POCUS journal最新文献

{"title":"A Train-the-Trainer Point of Care Ultrasound (POCUS) Program for Pediatric Pneumonia in a Low-Resource Setting.","authors":"Michelle S Lee, Fatima Mir, Amerta Ladhani, Huba Atiq, Shaun K Morris, Mark O Tessaro","doi":"10.24908/pocusj.v10i01.18285","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.18285","url":null,"abstract":"<p><strong>Background: </strong>Lung point of care ultrasound (POCUS) has the potential to transform pediatric pneumonia care in low resource settings. Prior studies of novice POCUS users in such settings showed high agreement with remote POCUS experts for diagnosing pediatric pneumonia, but use of remote experts may falsely inflate this agreement.</p><p><strong>Objectives: </strong>This study aimed to 1. Deliver a train-the-trainer program in Pakistan on lung POCUS for diagnosing pediatric pneumonia; 2. Determine inter-rater reliability between i) study-trained community health workers (CHWs) and a remote expert, with both interpreting POCUS examinations acquired by the CHWs, and ii) study-trained CHWs and local champions, with both interpreting examinations that they had acquired.</p><p><strong>Methods: </strong>Phase 1: Canadian pediatric POCUS experts developed and delivered a lung POCUS training program for two user groups in Pakistan. These groups included local champions (who had POCUS experience) and CHWs (who were POCUS novices). Phase 2: Children with suspected pneumonia underwent two lung POCUS examinations, one by a CHW and one by a local champion. Examinations were recorded and later reviewed by a remote expert for interpretation and quality assurance. Inter-rater reliability was determined.</p><p><strong>Results: </strong>Two local champions and three CHWs were successfully trained. An analysis of 231 recruited patients showed strong inter-rater reliability between study-trained CHWs and remote expert interpretations (κ = 0.83). In contrast, inter-rater reliability was moderate (κ = 0.66) between interpretations by novices and local champions when these users interpreted the examinations that they themselves had acquired.</p><p><strong>Conclusion: </strong>Our study showed that train-the-trainer programs are feasible and can be effective, while highlighting the importance of hands-on training and having local champions provide longitudinal support to novices.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"157-163"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994086","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":"Interrater Agreement of Physicians Identifying Lung Sliding Artifact on B-Mode And M-Mode Point of Care Ultrasound (POCUS).","authors":"Ross Prager, Hans Clausdorff Fiedler, Delaney Smith, Derek Wu, Robert Arntfield","doi":"10.24908/pocusj.v10i01.17807","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.17807","url":null,"abstract":"<p><strong>Background: </strong>Chest point of care ultrasound (POCUS) is a first-line diagnostic test to identify lung sliding, an important artifact to diagnose or rule out pneumothorax. Despite enthusiastic adoption of this modality, the interrater reliability for physicians to identify lung sliding is unknown. Additionally, the relative diagnostic performance of physicians interpreting B-mode and M-mode ultrasound is unclear. We sought to determine the interrater reliability of physicians to detect lung sliding on B-mode and M-mode POCUS.</p><p><strong>Methods: </strong>We performed a cross-sectional interrater agreement study surveying acute care physicians on their interpretation of 20 B-mode and M-mode POCUS clips. Two experienced clinicians determined the reference standard diagnosis. Respondents reported their interpretation of each POCUS B-mode clip or M-mode image. The primary outcome was the interrater agreement, determined by an intra-class correlation coefficient (ICC).</p><p><strong>Results: </strong>From September to November 2023, there were 20 survey respondents. Fourteen (70%) respondents were resident physicians. Respondents were confident or very confident in their skill performing chest POCUS in 14 (70%) cases, with 19 (90%) performing chest POCUS every week or more frequently. The ICC on B-mode was 0.44 and for M-mode was 0.43, indicating moderate agreement. There were no significant differences in interrater reliability between subgroups of confidence or experience.</p><p><strong>Conclusion: </strong>There is only moderate interrater reliability between clinicians to diagnose lung sliding. Clinicians have superior accuracy on B-mode compared to M-mode clips.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"92-98"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030981","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 Right Turn in Diagnosis: Highlighting the Importance of TAPSE in Isolated Right Ventricular Myocardial Infarction.","authors":"Vasudha Dinesh, Arun A Mohanan, Amaravathi Uthayakumar, Vinodha Chandrashekar","doi":"10.24908/pocusj.v10i01.18433","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.18433","url":null,"abstract":"<p><p>Isolated right ventricular myocardial infarction (RVMI) is a rare but significant clinical entity that can present with atypical findings on a standard electrocardiograph (ECG). We present the case of a 65-year-old man with a history of chronic smoking and alcohol use who presented to the emergency department with acute chest pain. An initial ECG showed ST-segment elevation in lead V1 and depression in leads I, aVL, and V2-V6, which did not meet ST-segment elevation myocardial infarction (STEMI) criteria. A right-sided ECG revealed ST-segment elevation in V3R-V6R, concerning for RVMI. Notably, cardiac point of care ultrasound (POCUS) demonstrated normal left ventricular (LV) function without LV or right ventricular (RV) regional wall motion abnormalities (RWMA). However, tricuspid annular plane systolic excursion (TAPSE) was significantly reduced at 1 cm, indicating RV dysfunction despite the absence of RWMA. This is the first known case report that highlights the importance of TAPSE in assessing RV function in isolated RVMI cases. Early recognition and management are crucial, especially in patients with typical presentations, as prompt treatment can prevent complications. This case underscores the need for emergency physicians to maintain a high index of suspicion for RVMI, particularly in atypical presentations, and to utilize cardiac POCUS as an essential tool for evaluation.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"68-71"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036907","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":"Performance of the Cardiovascular Point of Care Ultrasound (POCUS) Exam by Internal Medicine Residents.","authors":"Christopher Chew, Katherine Lang, Manuel De La Rosa, Amanda K Bertram, Ariella Apfel Stein, Apurva Sharma, Timothy M Niessen, Brian T Garibaldi","doi":"10.24908/pocusj.v10i01.17791","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.17791","url":null,"abstract":"<p><strong>Background: </strong>Few studies have examined internal medicine residents' performance using cardiovascular point of care ultrasound (POCUS).</p><p><strong>Methods: </strong>From 2019 to 2022, first-year residents from two academic medical centers in Baltimore participated in the Assessment of Examination and Communication Skills (APECS). Interns examined a single patient with aortic insufficiency and were assessed on physical exam and POCUS technique, identifying physical exam and POCUS findings, generating a differential diagnosis, clinical judgment, and maintaining patient welfare. Spearman's correlation test was used to describe associations between clinical domains. Preceptor comments were examined to identify common errors in physical exam and POCUS exam technique and in identifying correct findings.</p><p><strong>Results: </strong>Fifty-three first-year residents (interns) performed a cardiovascular POCUS exam. Of these, 44 (83%) scored either \"unsatisfactory\" or \"borderline\" on their POCUS technique with a mean score of 29.5 (out of 100). Seventeen (32%) interns were able to correctly obtain a parasternal-long axis (PLAX) view with only 26 (52%) attempting an apical four-chamber (AP4) or subcostal (SUBC) view. Of the 11 participants who correctly obtained both PLAX and parasternal-short views (PSAX), 10 were able to properly identify a normal ejection fraction and the absence of a pericardial effusion. POCUS technique was statistically significantly associated with physical exam technique, identifying the correct POCUS findings, and generating a correct differential diagnosis (r=0.46, p<0.01; r=0.41, p=<0.01; r=0.60, p=<0.01, respectively).</p><p><strong>Conclusion: </strong>Internal medicine interns showed variable skill in performing and interpreting a cardiovascular POCUS exam. Further emphasis on teaching cardiovascular POCUS skills would likely increase ability to identify relevant cardiovascular findings and improve patient care.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"38-44"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014177","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":"The Sound of Safety: DIVOT (Doppler Imaging for Vascular Orientation in Thoracic Procedures) Protocol.","authors":"Amy Fraser, Daniel S Brenner, Matthew Coghlan, Heather Andrade, Maya Haouili, William Graham Carlos, Edwin Jackson","doi":"10.24908/pocusj.v10i01.18071","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.18071","url":null,"abstract":"<p><p>Each year, more than 200,000 thoracentesis and percutaneous chest tube thoracostomy procedures are performed in the United States [1-4]. In both procedures, the initial step involves advancing a needle over the superior aspect of the rib into the intercostal space to access the pleural cavity. Traditional teaching suggests that this technique avoids the neurovascular bundle, which is typically shielded by the inferior border of the rib. However, this technique does not guarantee safety. Computed tomography studies have shown that the intercostal arteries (ICAs) are highly tortuous, with positions that can vary significantly within the intercostal space [5-7]. This variability can lead to ICA laceration even with an optimal traditional technique [8-9]. Significant hemorrhage into the pleural space may initially go unnoticed but can progress to hemorrhagic shock or even tension hemothorax physiology [10-12]. Improved procedural guidance is needed to enhance safety and achieve the goal of zero patient harm. We propose the DIVOT (Doppler Imaging for Vascular Orientation in Thoracic procedures) protocol using a combination of high-frequency linear ultrasound, color, and Power Doppler (PD) to identify an ICA and its collaterals before needle insertion. This can reduce the risk of accidental vascular injury during thoracentesis or percutaneous chest tube thoracostomy.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"83-87"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044312","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 April 2025 10 Year Anniversary Issue.","authors":"","doi":"10.24908/pocusj.v10i01.19279","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.19279","url":null,"abstract":"","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024832","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":"Identification of Pediatric Retrocecal Appendicitis Using Point of Care Ultrasound (POCUS).","authors":"Carl Kaplan, Raizada Vaid, Michael Secko","doi":"10.24908/pocusj.v10i01.17744","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.17744","url":null,"abstract":"<p><p>Acute appendicitis is the most common pediatric surgical emergency. Diagnosis may be made by targeted point of care ultrasound (POCUS) of the right lower quadrant (RLQ) abdomen. This can be performed by trained emergency physicians and has similar accuracy to ultrasound performed by radiology technologists and interpreted by radiologists (RADUS) [1,2]. Pediatric patients with appendicitis may present without classical clinical signs and symptoms. Retrocecal appendicitis is often diagnosed late at perforation due to the anatomical position limiting diagnosis with ultrasound, despite the high prevalence of retrocecal appendix as an anatomic variation (up to 65%). Given the limited sensitivity for ultrasound in the diagnosis of appendicitis in patients with retrocecal appendix, these patients often undergo advanced imaging with computed tomography (CT) or magnetic resonance imaging (MRI), especially when increased abdominal wall thickness and/or high Body Mass Index (BMI) further limit the ultrasound examination [4-6]. We present a case series of retrocecal appendicitis imaged and diagnosed with POCUS, using novel transducer and patient positioning. In addition to standard graded compression of the RLQ with POCUS, this technique may add to the diagnostic accuracy of patients presenting atypically with anatomic variants.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"192-195"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046056","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":"What Lies Beneath? Using Point of Care Ultrasound (POCUS) to Identify Soft Tissue Foreign Bodies in Children and Adults: A Literature Review.","authors":"David McCreary, Bhaskar Sarvesh, Maria Munir","doi":"10.24908/pocusj.v10i01.18072","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.18072","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to evaluate and appraise the existing evidence on the use of point of care ultrasound (POCUS) for identifying soft tissue foreign bodies (FBs).</p><p><strong>Methods: </strong>We searched PubMed, Medline, CINAHL, and Cochrane databases for prospective and retrospective studies evaluating the reliability of POCUS in identifying soft tissue FBs. Our primary intention was to review the paediatric-specific evidence base. However, due to a paucity of literature in this area, we also included relevant adult studies and case reports.</p><p><strong>Results: </strong>We identified a total of 42 unique articles with relevance to our study objective, of which 3 were paediatric cohort studies and 5 were cohort studies involving paediatric patients. There were two paediatric case series and six individual case reports relating to paediatric patients. The remaining studies either involved adults, did not specify the age of their subjects, or were relevant in-vitro studies.</p><p><strong>Conclusion: </strong>POCUS-users regard it as an effective tool for detecting soft tissue FBs. However, the existing evidence base for POCUS use in paediatric patients is limited. Evidence in adults is also relatively lacking compared with other areas of POCUS research, with few large studies evaluating its reliability. This literature review highlights the need for a large prospective paediatric study in order to confirm its effectiveness compared to traditional radiological imaging.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"110-118"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000143","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":"Point of Care Transesophageal Echocardiogram-guided CPR: Area of maximal compression.","authors":"Yannis Amador","doi":"10.24908/pocusj.v10i01.18111","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.18111","url":null,"abstract":"<p><p>During cardiopulmonary resuscitation (CPR), chest compressions are critical for augmenting cardiac output, primarily through left ventricular (LV) compression. However, achieving optimal compression without direct visualization can be challenging. Point of care transesophageal echocardiography (TEE) serves as an invaluable tool for real-time guidance, ensuring accurate chest compression positioning over the LV apex. In this case, initial compressions were misaligned over the left ventricular outflow tract (LVOT) and aortic valve (AV). TEE assessment enabled real-time identification and precise repositioning of compressions to the LV apex, resulting in marked improvements in arterial pressure waveforms and end-tidal CO₂ (ETCO₂)-both reliable indicators of CPR quality. This case highlights the critical role of TEE in cardiac arrest management, offering real-time diagnostic insights and optimizing compression mechanics. Integrating TEE into resuscitation protocols enhances the quality of chest compressions, supports hemodynamic stability, and may ultimately improve patient outcomes.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"61-63"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037908","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":"The Utilization of Point of Care Ultrasound (POCUS) for the Confirmation of Gastric and Post-Pyloric Feeding Tube Placement in a Pediatric Intensive Care Unit.","authors":"Alonso Marron, Michael S Wolf, Marla Levine, Jeremy S Boyd, Marta Hernanz-Schulman","doi":"10.24908/pocusj.v10i01.17785","DOIUrl":"https://doi.org/10.24908/pocusj.v10i01.17785","url":null,"abstract":"<p><p>The aim of this study was to investigate the role of point of care ultrasound (POCUS) as an alternative imaging modality to confirm the location of gastric and post-pyloric feeding tubes in patients admitted to the pediatric intensive care unit (PICU). This was a prospective descriptive study performed at a tertiary care children's hospital. Patients from birth to 17 years of age in whom the medical team placed a temporary enteral feeding tube were eligible for enrollment. The study physician, who was blinded to the radiographic findings, performed a POCUS study of the abdomen. An abdominal radiograph was obtained to confirm the placement in all patients. A total of 13 patients were enrolled, and 14 abdominal POCUS exams were completed. POCUS accurately identified the location of the enteral feeding tube in 10 of the 14 cases. POCUS had a sensitivity and specificity of 85.7% and 57.1%, respectively, in identifying gastric tubes. It had a sensitivity and specificity of 66.7% and 87.5%, respectively, in identifying post-pyloric tubes. No adverse events were reported. This study showed that POCUS had moderate sensitivity and specificity and was, overall, safe. Further studies can assess the level of training needed for improvement in accuracy, and larger studies can help support the findings of this data that POCUS is a safe and accurate alternative to radiographs for enteral feeding tube placement confirmation.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"10 1","pages":"164-174"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054903","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}