Bedside Ultrasonography Research Articles

Does Ultrasound Really Good Enough to Evaluate the Pneumothorax in the Emergency Department

Thorax computed tomography in patients with thoracic trauma is undeniably a highly beneficial method. However, it also has disadvantages such as difficulties in transferring critical patients to computed tomography, delays in diagnosis, the risk of radiation exposure, and higher costs. On the other hand, ultrasonography can be rapidly performed at the bedside and is a non-invasive technique that poses no risk of radiation exposure. These advantages make it a valuable method in the early diagnosis of thoracic trauma. Therefore, this study aimed to provide insights into the sensitivity and accuracy of bedside ultrasonography in diagnosing pneumothorax in patients presenting with thorax trauma in an emergency department. The study sample comprised 132 patients over 18 years of age who were transferred with thorax trauma to the Emergency Clinic of Bakırköy Dr. Sadi Konuk Training and Research Hospital between January 30, 2015, and June 30, 2015. Ultrasonographic examinations were performed before thoracic computed tomography in all patients for whom a thorax computed tomography was indicated based on the clinical examination by the emergency room physician. The thoracic computed tomography reports, interpreted by a radiologist who was blinded to the ultrasonographic and clinical findings of the patients, were accepted as the gold standard. All 132 patients included in the study underwent Thorax ultrasonography. The average age of the patients was 76.5%, with the youngest patient being 18 years old and the oldest one being 90 years old. Of the patients, 45.38% (n = 101) were men. The results of Thorax ultrasonography showed that 19 patients had pneumothorax. These findings were then compared with the Thorax computed tomography results accepted as the gold standard. The results revealed that Thorax ultrasonography had a sensitivity of 56.2% and a specificity of 99% in detecting pneumothorax. According to the grading on CT, our observation revealed that the sensitivity of ultrasonography to detect pneumothorax increased proportionally with the severity of pneumothorax detected on thoracic computed tomography. The sensitivity of ultrasonography in patients with a grade 2 pneumothorax and those with a grade 3 pneumothorax, according to Thorax computed tomography, was found to be 70% and 100%, respectively. Thorax ultrasonography is a useful technique with high specificity in diagnosing pneumothorax, but its sensitivity decreases significantly when the size is below 1 cm.

Intraoperative FoCUS: Training Practices and Views on Feasibility

To investigate whether resident anesthesiologists perceive intraoperative focused cardiac ultrasonography (FoCUS) as feasible, the self-reported confidence of residents performing intraoperative FoCUS, and United States graduate medical education resident ultrasound training practices. A cross-sectional survey. The United States Accreditation Council for Graduate Medical Education-listed anesthesiology programs over a 3-month period between June 2022 to September 2022. United States anesthesiology residents. A survey. Reported training practices were as follows: 87.3% of respondents reported formal FoCUS training, and the most commonly reported training was "lectures+live-model training under 5 hours annually" at 31%. Most respondents (82%) stated that faculty never or rarely performed bedside FoCUS, and most respondents (69%) reported no intraoperative FoCUS education exposure. The proportion of residents who reported a positive view on the perceived feasibility of intraoperative FoCUS was 53.2% for extremity surgery, 19.8% for laparoscopic surgery, 18.6% for exploratory laparotomy surgery, and 7.9% for robotic surgery. Most respondents (78.6%) indicated a lack of confidence in performing intraoperative FoCUS independently. The authors found no statistical difference in views on feasibility or reported confidence independently performing FoCUS across training years. Training that included "lectures+simulation" or "live-model" for more than 5 hours annually, faculty routinely using bedside FoCUS, and frequent exposure to intraoperative FoCUS increased the odds of reporting confidence. The misconception that intraoperative FoCUS is infeasible appears prevalent, and most of the authors' respondents expressed a lack of comfort independently performing intraoperative FoCUS. Alterations of training practices, including increasing faculty usage of bedside ultrasonography, increasing trainee time performing FoCUS, and incorporating specific intraoperative ultrasound into the ultrasound curriculum, may address these deficiencies.

Chest X-Ray Remains a Vital Component Prior to Tube Thoracostomy.

The identification and treatment of traumatic pneumothorax (PTX) has long been a focus of bedside imaging in the trauma patient. While the emergence of bedside ultrasound (BUS) provides an opportunity for earlier detection, the need for tube thoracostomy (TT) based on bedside imaging, including BUS and supine AP chest X-ray (CXR) is less established in the medical literature. Retrospective data from 2017 to 2020 were collected of all adult trauma activations at a level 1 rural trauma facility. Every adult patient included in this study received a CXR and BUS (eFast) upon arrival. The need for TT was determined by the emergency medicine attending or the trauma surgery attending evaluating the patient. McNemar's chi-squared test and conditional logistic regression analysis were performed comparing BUS, CXR, and the combination of BUS and CXR findings for the need for TT. Subgroup analyses were performed comparing BUS, CXR, and the combination of BUS and CXR for the detection of PTX compared to CT scan. Of the 12,244 patients who underwent trauma activation during this timeframe, 602 were included in the study. 74.9% were males with an age range of 36-63years. Of the 602 patients, 210 received TT. Positive PTX was recorded with BUS in 128 (21%) patients with 16 false negatives (FNs) and 98 false positives (FPs), 100 (17%) PTX were identified with CXR with 114 FNs and 4 FPs, and 72 (11.9%) were noted on both CXR and BUS with 140 FNs and 2 FPs. The odds ratio of TT placement was 22 times with positive BUS alone (P < .0001, 95% CI: 10.9-43.47), 47 times with positive CXR alone (P < .0001, 95% CI: 16.99-127.5), and 70 times with both positive CXR and BUS (P < .0001, 95% CI: 17.08-288.4). A positive finding of PTX on BUS combined with CXR is more indicative of the need for TT in the trauma patient when compared with BUS or CXR alone.

The role of optic nerve sheath diameter measurement in the diagnosis of brain death.

The aim of this study is to evaluate the correlation between optic nerve sheath diameter (ONSD) measured using computed tomography (CT), and ONSD measured using bedside ultrasonography (USG) in the diagnosis of brain death. A total of 21 brain-dead patients were included in the study. The ONSD values of these patients were measured using both USG and CT before and after brain death, and the relationship between these measurements was evaluated. There was a high level of correlation between the right-left eye ONSD measurements conducted before brain death using USG and CT, respectively (p=0.000, p=0.001). There was a high level of correlation between the right-left eye ONSD measurements conducted after brain death using USG and CT, respectively (p=0.000, p=0.00). Pre-brain death ONSD mean values of both left and right eyes, measured using USG and CT, were found to be statistically significantly lower than the mean values of post-brain death measurements. In conclusion, a statistically significant difference was found between the optic nerve sheath diameter values measured before and after brain death using USG and CT. At the same time, it was determined that the values of the optic nerve sheath diameter measured using both CT and USG were correlated.

Incidence of postoperative pulmonary congestion as diagnosed by lung ultrasound in surgeries performed under general anaesthesia: A prospective, observational study.

Administering liberal fluid raises concerns about pulmonary congestion postoperatively. Bedside ultrasonography is a valuable tool for the early detection of pulmonary congestion. In this study, we have used it to ascertain the impact of the duration of surgery and intraoperative fluid volume on the causation of pulmonary congestion. Our objective was to determine the incidence of pulmonary congestion as diagnosed by lung ultrasound in patients undergoing general anaesthesia with varied fluid administration. Seventy participants of American Society of Anesthesiologists physical status I and II, aged between 18 and 60 years, undergoing elective extrathoracic surgeries of over 3 h under general anaesthesia were included. Preoperative lung ultrasound was carried out in all patients, and a postoperative lung ultrasound was carried out at 1 h after extubation. The appearance of three or more "B"-lines was considered positive for lung congestion. Significant differences (P < 0.001) were found in the duration of surgery and the appearance of B-lines in the postoperative period. Participants who developed B lines received, on average, 150% more fluid (1148.16 ± 291.79 ml) than those who did not (591.29 ± 398.42 ml) (P = 0.0240). Net fluid balance was also significantly different in patients who developed B lines (P = 0.0014). None of the patients developed symptoms of lung congestion postoperatively. Long duration of surgery under general anaesthesia (>3 h) with the administration of large volumes of intraoperative fluid and a large net fluid balance are associated with lung congestion as diagnosed by lung ultrasound.

Ultrasonography-Guided Intra-Arterial Hyaluronidase Treatment of Vascular Occlusions.

The purpose of this article is to introduce a recommendation for an adjunct approach to the current treatment protocol for vascular occlusion (VO). Current guidelines for treatment of VO do not incorporate the use of ultrasonographic technology. Using bedside ultrasonography has gained recognition as an effective way to map out the vessels of the face to prevent VO. Ultrasonography has also been found to be helpful for treating VO as well as other hyaluronic acid filler-related complications.

Development and validation of a nomogram for difficult laryngoscopy at visual laryngoscopy: a prospective nested case-control study.

Unsuccessful airway management is associated with increased perioperative morbidity and mortality. Difficult laryngoscopy is a leading cause of unanticipated difficult airways and presents a challenge for anesthesiologists. Airway ultrasound assessment can be used as a priority diagnostic strategy for difficult laryngoscopy because of its diagnostic performance in difficult airways. This study was designed to develop a comprehensive model based on multivariate statistical analysis (including bedside examination tests and ultrasonography) for difficult laryngoscopy. This study was conducted from December 27, 2021, to September 16, 2022. All patients underwent an airway ultrasonographic measurement with a standard operating procedure. The baseline characteristics and bedside examination tests were also recorded. Laryngoscopy with a Cormack-Lehane (CL) grade of 1-2 was defined as "easy laryngoscopy", whereas "difficult laryngoscopy" was based on a CL grade of 3-4. The prediction model was built by using baseline characteristics, bedside examination tests, and ultrasonographic measurements as independent variables and easy/difficult laryngoscopy as the dependent variable. A total of 516 patients were eligible, and 456 patients were finally enrolled in the study. A 4-variable analysis, including inter-incisor gap (IIG), thyromental distance (TMD), the distance from the skin to the tongue root, and airway-related diseases, was performed to construct the optimum prediction model. The area under curve (AUC) value of the prediction model was 0.933 [95% confidence interval (CI): 0.770 to 0.935] in the training set and 0.956 (95% CI: 0.915 to 0.997) in the validation set. The comprehensive model and nomogram, especially the integration of tongue root thickness, can predict the risk of difficult laryngoscopy more accurately and reliably than any other screening method alone, allowing for reasonable individualized regimen decision-making.

An association between gastric contents and gastric volume with gender and comorbidities: An observational study

Abstract Background and Aims: The data regarding fasting gastric contents and gastric volume in patients with comorbidity are lacking. The present study was conducted to determine an association between gender and comorbidities with gastric contents and gastric volume determined by ultrasonography in 8 h fasting patients. It was hypothesized that there is no association between gastric contents and gastric volume with gender and comorbidities. Materials and Methods: The present cross-sectional observational study was conducted in patients aged between 18 and 60 years posted for elective surgery. The patients were advised to overnight fast for a minimum of 8 h. Preoperative bedside ultrasonography was done in the right lateral decubitus position. According to the appearance on the ultrasound, the contents were identified as either empty, clear liquids, or solids. Antral cross-section area was measured and gastric volume was estimated. Statistical Package for Social Sciences for Windows, version 22, was used for analysis. Comparison of the distribution of categorical variables was done using the Chi-square test/Fisher’s exact test. Comparison of parametric and nonparametric continuous variables was done using unpaired t-test and Kruskal–Wallis test, respectively. Results: The mean gastric volume among males and females was 64.8 mL and 64.2 mL, respectively (P = 0.896). The median gastric volume and the median gastric volume in mL/kg were significantly higher in patients who had chronic kidney disease (4.53 mL/kg and 125.5 mL) as compared to other comorbidities such as diabetes mellitus (1.88 mL/kg and 52.3 mL), hypertension (2.05 mL/kg and 53.9 mL), hypothyroidism (1.69 mL/kg and 48.9 mL), and obesity (2.18 mL/kg and 65.6 mL). The percentage of patients who had no gastric content was significantly higher in males as compared to females. There was no statistically significant difference in the type of gastric contents and comorbidities. Conclusions: There was an association between gastric volume and comorbidities, but there was no association between gastric contents and comorbidities. There was an association between gastric contents and gender, but there was an association between gastric volume and gender.

Inferior vena cava ultrasound and other techniques for assessment of intravascular and extravascular volume: an update.

Goals of volume management are to accurately assess intravascular and extravascular volume and predict response to volume administration, vasopressor support or volume removal. Data are reviewed that support the following: (i)Dynamic parameters reliably guide volume administration and may improve clinical outcomes compared with static parameters, but some are invasive or only validated with mechanical ventilation without spontaneous breathing. (ii)Ultrasound visualization of inferior vena cava (IVC) diameter variations with respiration reliably assesses intravascular volume and predicts volume responsiveness. (iii)Although physiology of IVC respiratory variations differs with mechanical ventilation and spontaneous breathing, the IVC collapsibility index (CI) and distensibility index are interconvertible. (iv)Prediction of volume responsiveness by IVC CI is comparable for mechanical ventilation and spontaneous breathing patients. (v)Respiratory variations of subclavian/proximal axillary and internal jugular veins by ultrasound are alternative sites, with comparable reliability. (vi)Data support clinical applicability of IVC CI to predict hypotension with anesthesia, guide ultrafiltration goals, predict dry weight, predict intra-dialytic hypotension and assess acute decompensated heart failure. (vii)IVC ultrasound may complement ultrasound of heart and lungs, and abdominal organs for venous congestion, for assessing and managing volume overload and deresuscitation, renal failure and shock. (viii)IVC ultrasound has limitations including inadequate visualization. Ultrasound data should always be interpreted in clinical context. Additional studies are required to further assess and validate the role of bedside ultrasonography in clinical care.

Adverse Clinical Outcomes Among Patients With Acute Low-risk Pulmonary Embolism and Concerning Computed Tomography Imaging Findings

Most patients presenting to US emergency departments (EDs) with acute pulmonary embolism (PE) are hospitalized, despite evidence from multiple society-based guidelines recommending consideration of outpatient treatment for those with low risk stratification scores. One barrier to outpatient treatment may be clinician concern regarding findings on PE-protocol computed tomography (CTPE), which are perceived as high risk but not incorporated into commonly used risk stratification tools. To evaluate the association of concerning CTPE findings with outcomes and treatment of patients in the ED with acute, low-risk PE. This cohort study used a registry of all acute PEs diagnosed in the adult ED of an academic medical center from October 10, 2016, to December 31, 2019. Acute PE cases were divided into high- and low-risk groups based on PE Severity Index (PESI) class alone or using a combination of PESI class and biomarker results. The low-risk group was further divided based on the presence of concerning CTPE findings: (1) bilateral central embolus, (2) right ventricle-to-left ventricle ratio greater than 1.0, (3) right ventricle enlargement, (4) septal abnormality, or (5) pulmonary infarction. Data analysis was conducted from June to October 2022. The primary outcome was all-cause mortality at 7 and 30 days. Secondary outcomes included hospitalization, length of stay, need for intensive care, use of echocardiography and/or bedside ultrasonography, and activation of the PE response team (PERT) . Of 817 patients (median [IQR] age, 58 [47-71] years; 417 (51.0%) female patients; 129 [15.8%] Black and 645 [78.9%] White patients) with acute PEs, 331 (40.5%) were low risk and 486 (59.5%) were high risk by PESI score. Clinical outcomes were similar for all low-risk patients, with no 30-day deaths in the low-risk group with concerning CTPE findings (0 of 151 patients) vs 4 of 180 (2.2%) in the low-risk group without concerning CTPE findings and 88 (18.1%) in the high-risk group (P < .001). Low-risk patients with concerning CTPE findings were less frequently discharged from the ED than those without concerning CTPE findings (3 [2.0%] vs 14 [7.8%]; P = .01) and had more frequent echocardiography (87 [57.6%] vs 49 [27.2%]; P < .001) and PERT activation for consideration of advanced therapies (34 [22.5%] vs 11 [6.1%]; P < .001). In this single-center study, CTPE findings widely believed to confer high risk were associated with increased hospitalization and resource utilization in patients with low-risk PE but not short-term adverse clinical outcomes.

Global research trends in prediction of difficult airways: A bibliometric and visualization study.

Many tools are used to predict difficult airway, including bedside screening tests, radiological variables, and ultrasonography. However, the "gold standard" to identify difficult airway before intubation has not been established. The assessment and prediction of difficult airway is receiving increasing attention in clinical practice due to the devastating results of failed oxygenation or intubation. A literature visualization study is necessary to understand the research trend and help tailor future research directions. Science citation index-expanded web of Science database were used to search for literature related to assessment and prediction of difficult airways published before May 9th, 2022. VOS viewer software was used for visual analysis, including literature statistics, and co-occurrence analysis. A total of 2609 articles were included. The amount of relevant research interest and literature is increasing every year. According to co-occurrence network analysis, the research results can be grouped into the following 5 clusters, intubation approaches, intubation in special populations, difficult airway assessment tests, intubation in critical care/emergency settings and education, and laryngoscopes. Co-occurrence overlay analysis showed that video laryngoscopes and index prediction (including computed tomography and ultrasonography), emerged recently and comprised an important percentage of current studies. It can be predicted that future studies should focus on understanding the upper airway anatomy and constructing risk index predictions. Based on current global research trends, risk index predictions are the next hot topics in the evaluation and prediction of difficult airways, and video laryngoscopes will continue to be a hot topic in this field.

Use of Bedside Ultrasound at Wexford General Hospital Emergency Department: Compliance to NICE Guidelines [NG158] for Venous Thromboembolic Disease

Introduction:Ultrasound is the standard imaging technique for diagnosing lower limb deep venous thrombosis (DVT). The National Institute for Health and Care Excellence (NICE) guidance 158 recommendation 1.1.3 states that all patients with sufficient pretest probability for DVT should be offered a proximal leg vein ultrasound within four hours. However, due to high patient volumes, formal radiology department ultrasound wait times often exceed one week. Point-of-care ultrasound (POCUS) is used to bridge diagnostic delay in our emergency department (ED) .This study aimed to quantify numbers offered POCUS for suspected proximal lower DVT in our ED and accuracy of such studies.Method:A retrospective review of electronic records was conducted for patients who underwent formal lower-limb ultrasound for suspected DVT at our hospital over a three-month period (August 1, 2022-October 12, 2022). Patient charts for all ED presentations were assessed to determine whether POCUS was offered and whether DVT was diagnosed.Statistical analysis was conducted using PRISM v9.Results:80 formal ultrasound scans were performed at our hospital for lower limb DVT. 58 were requested for patients presenting to ED, of which 42 had complete records available meeting selection criteria.POCUS was offered to 24 patients in ED (57.1%). Sensitivity was 66% (95% CI 12%- 98%), and specificity was 94.1% (95% CI 75%-99%). Overall accuracy was 90%, with only one false negative study identified at formal follow-up ultrasound.Conclusion:Although sample size was small, our results suggest that POCUS is an accurate but underused tool to diagnose lower limb DVT. Developing a standardized protocol for performing and reporting POCUS DVT scans in ED should allow for earlier diagnosis and initiation of appropriate treatment where necessary.

Super resolution imaging reconstruction reveals that gold standard methods may not correctly conclude neural/brain functional recovery.

The status of cerebral perfusion and its restoration level play a vital role in the prognosis and clinical decision making of many neurosurgical diseases. As such, gold standard methods including CT, MR and ICP monitoring, which can indicate and measure cerebral perfusion and restoration, have been widely adopted to evaluate whether or not a patient has recovered from neurofunctional disabilities. This robust combination of methods, however, is confronted with a growing number of contradictions in recent years due to its inability to measure the status of cerebral reperfusion in microvasculature level, even though this has been shown to determine neurofunctional restoration as well or even better. To this date, nevertheless, we have very limited imaging methods that could evaluate human cerebral microperfusion both safely and accurately under most neurosurgical conditions. We herein report a new method of acquiring a patient's cerebral microperfusion status noninvasively which could display the precise distribution of microvasculature in deep cerebral regions with a resolution of ∼30µm, using everyday bed-side ultrasonography combined with a computerized super-resolution reconstruction algorithm. Using this imaging modality, we found that a patient's cerebral microperfusion might not be improved by some routine administrations even though the gold standard method had yielded the opposite conclusions. Our imaging modality retains the safe, portable feature of ordinary ultrasonography while possesses the extraordinary super-resolution nature, which enables an efficient, precise diagnosis of cerebral perfusion. Most importantly, the super resolution nature of this method may also facilitate early-stage evaluation of a patient's neurofunctional restoration level and avoid overoptimistic conclusions from conventional angiography or ICP monitoring.

Ultrasonography of Diaphragm to Predict Extubation Outcome.

Background and objectives An intensivist's decision, when it comes to weaning off a patient from mechanical ventilationand extubation, is based on many criteria.Problems can be associated with both prolonged ventilation and early extubation. Therefore, for optimal functioning of the diaphragm, the primary inspiratory muscle, it is important to resume spontaneous ventilation after extubation irrespective of the cause of respiratory failure. Thus, diaphragmatic parameters can prove useful in predicting the rate of success of extubation. However, till date in our institute, extubation has been done using only the standard parameters; hence, in this study, diaphragmatic parameters obtained by ultrasonography-diaphragmatic thickening fraction (dTF) and diaphragmatic excursion (DE) have been studied to predict extubation outcome. The objectives of this study are to (1) measure the diaphragmatic thickening fraction (dTF) in % and diaphragmatic excursion (DE) in cm before and after the spontaneous breathing trial (SBT) and (2) compare dTF and DE with standard extubation parameters in order to predict extubation outcome. Materials and methods This is a prospective, double-blind, observational study. The number of patients involved was 41. After obtaining ethical committee clearance, informed consent was taken from the patients' attendants. In this study, we divided doctors into the treating team and the research team. The treating team comprised the primary doctors working in the intensive care unit (ICU), and they evaluated the patients' readiness for pressure support ventilation. The research team performed diaphragmatic ultrasonography on those patients who met the inclusion criteria. The treating team was blinded to the dTF and DE results obtained by the research team. Prior to extubation, all the patients had to satisfy the standard extubation criteria followed at R. L. Jalappa Hospital and Research Centre (RLJH), Kolar Results We observed that 68.29 (%) of the patients with normal dTF and DE values and 21.95(%) with slightly lower dTF and DE values were extubated successfully, and 7.31 (%) with normal dTF and DE values were reintubated; 2.43 (%) were extubated onto non-invasive ventilation (NIV). Conclusion From our study, we have concluded that bedside ultrasonography of the diaphragm, that is the measurement of diaphragm for dTF and DE always compliments the standard criteria for extubation and can be used for weaning the patients from mechanical ventilation, as bedside ultrasonography is not only easy and convenient but also a reliable parameter in predicting the outcome of weaning,however, it cannot be used as a sole criteria.

A bedside ultrasound protocol to the measurement of the systemic vascular resistances: Preliminary results in the patients with sepsis.

The use of the ultrasound (US) bedside examination is increasing for the detailed evaluation of the hemodynamic parameters, allowing the physicians to set the appropriate therapeutic strategies with greater precision. The aim of this study is to evaluate the hemodynamic parameters (the cardiac output or CO, the central venous pressure or CVP and the systemic vascular resistance or SVR) in the patients with sepsis, by using a bedside US approach. We consecutively enrolled n.82 patients of S.Andrea Hospital (n.47 with sepsis and n.35 without sepsis), examining the hemodynamic parameters by a bedside US evaluation. The incidence of sepsis was more than 50% of cases. The patients with sepsis presented higher comorbidity and polypharmacy (p < 0.01, p < 0.001), with increased creatinine (p < 0.001) and consequent esteemed glomerular filtration rate (p < 0.01), C-reactive protein (p < 0.01), SOFA (Sepsis-related Organ Failure Assessment) score (p < 1.58×10-7) and reduced SVR (p < 0.05). The SOFA score was inversely related to the SVR (p < 0.05). To our best knowledge, this is the first study with a bedside US protocol to measure SVR, beyond the abdominal and cardiac qualitative evaluation.

Point-of-Care Ultrasonography Helped to Rapidly Detect Pneumomediastinum in a Vomiting Female

Vomiting-induced pneumomediastinum is a rare presentation and can be a result of alveolar rupture (Mackler effect) or Boerhaave syndrome. Patients diagnosed with Boerhaave syndrome may present with the classic Mackler triad of vomiting, chest pain, and subcutaneous emphysema. However, there exists a large overlap of symptoms accompanying Boerhaave syndrome and the Macklin effect, including retrosternal chest pain, neck discomfort, cough, sore throat, dysphagia, dysphonia, and dyspnea. Boerhaave syndrome is a dangerous condition. Delayed diagnosis of Boerhaave syndrome may worsen sepsis and cause mortality. Therefore, early diagnosis and timely management are important to prevent further complications. Here, we present a case of vomiting-induced pneumomediastinum, which supports the use of bedside ultrasonography to aid in the diagnosis and rapid differentiation of etiology of pneumomediastinum.

Major Aeroportia Detected on Bedside Ultrasound in a Critically Ill Cardiac Surgery Patient.

"Major Aeroportia Detected on Bedside Ultrasound in Critically Ill Cardiac Surgery Patient." American Journal of Respiratory and Critical Care Medicine, 0(ja), pp. –

Concise, Practical Review on Transthoracic Lung Ultrasound in Prehospital Diagnosis of Dyspnea in Adults.

Ultrasonography is a relatively young but widely recognized method of imaging parenchymal organs, including the lungs. Our concise, practical review on transthoracic lung ultrasound (LUS) in the prehospital diagnosis of dyspnea in adults attempts to summarize current knowledge in the field. Furthermore, we discussed POCUS protocols in the analyzed context, discussing their usefulness. We concluded that bedside ultrasonography, or point of care (POCUS), is developing rapidly; however, the knowledge about the use of LUS in a pre-hospital setting is scarce, highlighting the need for further research in this field. Additionally, despite the possibility of using various ultrasound protocols in diagnosing a patient with dyspnea, there is no comprehensive and, at the same time, highly sensitive and specific protocol covering a satisfactory saccade of differential diagnosis of this symptom. It seems reasonable to conduct further targeted research to create such a dedicated solution.

The Incremental Role of Multiorgan Point-of-Care Ultrasounds in the Emergency Setting.

Point-of-care ultrasonography (POCUS) represents a goal-directed ultrasound examination performed by clinicians directly involved in patient healthcare. POCUS has been widely used in emergency departments, where US exams allow physicians to make quick diagnoses and to recognize early life-threatening conditions which require prompt interventions. Although initially meant for the real-time evaluation of cardiovascular and respiratory pathologies, its use has been extended to a wide range of clinical applications, such as screening for deep-vein thrombosis and trauma, abdominal ultrasonography of the right upper quadrant and appendix, and guidance for invasive procedures. Moreover, recently, bedside ultrasounds have been used to evaluate the fluid balance and to guide decongestive therapy in acutely decompensated heart failure. The aim of the present review was to discuss the most common applications of POCUS in the emergency setting.

The Prediction of the Increase in intracranial Pressure in Stroke Patients Given Recombinant Tissue Plasminogen Activator by Measuring the optic Nerve Sheath Diameter on bedside Ultrasound.

Background: The aim of this study is based on the effects of the treatment, the recombinant tissue plasminogen activator (rTPA), applied to stroke patients in Emergency Departments (ED) by intravenous, to optic nerve sheath diameter (ONSD) measurements.&#x0D; Material and Methods: The study was designed as prospective and observational. A total of 41 patients were included in this study with the following diagnoses: an acute clinical stroke, known well-being within 4.5 hours, and who had a finding for rTPA. Ultrasonographic (USG) ONSD measurements have been performed on a voluntary basis with the consent of the patients and their relatives.&#x0D; Results: A statistically significant difference has been found between the ONSDs measured at the 0th, 15th, 30th and 60th minutes of the patients who were admitted to the ED and were on rTPA treatment due to stroke (p&lt;0.05). Due to a large number of positive differences, the ONSD at the 15th, 30th, and 60th minutes was found higher than at the 0th minute. A statistically significant difference has also been found between ONSD measured at the 15th, 30th, and 60th minutes during rTPA treatment (p&lt;0.05). Since the existence of a large number of positive differences, the ONSD at the 30th and 60th minutes is found to be higher than at the 15th minute. Finally, the difference of statistically significant values between the 30th and 60th-minute ONSD was determined by the Sign Test. According to the result of the Sign Test, a statistically significant difference was found to be between the ONSD differences of the 30th and 60th minutes of rTPA treatment (p&lt;0.05).&#x0D; Conclusions: Serial ONSD measurements performed at the bedside during the early stage in order to follow up on the intracranial complications of stroke patients may be misleading for the follow-up of complications within the first 60 minutes, which is the most critical stage. In this stage, symptom monitoring should be used in combination with ONSD and the decision should be made for treatment continues, accordingly.