POCUS journal最新文献

{"title":"Diagnosis of Cutaneous Larva Migrans using Point of Care Ultrasound","authors":"Daniella Lamour, Robert A. Farrow, Jean Pierre, Paul Khalil","doi":"10.24908/pocus.v9i1.17470","DOIUrl":"https://doi.org/10.24908/pocus.v9i1.17470","url":null,"abstract":"Abstract Larva migrans is a cutaneous parasitic infection that occurs when an immature hookworm larva inadvertently penetrates the dermis of a human, typically on the extremities. Traditionally, a clinical diagnosis is made when a tortuous/serpiginous eruption is seen superficially in the skin with complaints of intense pruritus. Point of care ultrasound (POCUS) is a useful diagnostic tool for soft tissue complaints in the emergency department (ED). We describe a case of an 18-year-old woman who presented to the ED with foot pruritis four days after walking on the beach barefoot. POCUS examination revealed several motile structures in the dermis of the patient’s foot, confirming our suspicion of cutaneous larva migrans. The patient was then placed on an oral anthelmintic and her symptoms resolved shortly after.","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"54 16","pages":"33 - 35"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid Flow Time Compared with Invasive Monitoring as a Predictor of Volume Responsiveness in ICU patients.","authors":"Tomislav Jelic, Jordan Chenkin","doi":"10.24908/pocus.v8i2.16545","DOIUrl":"https://doi.org/10.24908/pocus.v8i2.16545","url":null,"abstract":"<p><p><b>Objectives</b><b>:</b> Identifying patients who will have an increase in their cardiac output from volume administration is difficult to identify. We propose the use of carotid flow time, which is a non-invasive means to determine if a patient is volume responsive. <b>Methods</b><b>:</b> Patients admitted to a critical care unit with a pulmonary artery catheter in place were enrolled. We perform a carotid flow time and pulmonary artery catheter measurement of cardiac output pre and post-passive leg raise and comparing the two. An increase of 10% change in the pre- vs. post-passive leg raise measurement would be indicative of a patient who is volume responsive. <b>Results</b><b>:</b> We identified 8 patients who were volume responsive as determined by the gold standard pulmonary artery catheter. The sensitivity 87.5% and specificity 90.9%. Pearson correlation coefficient between PA-CO measurements and CFT was r=0.8316, indicative of strong correlation between the two measurements. <b>Conclusion</b><b>:</b> In our patient sample of critically ill patients with pulmonary artery catheters, we found a strong correlation between corrected carotid flow times and cardiac output measurements from pulmonary artery catheters.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"8 2","pages":"212-216"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10723903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138814224","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":"Handheld Lung Ultrasound to Detect COVID-19 Pneumonia in Inpatients: A Prospective Cohort Study.","authors":"Thomas F Heyne, Kay Negishi, Daniel S Choi, Ahad A Al Saud, Lucas X Marinacci, Patrick Y Smithedajkul, Lily R Devaraj, Brent P Little, Dexter P Mendoza, Efren J Flores, Milena Petranovic, Steven P Toal, Hamid Shokoohi, Andrew S Liteplo, Benjamin P Geisler","doi":"10.24908/pocus.v8i2.16484","DOIUrl":"10.24908/pocus.v8i2.16484","url":null,"abstract":"<p><p><b>Background</b>: Chest imaging, including chest X-ray (CXR) and computed tomography (CT), can be a helpful adjunct to nucleic acid test (NAT) in the diagnosis and management of Coronavirus Disease 2019 (COVID-19). Lung point of care ultrasound (POCUS), particularly with handheld devices, is an imaging alternative that is rapid, highly portable, and more accessible in low-resource settings. A standardized POCUS scanning protocol has been proposed to assess the severity of COVID-19 pneumonia, but it has not been sufficiently validated to assess diagnostic accuracy for COVID-19 pneumonia. <b>Purpose</b>: To assess the diagnostic performance of a standardized lung POCUS protocol using a handheld POCUS device to detect patients with either a positive NAT or a COVID-19-typical pattern on CT scan. Methods: Adult inpatients with confirmed or suspected COVID-19 and a recent CT were recruited from April to July 2020. Twelve lung zones were scanned with a handheld POCUS machine. Images were reviewed independently by blinded experts and scored according to the proposed protocol. Patients were divided into low, intermediate, and high suspicion based on their POCUS score. <b>Results</b>: Of 79 subjects, 26.6% had a positive NAT and 31.6% had a typical CT pattern. The receiver operator curve for POCUS had an area under the curve (AUC) of 0.787 for positive NAT and 0.820 for a typical CT. Using a two-point cutoff system, POCUS had a sensitivity of 0.90 and 1.00 compared to NAT and typical CT pattern, respectively, at the lower cutoff; it had a specificity of 0.90 and 0.89 compared to NAT and typical CT pattern at the higher cutoff, respectively. <b>Conclusions</b>: The proposed lung POCUS protocol with a handheld device showed reasonable diagnostic performance to detect inpatients with a positive NAT or typical CT pattern for COVID-19. Particularly in low-resource settings, POCUS with handheld devices may serve as a helpful adjunct for persons under investigation for COVID-19 pneumonia.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"8 2","pages":"175-183"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10721309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138814244","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":"Optimizing Care for High-Risk Multiple Pregnancy with POCUS - A Case of Quadruplet Pregnancy Early Diagnosis.","authors":"Bernardo Vidal Pimentel, Christopher Tsoutsoulas, Kristin Lythgoe, Frank Myslik","doi":"10.24908/pocus.v8i2.16562","DOIUrl":"https://doi.org/10.24908/pocus.v8i2.16562","url":null,"abstract":"<p><p>Managing multiple pregnancies is challenging and requires careful evaluation. Point of care ultrasound (POCUS) has emerged as a potentially crucial tool in assessing suspected first-trimester pregnancies. However, its role in evaluating multiple pregnancies remains uncertain. We present the case of a 36-year-old Ghanaian female who presented with acute vaginal bleeding after undergoing in vitro fertilization. A bedside transabdominal POCUS identified four intrauterine gestations with fetal poles and cardiac activity, suggesting a quadruplet viable pregnancy. A subsequent transvaginal ultrasound confirmed the findings. The patient was discharged with a follow-up appointment with an Obstetrician-Gynecologist. This case highlights the significance of POCUS in early pregnancy diagnosis, facilitating accurate identification and appropriate referral for further management. It also demonstrates the utility of POCUS in determining gestational age and viability. To our knowledge, no published case reports specifically address the diagnosis of a quadruplet pregnancy, emphasizing the role of POCUS in optimizing care for high-risk multiple pregnancies.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"8 2","pages":"126-128"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10721298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138814263","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":"Renal Transplant Artery Stenosis and Kinking: An Unusual Association.","authors":"R Haridian Sosa Barrios, V Burguera Vion, E Casillas Sagrado, D Villa Hurtado, S Jiménez Álvaro, I Martín Capón, M Fernández Lucas, Maite E Rivera Gorrín","doi":"10.24908/pocus.v8i2.16461","DOIUrl":"https://doi.org/10.24908/pocus.v8i2.16461","url":null,"abstract":"<p><p>Renal artery stenosis of the kidney allograft associated with kinking is not a frequent finding. As a correctable cause of graft dysfunction, it is important to diagnose it as soon as possible to avoid further graft damage and improve graft and patient survival. As pulsed wave Doppler ultrasound mapping of the graft's renal arteries is essential to diagnose possible alterations, point of care ultrasound (POCUS) is a highly useful tool for early diagnosis. We present a case in which nephrologists performed this examination promptly allowing a timely diagnosis and treatment plan.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"8 2","pages":"132-135"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10721294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138814319","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 Impact of a Handheld Ultrasound Device in a Rheumatic Heart Disease Screening Program in Ethiopia.","authors":"Zachary P Kaltenborn, Anteneh Zewde, Jonathan D Kirsch, Michelle Yates, Katelyn M Tessier, Eileen Nemec, Ronald A Johannsen","doi":"10.24908/pocus.v8i2.16390","DOIUrl":"https://doi.org/10.24908/pocus.v8i2.16390","url":null,"abstract":"<p><p><b>Background:</b> Rheumatic heart disease (RHD) affects 33 million people in low and middle income countries and is the leading cause of cardiovascular death among children and young adults. Penicillin prophylaxis prevents progression in asymptomatic disease. Efforts to expand echocardiographic screening are focusing on simplified protocols, non-physician ultrasonographers, and portable ultrasound devices, including handheld ultrasound. Recent advances support the use of single-view screening protocols. With the increasing availability and low cost of handheld devices, studies are needed to evaluate their performance in these settings. <b>Methods:</b> We conducted a retrospective study comparing the rate of screen positive ultrasounds before and after the use of a handheld ultrasound in an RHD screening program in Ethiopia. We also performed a cross-sectional device comparison in 19 at-risk school-children participating in the rheumatic heart disease screening program. <b>Results:</b> Between March of 2019 and January of 2022, 6631 children were screened for rheumatic heart disease of whom 4029 were screened after the introduction of a handheld device. Before the use of the handheld ultrasound device 291 (11.2%) children had a screen positive ultrasounds compared with 167 (4.1%) afterwards (p<0.001). We also compared non-expert to expert interpretation by device and found a significant difference in interpretation for the Lumify (p=0.025). There was a trend towards shorter jet length by color Doppler in the handheld ultrasound device for both expert and non-expert review. <b>Conclusions:</b> Our study highlights that the screen-positive rate in a RHD screening program is influenced by the device being used in the screening process.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"8 2","pages":"193-201"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10721305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138814336","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 Use of POCUS-Obtained Optic Nerve Sheath Diameter in Intracerebral Hemorrhage.","authors":"Alireza Nathani, Shekhar A Ghamande, Sarita Kambhampati, Braden Anderson, Matthew Lohse, Heath D White","doi":"10.24908/pocus.v8i2.16563","DOIUrl":"https://doi.org/10.24908/pocus.v8i2.16563","url":null,"abstract":"Background: Intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. ICH causes increased intracranial pressure (ICP), leading to brain herniation as the disease progresses. Neurological physical exam and monitoring of the disease progression can be challenging due to the impaired consciousness and routine clinical management in this patient population. Given the continuity of the intracranial cavity with the optic nerve subarachnoid space, an increased ICH leads to distension of the optic nerve sheath. We herein examined the correlation between the ICH volume and the optic nerve sheath diameter (ONSD) measured by point of care ultrasound (POCUS). Methods: Patients with ICH diagnosed with a head computed tomography (CT) scan were prospectively enrolled in this study. A portable ultrasound was used to measure the (ONSD); the volume of ICH hematoma, the Acute Physiology And Chronic Health Evaluation IV score, and the Intracerebral Hemorrhage score were collected. A Spearman rank correlation coefficient test was used to assess the relationship between continuous variables. A Wilcoxon rank sum test was used to assess differences in continuous variables between two groups. A p-value less than 0.05 was deemed as statistically significant. Results: A total of 28 subjects were enrolled. A moderate positive correlation was detected between hemorrhage volume and the average ONSD (correlation = 0.4214, p = 0.0255). A weak positive correlation was detected between average ONSD and APACHE IV (correlation = 0.2347, p = 0.2294). A weak moderate positive correlation was detected between average ONSD and ICH score (correlation = 0.1160, p = 0.5566). Conclusions: In this study we demonstrate that ONSD is moderately correlated with hematoma size. A potential application may include serial measurements of the ONSD with ultrasound. This may offer a quick, non-invasive technique that can be used in an intracerebral hemorrhage to monitor the stability or expansion of a hematoma indirectly, and potentially catch a catastrophic event like cerebral herniation.","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"8 2","pages":"170-174"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10721284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138814415","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 Use of Point of Care Ultrasound in Diagnosis of Peritonsillar Abscess.","authors":"Brian Kohen, Melanie Perez, Jheanelle Mckay, Rolando Zamora, Curtis Xu","doi":"10.24908/pocus.v8i2.16568","DOIUrl":"https://doi.org/10.24908/pocus.v8i2.16568","url":null,"abstract":"<p><p>The use of point of care ultrasound (POCUS) for diagnosis and treatment of peritonsillar abscess (PTA) is increasing 1. Proven advantages include improved diagnostic accuracy and treatment success rates as well as decreased otolaryngology consultation, computed tomography (CT) usage, return visits to the emergency department (ED), and length of stay 1. We present a case of a patient with a PTA that was diagnosed and successfully treated utilizing POCUS, avoiding the need for otolaryngology consultation and CT.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"8 2","pages":"116-117"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10721292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138814426","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":"Brain Point of Care Ultrasound in Young Children Receiving Computed Tomography in the Emergency Department: A Proof of Concept Study.","authors":"Stephanie R Davenport, Nadya Ben Fadel, Jorge Davila, Nick Barrowman, Vid Bijelic, Allan E Shefrin","doi":"10.24908/pocus.v8i2.16435","DOIUrl":"https://doi.org/10.24908/pocus.v8i2.16435","url":null,"abstract":"<p><p><b>Background</b>: Point of Care Ultrasound (POCUS) is an important tool in pediatric emergency medicine. In neonatal intensive care medicine ultrasound is often used to evaluate the brains of sick neonates. In theory, POCUS could be used in the ED in young children to evaluate the brain for abnormal pathology. <b>Objectives</b>: To examine the ability of PEM faculty to use brain POCUS to identify clinically significant brain injuries in children with head injuries and/or abnormal neurological exams, and generate sensitivity and specificity of brain POCUS in assessing such findings. <b>Methods</b>: This study used a convenience sample of patients seen in a tertiary care pediatric centre who required a CT head. A team of physicians who were trained at a workshop for brain POCUS were on call to perform the POCUS while being blinded to the results of the CT. <b>Results:</b> 21 children were enrolled in the study. Five (24%) of the patients had a CT that was positive for intracranial bleeds. Of the 5 patients with a positive CT, 3 had a brain POCUS scan that was also positive. The two false negative brain POCUS scans were on patients with small bleeds (no surgical intervention required) on CT, as reported by radiology. The sensitivity of brain POCUS was 60% (CI 15% - 95%) with a specificity of 94% (CI 70%-100%). The diagnostic accuracy of brain POCUS was 86% (CI 64% - 97%). <b>Conclusion:</b> This small proof of concept study shows that brain POCUS is an imaging modality with reasonable sensitivity and specificity in identifying intracranial pathologies that are present on CT. Its use may be most beneficial to expedite definitive imaging and subspeciality involvement.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"8 2","pages":"165-169"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10721297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138814193","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":"Critical Care Ultrasound Competency of Fellows and Faculty in Pulmonary and Critical Care Medicine: A Nationwide Survey.","authors":"Mark H Adelman, Himanshu Deshwal, Deepak Pradhan","doi":"10.24908/pocus.v8i2.16640","DOIUrl":"https://doi.org/10.24908/pocus.v8i2.16640","url":null,"abstract":"<p><p><b>Purpose:</b> Competency assessment standards for Critical Care Ultrasonography (CCUS) for Graduate Medical Education (GME) trainees in pulmonary/critical care medicine (PCCM) fellowship programs are lacking. We sought to answer the following research questions: How are PCCM fellows and teaching faculty assessed for CCUS competency? Which CCUS teaching methods are perceived as most effective by program directors (PDs) and fellows. <b>Methods:</b> Cross-sectional, nationwide, electronic survey of PCCM PDs and fellows in accredited GME training programs. <b>Results:</b> PDs and fellows both reported the highest rates of fellow competence to use CCUS for invasive procedural guidance, but lower rates for assessment of deep vein thrombosis and abdominal organs. 54% and 90% of PDs reported never assessing fellows or teaching faculty for CCUS competency, respectively. PDs and fellows perceived hands-on workshops and directly supervised CCUS exams as more effective learning methods than unsupervised CCUS archival with subsequent review and self-directed learning. <b>Conclusions:</b> There is substantial variation in CCUS competency assessment among PCCM fellows and teaching faculty nationwide. The majority of training programs do not formally assess fellows or teaching faculty for CCUS competence. Guidelines are needed to formulate standardized competency assessment tools for PCCM fellowship programs.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"8 2","pages":"202-211"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10721306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138814229","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}