A Review on Abdominal Point-of-Care Ultrasound

Multiple studies confirm that point of care ultrasound (PoCUS) has a high sensitivity and specificity for cholelithiasis and cholecystitis. However, there is poor perceived reliability of biliary PoCUS by surgeons. This survey was performed to assess surgeons’ opinions on using PoCUS in gallstone disease and barriers that exist for its institution. The majority (60.3%) of respondents reported a total lack of confidence in PoCUS for the diagnosis of biliary disease. Most felt the sensitivity of PoCUS was poor and had concerns about the user-dependent nature of the test and the lack of imaging details provided. If offered ideal clinical/laboratory findings with PoCUS results, only 4.7% of surgeons would definitely operate for unremitting biliary colic and 5.4% for cholecystitis. The ability to replicate findings independently increased confidence in clinical decision-making. Our findings suggest there is substantial distrust in biliary PoCUS but that specific ultrasound training for the surgical workforce may prove tremendously beneficial for its utilization.

The role of clinician-performed ultrasonography (US) for suspected appendicitis is unclear. Published data conclude that US has high specificity to rule in the diagnosis of appendicitis, with variable sensitivity to rule it out. Newer data suggest that point-of-care (POC) US may have similar test characteristics. Our objective was to evaluate the effect of POC US in children with suspected appendicitis and its effect on emergency department (ED) length of stay (LOS) and computed tomography (CT) utilization. This was a prospective observational convenience sample of children with suspected appendicitis requiring imaging evaluation that adhered to the Standards for the Reporting of Diagnostic accuracy studies (STARD) criteria. Outcomes were determined by operative or pathology report in those who had appendicitis, and 3-week phone follow-up in those patients who were nonoperative. Differences in ED LOS were analyzed by one-way analysis of variance (ANOVA) between patients who received dispositions after POC US, radiology US, or CT. Test performance characteristics were calculated for all imaging modalities. Among 150 enrolled patients, 50 had appendicitis (33.3%). There were no missed cases of appendicitis in discharged patients at 3-week phone follow-up, nor negative laparotomies in those who went to the operating room. Those who had dispositions after POC US (n=25) had a significantly decreased mean ED LOS (154minutes, 95% confidence interval [CI]=115 to 193minutes) compared with those requiring radiology US (288minutes, 95% CI=257 to 319minutes) or CT scan (487minutes; 95% CI=434 to 540minutes). Baseline CT rate was 44.2% (95% CI=30.7% to 57.7%) prior to study start and decreased to 27.3% (95% CI=20.17% to 34.43%) during the study. CTs were avoided in four patients with conclusive POC US results and inconclusive radiology US results. The sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) forPOC US were60% (95% CI=46% to 72%), 94% (95% CI=88% to 97%), 10 (95% CI=4 to 23), and 0.4 (95% CI=0.3 to 0.6). For radiology US they were 63% (95% CI=48% to 75%), 99% (95% CI=94% to 99%), 94 (95% CI=6 to 1,500), and 0.4 (95% CI=0.3 to 0.6); and for CT they were 83% (95% CI=58% to 95%), 98% (95% CI=85% to 99%), 45 (95% CI=3 to 707), and 0.2 (95% CI=0.05 to 0.5). It may be feasible to reduce ED LOS and avoid CT scan when using POC US to evaluate children with suspected appendicitis. Test characteristics for POC US have high specificity to rule in appendicitis, similar to radiology US. Addition of POC US prior to sequential radiology imaging was safe, without missed cases of appendicitis or negative laparotomies.

Background: The role of Point-of-Care (POC) ultrasonography in domestic Mass Casualty Incidents (MCI) has not been well established. On April 15th, 2013, two improvised explosive devices were detonated near the finish line of the Boston Marathon injuring 264 patients and killing 3. These patients were rapidly stabilized and transported to Boston area hospitals. Objectives: To examine the role of POC ultrasonography during the Emergency Department response to a large-scale domestic MCI, and to identify successful processes as well as barriers to care delivery in order to best prepare for future events. Methods: An online survey containing multiple-choice and open-response questions was distributed to Emergency Medicine housestaff, physician assistants, fellows and attending physicians in the Boston area Emergency Departments who cared for patients during the Boston Marathon MCI. Results: There were 50 respondents from 6 hospitals who were directly involved with patient care. 23 respondents (46%) performed POC ultrasounds during the MCI, but only 8 of these respondents (35%) documented findings in the usual fashion by saving images including patients medical record numbers. Many respondents altered documentation patterns due to lack of patient information/registration data and to time constraints. Focused assessment with sonography in trauma (FAST) exams were reported as the most useful application (96%), followed by lung sliding (36%), and soft tissue/foreign body exams (18%). Respondents noted that POC ultrasound provided clinical information sooner then plain films and computed tomography (CT) scans, as these traditional imaging resources were significantly overwhelmed. Many described the value of POC ultrasound in resource allocation and triage once acute intra-abdominal and thoracic injuries had been excluded. Respondents reported being hindered by too few ultrasound systems or systems with long boot-up times and/or lack of battery power. Conclusions: Though limited by our retrospective survey-based methodology, our findings indicate that POC ultrasound was utilized in the hospital-based response to a large-scale domestic MCI. POC ultrasound was especially useful given delays in traditional imaging. Our findings highlight the difficulties with normal documentation patterns during such events, and suggest that specific planning for POC ultrasound should be incorporated into future MCI preparedness.

SARS-CoV-2 infection in children is uncommon compared to adult population. However, some children required hospital and/or PICU admission. The aim of this short communication is to share our experience with Point-of-Care Ultrasound (POCUS) when managing these patients. Remarkably, all cases presented pleural and pericardial effusions, detected by POCUS, despite showing an adequate urinary output and prior to receiving any kind of fluid resuscitation. Effusions have been described as rare among SARS-CoV-2 infection in adult population. By performing portable chest X-Ray they would have gone unnoticed in our patients. Other POCUS findings consisted of all types of consolidations and coalescent B-line patterns. POCUS was also performed in order to optimize PEEP, checking adequate endotracheal intubation positioning (avoiding the risk of contagiousness related to auscultation in this framework), and to assess volemia status, cardiac performance, and brain neuro-monitoring. There was not cross-infection. In pediatric SARS-CoV-19 effusions are frequent but easily unnoticed unless lung and echo POCUS are performed.

Point of care (POC) ocular ultrasound is becoming commonly used by emergency physicians in the evaluation of emergency department (ED) patients with

Point of care ultrasound is an important perioperative tool as it is portable and reproducible. Moreover, in the COVID-19 pandemic the equipment can be easily protected and allows a complement to physical examination and technical performance. Lung ultrasound can be used for screening, diagnosis and stratification of the disease preoperatively as well as management of ventilation in the intraoperative period and postoperatively. Perioperative point of care ultrasound also includes techniques such as central line insertion and confirmation and correct gastric tube placement. Once again, point of care ultrasound is extremely useful in the perioperative period, especially for the anesthesiologist working in the midst of COVID-19 pandemic.

Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.

Background : The utility of point-of-care ultrasound is well supported by many randomized controlled trials. Gradually pediatric emergency medicine providers and pediatricians are also embracing this technology in everyday practice. Recently American Academy of pediatrics concluded in its policy statement that evidence in support of point-of care ultrasonography as an adjunct to the clinical effectiveness of primary emergency medicine personnel including pediatricians and neonatologists is growing. It further recommended establishment of training, credentialing, and programs for point of care ultrasound to improve the care of pediatric patients. In Indian scenario there are no standard guidelines for the practice of point-of-care ultrasound by pediatricians. Results : Keeping this perspective in mind we present here a case series of five patients with cardiac masses which were detected during point of care ultrasound. First case was paraneonate who presented with pyrexia of unknown origin and refractory congestive cardiac failure .During POCUS left atrial mass was detected which was acting like mitral valve stenosis .Mass was removed surgically and was found to be myxoma . Second was known case of nephrotic syndrome presented with peritonitis and septic shock and right atrial thrombus was detected accidentally .He was started on low molecular weight heparin after stabilization and resolution of thrombus was seen on follow up. Third case was chronic renal disease on permanent dialysis with permacath in left internal jugular vein .He presented with flash pulmonary edema and right atrial mass at the tip of catheter .His blood culture grew citrobacter .He was treated for infective endocarditis but succumbed to his primary disease after 2 months. Fourth case was diagnosed case of ventricular septal defect at birth ,who presented to us with stroke and mitral valve vegetations were found during POCUS. His blood culture grew rapidly growing non-tuberculous mycobacteria .He died after 3 months of diagnosis.Fifth case was diagnosed case of acute myeloid leukemia with febrile neutropenia ,who had large right ventricular mass which was removed by open heart surgery and turned out to aspergilloma. He had stormy post operative course and died . Conclusion : Out of five patients,four patient had predisposing factors for either thrombus or infective endocarditis and three patient died during course of illness. In all these patients ,detection of cardiac mass by point of care ultrasonography accelerated the management.

Introduction Point-of-care (POC) ultrasonography is rapidly expanding within clinical practice. POC ultrasonography is per definition a bedside examination performed and interpreted by the treating physician. The development witnessed, in part, reflects equipment of increased quality, mobility and availability—the latter as a result of reduced costs. POC ultrasonography appears to be a safe and valuable tool, supporting the physician in patient management. It holds obvious advantages in being an easily repeatable and real-time examination that supplies images, which correlate directly to the patient’s symptoms or the clinically suspected diagnosis. In terms of airway, breathing, circulation (ABC-) ultrasonography, it covers cardiac, pulmonary, abdominal and vascular ultrasound. The aim of this critical review was to discuss POC ultrasonography. Conclusion The diffusion of POC ultrasonography will continue into the acute care specialities, such as emergency medicine, anaesthesiology and intensive care. With appropriate training as well as quality and competence assurance, optimal use of this technology could lead to a reduction in medical errors, accurate diagnosis, optimal treatment, accurate referral and better overall results.

'Point-of-care ultrasound' - legitimate terminology.

![][1] The first pediatric-specific point-of-care ultrasound guidelines are outlined in an AAP policy statement and technical report published in the April issue of Pediatrics (2015;135:e1097-e1104 and e1113-e1122; [bit.ly/1M3P5MQ][2] and [bit.ly/1FOGiKA][3]). ![][4]

Background and Objective: Most pediatric emergency medicine (PEM) fellowships incorporate point-of-care ultrasound (POCUS) training into their curricula. The lack of standardized assessment tools results in variability in the assessment of fellows’ POCUS competency. The common forms of assessment include direct observation, image review, quality assessment, and online or locally developed written examinations. We aimed to develop an evidence-based and consensus-derived template that will serve as a standardized structure for a pediatric POCUS competency assessment tool. Methods: Three authors …

Point-of-Care ultrasound (POCUS) is currently a key tool in evaluating the hemodynamic situation of the critically ill patient. One of the challenges it poses is the evaluation of venous congestion, which presents a very important role in the production of adverse effects in the critically ill patient. The main objective of the study is the development of a venous congestion classification system (VExUS) that uses POCUS to predict acute kidney injury (AKI) after cardiac surgery. This is a prospective, observational, post-hoc, single-center study that includes145 patients. Four measurements are performed: Doppler ultrasound of the hepatic, portal, and intra-renal veins and measurement of the inferior vena cava (IVC) during the first 72 hours after surgery. As a result of this research we can conclude that the use of POCUS associating different measures allows us to identify venous congestion.

Increasingly, echocardiography has been used for hemodynamic monitoring in critically ill patients.It’s different from traditional cardiac ultrasound.For critically ill patients, it can be used not only for disease assessment, timely detection, but also for the dynamic evaluation of multiple-objective integration monitoring and evaluation of the data obtained together with other monitoring methods, in order to provide timely and accurate guidance for the diagnosis and treatment. Key words: Echocardiography; Point of care ultrasound; Hemodynamics; Monitoring

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