POCUS journal最新文献

{"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}

{"title":"Survey on Cardiologists' Perspectives on Cardiac Point of Care Ultrasound (POCUS).","authors":"Linda Liu, Christine Chow, Cooper Kersey, Brandon Wiley, Jonathan R Lindner, Andrew M Pattock, Carlos L Alviar, Sula Mazimbag, Yoonsik Cho, Kavita Khaira, James N Kirkpatrick, Younghoon Kwon","doi":"10.24908/pocus.v9i2.17258","DOIUrl":"10.24908/pocus.v9i2.17258","url":null,"abstract":"<p><p><b>Introduction</b>: Cardiac point of care ultrasound (POCUS) has been used with increasing frequency. As a result of this trend, this study sought to characterize cardiologists' perspectives on cardiac POCUS. <b>Methods:</b> An 18-question survey on demographics, cardiac POCUS clinical practice, education, and infrastructure was distributed by 16 academic medical centers. Likert scale responses were categorized into three groups: 1) \"strongly agree\" or \"agree\" 2) \"strongly disagree\" and \"disagree\" and 3) \"neutral.\" <b>Results:</b> Of the 140 survey responses collected from January to September 2021, 41% of respondents used cardiac POCUS more than twice in an inpatient week. Seventy-one percent of cardiologists believed that cardiac POCUS should be integrated more regularly into clinical practice and into cardiology fellowship education. Less than half of respondents (44%) reported easy access to POCUS devices, and more than half of respondents (56%) did not think there was appropriate institutional infrastructure to easily upload and document cardiac POCUS images (56%). <b>Conclusions</b>: Academic cardiologists had varying opinions on the use and impact of cardiac POCUS. However, most cardiologists believed that cardiac POCUS should be more incorporated within practice despite persisting infrastructure barriers.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"50-54"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782099","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 Rare Case of Hemoperitoneum Diagnosed with Point of Care Ultrasound (POCUS).","authors":"Jina Bai, Todd Cutler","doi":"10.24908/pocus.v9i2.17611","DOIUrl":"10.24908/pocus.v9i2.17611","url":null,"abstract":"<p><p>A 68-year-old man presented with one week of vague abdominal symptoms and was found to have new ascites and pulmonary embolism for which a heparin drip was initiated. We report a case diagnosing hemoperitoneum with point of care ultrasound (POCUS). Identifying hemoperitoneum can be challenging, but POCUS can be a useful tool for its diagnosis. There is limited literature on the sonographic characteristics of hemoperitoneum. Echogenicity of fluid is not a reliable distinguisher between exudative and transudative effusions. The diagnosis of hemoperitoneum in this case was suggested by the progression of POCUS findings over time rather than sonographic characteristics by themselves.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"24-26"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787854","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":"Lung Point in a Case of Bronchoscopy Lung Volume Reduction: Consider Its Mimics Before Inserting the Tube.","authors":"Mohannad Wazirali, Paul M Shaniuk","doi":"10.24908/pocus.v9i2.17551","DOIUrl":"10.24908/pocus.v9i2.17551","url":null,"abstract":"<p><p>Point of Care Ultrasound (POCUS) is used to evaluate many clinical scenarios. Chest POCUS has been integrated as a part of a clinical protocol to assess patients with lung pathology 1. The ability to detect pneumothorax using chest POCUS has been shown to be superior to chest radiography, with specificity reported to be as high as 100% when a lung point sign is identified. In addition to improved diagnostic accuracy, chest POCUS has the added benefits of ease of access and absence of ionizing radiation. Here we describe a case where a patient with a high pre-test probability for pneumothorax had a detected lung point sign, but pneumothorax was ruled out via Computed Tomography (CT). This case highlights the importance of considering the mimics of the lung point sign. This case also shows a unique and interesting finding related to pleural movement restriction post-Bronchoscopic lung volume reduction (BLVR).</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"46-49"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782085","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":"Evaluating a Lung Abscess in a Pediatric Patient using Point of Care Ultrasound (POCUS).","authors":"Alisha Ching, Charles William Kropf","doi":"10.24908/pocus.v9i2.17603","DOIUrl":"10.24908/pocus.v9i2.17603","url":null,"abstract":"<p><p>Application of ultrasound to evaluate pediatric respiratory disease in the emergency department setting is rapidly growing, particularly as we often weigh the risks of exposure to radiation with other readily available imaging modalities in the acute care setting. In this case report, we describe how point of care ultrasound (POCUS) was utilized by emergency providers to characterize a lung abscess diagnosed in a pediatric patient. We also compare the ultrasound findings to other imaging studies.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"36-38"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782076","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":"Implementation and Assessment of a Curriculum for Renal Point of Care Ultrasound (POCUS) Training.","authors":"Yoshiko Ishisaka, Hong Yu Wang, Hayato Mitaka, Elliot Charen, Paru Patrawalla","doi":"10.24908/pocus.v9i2.17479","DOIUrl":"10.24908/pocus.v9i2.17479","url":null,"abstract":"<p><p><b>Purpose:</b> Renal ultrasound is a non-invasive method to assess for obstructive acute kidney injury (AKI). Point of care ultrasound (POCUS) has been shown to be a good screening tool for obstructive AKI, and with formal training, has high sensitivity and specificity. We aimed to evaluate the effectiveness and feasibility of integrating a novel renal POCUS curriculum into an existing two-week nephrology rotation for internal medicine residents. <b>Methods:</b> We enrolled internal medicine residents rotating on a two-week nephrology rotation between September 2022 and June 2023. Pre-recorded online lectures and a hands-on session on image acquisition were provided. Pre-and post-rotation confidence questionnaires and knowledge tests were collected. At the end of the rotation, participants were evaluated using a skills checklist. Evaluation for knowledge retention was assessed 6-12-months post-rotation with a post-survey and knowledge test. <b>Results:</b> Of the 16 residents that were enrolled, 12 residents completed pre- and post-rotation questionnaires and tests, and 15 residents completed the 6-12-month follow-up. The confidence level showed significant improvement post-test and at 6-12-month follow-up. Knowledge test scores showed a trend towards improvement that did not achieve statistical significance (pre- 6.0 [5.0-7.25], post- 6.5 [5.75-8.0], 6-12-months 7.0 [6.0-8.0] p=0.40). On the skills checklist, an average of 16.8 out of 18 steps were done correctly. <b>Conclusion:</b> Our study showed confidence improvement and a trend towards knowledge improvement after integrating a novel Renal POCUS curriculum into a nephrology rotation. Further iterative changes, such as deliberate practice, or practice with immediate feedback, should be considered.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"62-67"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782078","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":"Sonographic Detection of Iatrogenic Carotid Artery Guidewires During Internal Jugular Vein Catheterization.","authors":"James H Moak, Kristen C Swann, Matthew M Kongkatong, Jakob E Ottenhoff, Christopher D Thom","doi":"10.24908/pocus.v9i2.17366","DOIUrl":"10.24908/pocus.v9i2.17366","url":null,"abstract":"<p><p><b>Background:</b> Visualization of the guidewire during internal jugular (IJ) vein catheterization by point of care ultrasound (POCUS) has been recommended for avoiding inadvertent carotid artery dilation. The purpose of this study was to determine the accuracy of POCUS for identifying guidewires inappropriately placed in the carotid artery. <b>Methods:</b> This prospective, observational study involved emergency medicine (EM) residents with varying experience in guidewire visualization. Using an inanimate model, investigators placed guidewires randomly into the carotid artery or IJ vein. Residents, blinded to guidewire location, scanned the model and recorded their findings. The test performance of POCUS for arterially placed guidewires was evaluated through calculation of sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and overall accuracy, using investigator placement as the non-reference standard. <b>Results:</b> Twenty-five residents performed 51 observations. The test performance of POCUS for identifying arterially placed guidewires was sensitivity 95.0% (95%CI = 73.1-99.7%), specificity 96.8% (95%CI = 81.5-99.8%), NPV 96.8% (95%CI = 81.5-99.8%), and PPV 95.0% (95%CI = 73.1-99.7%). The overall accuracy was 96.1% (95%CI = 86.8-98.9%). Residents reported being very confident in their findings in 88.2% of all observations (95%CI = 76.6-94.5%), somewhat confident in 9.8% (95%CI = 4.3-21.0%), and not very confident in 2.0% (95%CI = 0.4-10.3%). No errors occurred among upper-level residents (post-graduate years 2-3) or those reporting >5 prior wire visualizations in live patients. <b>Conclusions:</b> This study is the first to demonstrate that physicians can easily identify misplaced guidewires located in the carotid artery with a high degree of accuracy using POCUS. We recommend routine scanning of the IJ vein and carotid artery prior to vessel dilation to reduce the likelihood of carotid artery injury.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"88-92"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782095","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":"Team-Based Learning & Point of Care Ultrasound (POCUS) to Augment a Preclinical Cardiovascular Physiology Course.","authors":"Mark Danila, Cynthia Zheng, Ryan J Salvatore, Rachel Cary, Sara Youssef, Grace Pinhal-Eenfield, Catherine Chen","doi":"10.24908/pocus.v9i2.17241","DOIUrl":"10.24908/pocus.v9i2.17241","url":null,"abstract":"<p><p><b>Introduction:</b> There has been increasing interest in point of care ultrasound (POCUS) as a learning tool in preclinical medical anatomy and physiology courses. Few interventions have used team-based learning (TBL) to teach cardiac POCUS. This study investigates a novel TBL exercise designed to integrate cardiac anatomy, physiology, and cardiac POCUS education within a first-year cardiovascular (CV) course called Team-Based Learning - Ultrasound (TBL-US). <b>Methods</b>: The TBL-US exercise consisted of four phases: preparation, individual and team readiness assurance, image acquisition and application, and knowledge assessment. Six second-year students were trained to facilitate the session under physician supervision. Pre- and post-session knowledge assessments were administered to determine knowledge acquisition. Pre- and post-session surveys were administered to assess attitudes, beliefs, and confidence surrounding cardiac POCUS. Final exam scores were compared between participants and non-participants of TBL-US and stratified into high- and low-performing subgroups to account for pre-TBL baseline differences in ability between the groups. <b>Results</b>: A total of 54 first-year medical students completed TBL-US. Students showed significant improvement on the post-knowledge assessment compared to the pre-knowledge assessment (70.5% vs. 54.9% [p< 0.001]) and scored significantly higher on the final CV exam compared to non-participants (low-performing group: 85.92% vs. 81.02% [p=0.039], high-performing group: 89.22% vs. 85.95% [p=0.038]). Between 43.3-72.7% of students reported that TBL-US increased their understanding of CV anatomy, physiology, and cardiac POCUS. <b>Discussion</b>: Students found TBL-US to be a valuable teaching modality and improved student knowledge of CV anatomy, physiology, and cardiac POCUS. TBL-US effectively augments the learning of cardiac anatomy and physiology during the preclinical undergraduate medical curriculum.</p>","PeriodicalId":74470,"journal":{"name":"POCUS journal","volume":"9 2","pages":"80-87"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782101","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}