timely diagnostic option without radiation exposure.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"15-17"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11620796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cardiac Tumor and Liver Masses on Point of Care Ultrasound (POCUS): Implications in a Resource-Limited Setting.","authors":"Waseem Sous, George Limwado, Enoch Ndarama, Michaela Sous","doi":"10.24908/pocus.v9i2.17665","DOIUrl":"10.24908/pocus.v9i2.17665","url":null,"abstract":"<p><p>Malignant cardiac tumors are quite rare, but portend a poor prognosis 1, 2. Early identification and classification are essential given their aggressive nature, particularly when metastases are present 3, 4. Clinical presentations are varied, and detection relies primarily on echocardiography. Thus, cardiac tumors may go undiagnosed in areas where echocardiography is not routinely available 1, 5. In this case, point of care ultrasound (POCUS) rapidly detected a cardiac mass and liver lesions, prompting referral to a central hospital in Malawi for further evaluation. This case highlighted the potential role of POCUS as a readily available tool in a resource-limited setting, serving as a triage point for more definitive diagnosis and management 6, 7, 8.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"18-21"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Just In Time! Assessment of Internal Medicine Resident Point of Care Ultrasound (POCUS) Attitudes and Behaviors After Spaced Intervention at Two Residency Programs.","authors":"Kevin M Piro, Patricia A Carney, Christopher J Smith","doi":"10.24908/pocus.v9i2.17635","DOIUrl":"10.24908/pocus.v9i2.17635","url":null,"abstract":"<p><p>Point of care ultrasound (POCUS) is a complex psychomotor skill that requires scaffolded support for skill acquisition. However, the effect of spaced curricular elements on learner POCUS behaviors are not clearly understood. Using a multi-site observational cross-sectional survey study, we measured resident baseline POCUS use, behaviors, and attitudes and then implemented POCUS workflow and just-in-time POCUS curricula during internal medicine resident ward rotations and assessed changes. Self-reported personal and team POCUS use and documentation habits all improved between baseline and the just-in-time teaching. Personal POCUS use correlated with team POCUS use (ρ=0.431; p<0.001) and co-resident POCUS use (ρ=0.242; p=0.035). Attending POCUS use correlated with team POCUS use (ρ=0.523; p< 0.001), but not personal use. Overall, we found moderate, but statistically significant, improvements in reported resident and team performance of POCUS and documentation habits, suggesting that just-in-time interventions may promote POCUS use. Co-learning also appears to be a key influencer for POCUS use.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"93-101"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visualizing the Real Time Reduction of Pulled Elbow Using Point of Care Ultrasound (POCUS).","authors":"David J Mccreary, Mbbs Mrcph, Pgc Us","doi":"10.24908/pocus.v9i2.17961","DOIUrl":"10.24908/pocus.v9i2.17961","url":null,"abstract":"<p><p>POCUS is a useful tool for correctly identifying pulled elbow. We believe that clinicians working in Pediatric Emergency Departments should be encouraged to embrace using it in cases which are less straightforward - either due to an atypical history or based on examination findings. This will serve to not only increase safety and improve the patient journey, but also to improve the clinician's confidence in their practice. This is the first ever documented instance where the reduction of pulled elbow has been demonstrated in real time using POCUS.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"30-31"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Standard Gait Measures and Anterior Quadriceps Muscle Thickness as Measured by Point of Care Ultrasound (POCUS).","authors":"Uyanga Ganbat, Boris Feldman, Shane Arishenkoff, Graydon S Meneilly, Kenneth M Madden","doi":"10.24908/pocus.v9i2.17659","DOIUrl":"10.24908/pocus.v9i2.17659","url":null,"abstract":"<p><p><b>Background:</b> Gait parameters and sarcopenia both predict falls risk among older adults. Our objective was to evaluate whether fast, easy-to-obtain measures of anterior thigh muscle by point of care ultrasound (POCUS) are significantly associated with standard gait measures. <b>Methods:</b> All subjects were referred from ambulatory geriatric medicine clinics at an academic center. Quadriceps muscle thickness was measured by a portable ultrasound device. Gait variables were measured by the patient in comfortable walking shoes walking for six minutes. The primary response variables were gait variables, and the predictor variables were age, biological sex, body mass index, and muscle thickness. Univariate and multivariate regression analyses were performed. <b>Results:</b> A total of 150 participants were recruited from geriatric medicine clinics (65 women, 84 men). Muscle thickness was measured in 149 participants, and the mean (SD) was 1.91 (0.52) (median 1.82 cm, 0.96 to 3.68 cm). Univariate analysis of gait parameters with age showed a statistically significant correlation with gait speed (R²=0.16, P < 0.000), average stride length (R²=0.142, P < 0.000), and average stride velocity (R²=0.182, P < 0.000). Among all the gait variables, average swing time (P = 0.010) and average stance time (P = 0.010) were correlated significantly with muscle thickness. For multivariate analysis with age and gait variables, age was a significant independent variable for all gait variables that were significant in univariate analysis. <b>Conclusion:</b> POCUS showed a significant association with average swing time, average stance time, and step time variability. Although more work needs to be done, POCUS has the potential to be a rapid screening tool for gait assessment.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"117-124"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Piloting a Diagnostic Foot and Ankle Fracture Sonographic Algorithm with Rural and Adolescent Patients.","authors":"Tomas Alamin, Margaret Lin-Martore, Aaron E Kornblith, Aidan O'Donnell, Sally Gragalia","doi":"10.24908/pocus.v9i2.17550","DOIUrl":"10.24908/pocus.v9i2.17550","url":null,"abstract":"<p><p><b>Background:</b> Foot and ankle injuries are a common presenting complaint to the Emergency Department (ED) and are often assessed with plain radiography. Rural environments may not have access to radiography mandating the referral or transfer patients to regional centers for definitive diagnosis. The Ottawa Foot and Ankle Rules (OFAR) is a clinical decision rule that can assist in ruling out fractures. Point of care ultrasound (POCUS) can augment this decision rule. The objective of this study was to assess both the feasibility and test characteristics of a previously described POCUS augmented clinical assessment, OFAR-POCUS, for adolescent and adult patients with foot and ankle pain in a rural environment. <b>Methods:</b> This was a prospective cohort study from June to August 2022 including patients with chief complaint of foot or ankle injury presenting to a rural clinic. Patients were included if they had positive finding(s) on the OFAR Test and required radiographic imaging. Patients were excluded if they did not consent, speak English, were unable to be scanned, had obvious joint deformities, had altered mental status, were not physiologically stable, had other injuries preventing sonography, were pregnant, or had previous injury with internal fixation, osteomyelitis, or rheumatoid arthritis. POCUS was performed before transport for radiography. POCUS examiners were POCUS novices who underwent a one and a half to two-hour, standardized foot and ankle POCUS training session. All POCUS studies were reviewed by two emergency medicine ultrasound fellowship trained faculty for quality assurance. Standard test characteristics were calculated for bedside clinician and expert POCUS interpretations compared to the radiographic control. <b>Results:</b> Thirteen POCUS examiners performed exams on 20 patients included in analysis; four patients had fractures on radiograph (20%). The bedside clinician POCUS interpretation had sensitivity (SN) = 100% (95% Cl, 40%-100%), specificity (SP) =94% (95% Cl, 70%-100%), and negative likelihood ratio (-LR) = 16.00 (95% Cl, 2.40-106.73). Expert POCUS interpretation had SN=75% (95% Cl, 19%-99%), SP=75% (95% Cl, 48%-93%), and -LR=0.33 (95% Cl, 0.06-1.86). <b>Conclusion:</b> A POCUS enhanced clinical strategy for clinically significant foot and ankle fractures in adolescent and adult patients in a rural setting is feasible. Larger studies are required to further characterize test characteristics and use of foot and ankle POCUS where plain radiography is unavailable.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"102-108"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}