Utility Of Point-of-care Ultrasound Research Articles

Anesthesiologists Cross the Quality Chasm with Point of Care Ultrasound (POCUS) Among Perioperative Patients

Background/Objective: POCUS is an invaluable tool for anatomical variation assessment, guidance of invasive interventions, and diagnosis of critical conditions that may change the anesthesiologist’s plan of care. This technology increases success rate, decreases time to surgery, and maximizes outcomes. The objective of this pilot program evaluation was to identify the anesthesiologists’ systems and processes for utilizing POCUS in clinical decision-making for patients during the perioperative phases of care for improved outcomes. Materials/Methods: A Multivariate Analysis of Variance (MANOVA) was conducted to identify differences across groups (scan type). The independent variable was the type of POCUS examination. The dependent variables included the patient’s: (1) Perioperative Status; (2) Cardiothoracic Anesthesiologist’s Review of Patient History and Formulating the Clinical Question; (3) Overall Risk Potential; (4) Aspiration Potential; (5) Issues Related to Cardiovascular Hemodynamics; (6) Issues Related to Volume Status; (7) Clinical Question Answered by POCUS; (8) Change in Plan of Care; (9) Interventions; and (10) Pharmacological Interventions. Results: MANOVA findings (Wilks’ λ) identified a statistically significant interaction between POCUS scan type and the cardiothoracic anesthesiologist’s clinical decision-making (p < 0.0001). The following four criteria were statistically significant: (1) patients (64%) were examined with POCUS preoperatively (p < 0.05); (2) patients (95%) identified as having some type of overall risk potential (p < 0.05); (3) patients (36%) specifically identified as an aspiration risk (p < 0.0001); and (4) patients (41%) identified with issues related to cardiovascular hemodynamics (p < 0.001). Conclusions: POCUS is a proven imaging modality that is easy, portable, sensitive, and specific for identifying various anatomical landmarks. POCUS utilization in the perioperative setting has potential to have a profound impact on successful surgical completion.

Utility of POCUS (Point of Care Ultrasound) in Renal Transplantation

Point of care ultrasound (POCUS) is gaining wide recognition in its bedside applications. The day-to-day practice of nephrology requires several ultrasonographic parameters for diagnosis. Hence, familiarity with basics of renal ultrasound imaging is becoming a necessary skill for every nephrologist. This review provides an overview of the normal and abnormal findings in a graft kidney and its environment throughout graft survival and after its failure. The correlative understanding of the clinical features with image findings provides the greatest advantage in applying POCUS at the bedside.

Barriers and facilitators to point-of-care ultrasound use in an academic emergency department by perceived usability

BackgroundWhile use of point-of-care ultrasound (POCUS) has become widespread in emergency medicine, its adoption and usage among emergency clinicians is variable. In this study, we explored the barriers and facilitators to POCUS use among emergency medicine clinicians in a tertiary care emergency department in the United States by clinical role and perceived usability of POCUS. MethodsWe initially administered a quantitative survey via REDCap and used a validated technology usability scale to categorize clinicians into tertiles of low, moderate, and high, based on perceived utility of POCUS. Subsequently, a purposeful sample in each category participated in semi-structured interviews until thematic saturation was reached (9–10 per category, 29 total). The qualitative interviews were analyzed using Braun and Clark's content analysis approach. A coding scheme was developed through initial review of 20 % of the transcripts, followed by operational definitions of codes, concept and category development, and selection of representative quotes. Analysis was supported by Dedoose software. ResultsWe identified 41 % (12/29) as high POCUS users, 31 % (9/29) as moderate, and 28 % (8/29) as low, based on perceived usability. Interviewees consisted of 24 % (7/29) attendings, 28 % (8/29) residents and 48 % (14/29) advanced practice providers (APPs). Attendings made up 50 % in the high POCUS group and 75 % of the low POCUS group were APPs. In the low group, the lack of prior and present POCUS training was a major barrier to POCUS use. The lack of time during clinical shifts was a major barrier to POCUS utility in the high and low groups. Availability of POCUS machines in clinical spaces was identified as a facilitator to POCUS use in the medium group. ConclusionsParticipants reported that POCUS facilitates patient disposition and clinical supervision enhances its use. Early POCUS education in professional school and continued POCUS training in clinical practice could facilitate POCUS use clinically. Structured POCUS courses and continued medical education programs may provide protected time to learn and practice POCUS. Moreover, accessible and standardized machines in the clinical environment could improve POCUS usage.

Point-of-Care Ultrasound for the General Pediatric Resident: A Needs Assessment.

Point-of-care ultrasound (POCUS) is a valuable tool in pediatric care, but formalized education on POCUS is not a standard part of pediatric residency. Our primary objective was to conduct a needs assessment to determine pediatric residents' attitudes toward ultrasound education. A Likert scale-based survey was distributed to residents at 48 pediatric residency programs. Respondents were asked to rate their agreement to statements about ultrasound education at their respective programs. Participants were also asked to rank ultrasound indications in order of importance. Ninety-seven survey responses were included in the final data set. Sixty percent of respondents had not performed any ultrasound scans during residency. Ninety-two percent of respondents indicated an interest in ultrasound training during residency and that they desired a formal POCUS curriculum. Eighty-one percent of residents indicated that having more ultrasound education would make their programs more attractive to applicants. Pediatric residents recognize the utility of POCUS and desire additional education during training.

Global survey on point-of-care ultrasound (pocus) use in child surgery

PurposeTo undertake a global assessment of existing ultrasound practices, barriers to access, point-of-care ultrasound (POCUS) training pathways, and the perceived clinical utility of POCUS in Child Surgery.MethodsAn electronic survey was disseminated via the GICS (Global Initiative of Children’s Surgery) network. 247 anonymized responses from 48 countries were collated. 71.3% (176/247) worked in child surgery.ResultsUltrasound was critical to practice with 84% (147/176) of requesting one daily or multiple times per week. Only 10% (17/176) could access emergency ultrasound < 1 h from request. The main barrier was a lack of trained personnel. HIC surgeons were more likely to have ultrasound training (24/29; 82.8%) compared with LMICs (74/147; 50.3%) (p = .001319; CI 95%). Self-perceived POCUS competence was associated with regularity of POCUS use (p < 0.001; CI 95%). Those who already practice POCUS most commonly use it for trauma, intussusception, and ultrasound-guided procedures. Majority (90%; 159/176) of child surgeons would attend formal POCUS training if available.ConclusionsUltrasound is critically important in children’s surgery globally, however, many surgeons experience barriers to timely access. There is a strong interest in learning POCUS for relevant pediatric surgical applications. Further research is needed to evaluate the best methods of training, accreditation, and governance.

Point of Care Ultrasound Utilization for Vascular Access in Trauma Patients

Point of Care Ultrasound Utilization for Vascular Access in Trauma Patients

Barriers to Point-of-Care Ultrasound Utilization Among Emergency Medicine Residents in Riyadh, Saudi Arabia.

Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable diagnostic tool in emergency medicine (EM). This study aimed to identify barriers to POCUS utilization among EM residents in the Riyadh region. An observational cross-sectional study was conducted among 116 EM residents from various training centers in Riyadh. Data were collected through self-administered questionnaires assessing demographics, ultrasound (US) training, perceived barriers, and facilitators to POCUS usage. Statistical analysis included descriptive statistics, multiple response dichotomy analysis, and multivariable linear regression. The majority of residents had completed US training and recognized the importance of POCUS in emergency settings. However, significant barriers were identified, including time constraints and logistical challenges. Multivariable regression analysis revealed associations between residents' training status, beliefs in incentives, anticipated POCUS use, and perceived barriers. This study highlights the importance of addressing barriers to POCUS integration into residency programs. Efforts should focus on optimizing training, addressing workflow challenges, and enhancing residents' confidence in POCUS utilization. Targeted interventions tailored to specific clinical contexts may facilitate greater acceptance and integration of POCUS into routine practice.

Usefulness of point of care ultrasound in older adults: a multicentre study across different geriatric care settings in Spain and the United Kingdom.

Point of care ultrasound (POCUS) is an imaging technique performed bedside. To date, few published studies have reported the usefulness of multiorgan POCUS in Geriatrics. The objective of this study was to describe the utility of multiorgan POCUS in the care of older adults admitted to geriatric care settings. Observational retrospective study of patients admitted to geriatric settings in Spain and UK. Multiorgan POCUS was performed when there was a specific clinical suspicion or unexplained torpid clinical course despite physical examination and complementary tests. A geriatrician with a certificate degree in comprehensive ultrasound and long-standing experience in POCUS carried out POCUS. All patients underwent multiorgan POCUS in a cephalo-caudal manner. Out of 368 patients admitted to geriatric units, 29% met the inclusion criteria. Average age was 85.9years (SD ± 6.1). POCUS identified 235 clinically significant findings (2.2 per patient). Findings were classified as 37.9% confirmed diagnosis, 16.6% ruled out diagnosis, 14.9% unsuspected relevant diagnoses and 30.6% clinical follow-ups. POCUS findings led to changes in pharmacological and non-pharmacological treatment in 66.3 and 69.2% respectively, resulted in completion or avoidance of invasive procedures in 17.8 and 15.9%, respectively, facilitating early referrals to other specialities in 14.9% and avoiding transfers in 25.2% of patients. Multiorgan POCUS is a tool that aids in the assessment and treatment of patients receiving care in geriatrics units. These results show the usefulness of POCUS in the management of older adults and suggest its inclusion in any curriculum of Geriatric Medicine speciality training.

Effect of Departmental and Physician-Selected Interventions on Point-of-Care Ultrasound Documentation Completion.

Background Point-of-care ultrasound (POCUS) has been disruptive to many experienced emergency physicians as it requires competence in a new physical skill, real-time image interpretation, and navigation of novel software for submission to the electronic health record (EHR). Incomplete documentation of a performed POCUS study used for clinical decision-making represents a potential medicolegal liability, may expose the patient to repetitive or potentially unnecessary imaging, and is a missed opportunity for reimbursement. Identifying effective facilitators of ED POCUS documentation completion requires additional investigation. Methods In the first part of this mixed-methods study, eligible attending physicians were stratified into levels of use ("high"/"low"/"never") based on recent POCUS documentation performance. Semi-structured interviews were conducted with high and low utilizers to explore their perceptions of the POCUS submission workflow and their receptivity to various proposed interventions. Qualitative data were analyzed using a thematic analysis that explored perceived usefulness and usability. The second part of the study consisted of two intervention phases. First, physicians achieving minimum POCUS documentation numbers were rewarded with additional shift scheduling flexibility. In the second phase, the intervention that garnered the most interview support, daily documentation reminder emails, was implemented. The primary outcome was the individual POCUS documentation rates calculated as all studies submitted divided by all studies performed (submitted plus unsubmitted) per month. Provider-level monthly data was aggregated into a departmental rate. Results Interviews were conducted with 12 physicians, six from the highest and six from the lowest documentation quartiles. Both groups supported the same two proposed interventions: reminder emails ranked first, then monetary rewards ranked second. High utilizers emphasized the clinical utility of POCUS, whereas low utilizers expressed concerns over "double billing" and exposure to medicolegal liability with uncertain scan interpretations. For low utilizers, a documentation decision could be dependent on the performing resident physician's displayed confidence. Both groups voiced frustration with the need to use a separate program, Qpath (Telexy Healthcare, Inc, Maple Ridge, British Columbia, Canada), for POCUS documentation. During intervention phase one, the aggregate departmental documentation rate increased from 44.6% to 60.1% with the introduction of the schedule request incentive. This improvement was seen across all documentation quartiles. The departmental rate remained stable and did not improve further following the addition of the daily documentation reminder emails in intervention phase two. When reminder emails ceased yet the day-off request incentive continued, the departmental rate did not drop. Conclusions The implementation of a non-financial shift scheduling incentivecorrelated with the largest increase in departmental POCUS documentation rate. Interviewees incorrectly predicted that email reminders would be the most influential intervention highlighting a mismatch between physician perception and effective drivers of behavior change.Further investigation may focus on determining the size and longevity of the isolated impact of a schedule request incentive, as one might expect diminishing marginal utility.

Questionnaire survey on point‐of‐care ultrasound utilization during cardiac arrest among emergency physicians in Hong Kong

AbstractIntroductionAlthough point‐of‐care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic tool during the management of out‐of‐hospital cardiac arrest (OHCA), opposing viewpoints exist. The objectives of this study are to investigate the knowledge, attitude, and practice (KAP) in POCUS utilization during OHCA among emergency medicine (EM) physicians in Hong Kong and to identify their barriers.MethodsA cross‐sectional questionnaire was conducted among EM physicians in 9 accident and emergency departments in Hong Kong. The questionnaire assessed participants' demographics, knowledge, attitude, practices, and barriers on this issue. Composite scores for KAP were calculated. Subgroup analysis and multiple regression analysis were used to explore the correlation between KAP and participants' demographics. Participants' barriers were evaluated by binary and open‐ended questions.ResultsA total of 224 questionnaires were distributed and 150 questionnaires were returned (response rate: 67.0%). Statistically significant associations of knowledge and attitude with practice were demonstrated (both p &lt; 0.001). Independent predictors of more frequent POCUS use in OHCA included EM fellowship status (p = 0.005), receiving training on this issue (p &lt; 0.001), and working in large hospitals (p = 0.007). The top‐ranked barriers were chaotic environment (74%), no structural education on this practice (63%), and the lack of staff (61%).ConclusionsThe knowledge and attitude of performing POCUS during OHCA were demonstrated to enhance EM physicians' practice. By improving physicians' knowledge and removing the possible barriers they are facing, POCUS can be optimally utilized during OHCA to improve patient care.

The Role of POCUS to Face COVID-19: A Narrative Review.

COVID-19 has been a challenging outbreak to face, with millions of deaths among the globe. Acute respiratory failure due to interstitial pneumonia was the leading cause of death other than prothrombotic activation and complications. Lung ultrasound (LUS) and point-of-care ultrasound (POCUS) are widely used not only to triage, to identify, and to monitor lungs involvement but also to assess hemodynamic status and thrombotic and hemorrhagic complications, mainly in critically ill patients. POCUS has gained growing consideration due to its bedside utilization, reliability, and reproducibility even in emergency settings especially in unstable patients. In this narrative review, we aim to describe LUS and POCUS utilization in COVID-19 infection based on the literature found on this topic. We reported the LUS patterns of COVID-19 pulmonary infection, the diagnostic accuracy with respect to CT lung scan, its prognostic value, the variety of scores and protocols proposed, and the utilization of POCUS to investigate the extra-lung complications.

Integration of Cardiac Point of Care Ultrasound (POCUS) in a Medical Physiology Course During the Preclinical Curriculum

Background: The early integration of hands-on point-of-care ultrasound (POCUS) during medical students' preclinical curriculum has expanded the utilization of this tool which can provide rapid and effective bedside diagnosis in clinical practice. Many medical schools that have incorporated POCUS into their curriculum allude to the limitations of a large class size, learning retention, and applying these skills to aid in diagnosing pathologic conditions. Indeed, it is interesting that there is currently no consensus as to what and how much hands-on ultrasound training should be included in the medical school curriculum. At Midwestern University (MWU), we introduced a 4-year inclusion of ultrasound training throughout the medical curriculum. The core Physiology courses taken in winter and spring quarter of first year medical school, incorporate several mandatory ultrasound workshops taken by osteopathic medical students and podiatry students together. This study hypothesizes that the incorporation of cardiac POCUS in small group physiology workshops increases student confidence in their ability to measure the parameters to effectively assess cardiac output. Moreover, we hypothesize that this hands-on teaching tool reinforces the concepts taught in the didactic lectures, applying the material in a clinically relevant manner. Data obtained during the 2023-2024 winter quarter will be presented at the APS meeting. Methods: This study aims to utilize a brief survey administered via REDCap, in a questionnaire format to first year osteopathic medical students and podiatric medical students after the cardiac physiology workshop administered during the first year of medical school. Survey questions will be generated using Likert 5-point scales, ratings of (strongly agree to strongly disagree, very comfortable to very uncomfortable, high level of competence to no level of competence, and very confident to very unconfident). Survey questions will seek to assess confidence level using POCUS, ease of quantifying assessments, and differences in perceptions between podiatry and osteopathic medical students. Associations between two question responses will be assessed using the Chi-square test for independent responses and McNemar test to compare responses that were paired. A p-value &lt;0.05 for both tests will indicate statistical significance. Furthermore, we aim to determine whether retention and application of the information taught during the cardiac POCUS workshop can be evaluated by student performance on POCUS-specific exam questions. IRB approval is currently pending. Results: We plan to share: (1) the survey questions, (2) data obtained using POCUS from the last academic years class cohort and the current class (specifically relating to their use of POCUS to calculate cardiac output) to highlight the variability in these assessments, (3) exam question analyses for the last 2-years (as assessment outcomes), (4) survey responses from the current class, (5) correlations of student perceived confidence and determined understanding. Conclusion: The introduction of POCUS utilization during the physiology courses in the first year of Osteopathic and Podiatry pre-clinical years reinforces key concepts covered in didactic lectures. We hypothesize that student perceptions of these workshops will be largely positive and improve student confidence in POCUS use. No funding. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Integration of Bladder Point of Care Ultrasound (POCUS) in a Medical Physiology Course During the Preclinical Curriculum

Background: The early integration of hands-on point-of-care ultrasound (POCUS) during medical students' preclinical curriculum has expanded the utilization of this tool which can provide rapid and effective bedside diagnosis in clinical practice. Many medical schools that have incorporated POCUS into their curriculum allude to the limitations of a large class size, learning retention, and applying these skills to aid in diagnosing pathologic conditions. Indeed, it is interesting that there is currently no consensus as to what and how much hands-on ultrasound training should be included in the medical school curriculum. At Midwestern University (MWU), we introduced a 4-year inclusion of ultrasound training throughout the medical curriculum. The core Physiology courses taken in winter and spring quarter of first year medical school, incorporate several mandatory ultrasound workshops taken by osteopathic medical students and podiatry students together. This study hypothesizes that the incorporation of bladder POCUS in small group physiology workshops increases student confidence in their ability to measure the parameters to effectively assess bladder volume. Moreover, we hypothesize that this hands-on teaching tool reinforces the concepts taught in the didactic lectures, applying the material in a clinically relevant manner Data obtained during the 2023-2024 spring quarter will be presented at the APS meeting. Methods: This study aims to utilize a brief survey administered via REDCap, in a questionnaire format to first year osteopathic medical students and podiatric medical students after the bladder physiology workshop administered during the first year of medical school. Survey questions will be generated using a Likert 5-point scale, a rating of (strongly agree to strongly disagree, very comfortable to very uncomfortable, high level of competence to no level of competence, and very confident to very unconfident). Survey questions will seek to assess confidence level using POCUS, ease of quantifying assessments, and differences in perceptions between podiatry and osteopathic medical students. Associations between two question responses will be assessed using the Chi-square test for independent responses and McNemar test to compare responses that were paired. A p-value &lt;0.05 for both tests will indicate statistical significance. Furthermore, we aim to determine whether retention and application of the information taught during the bladder POCUS workshops can be evaluated by student performance on POCUS-specific exam questions. IRB approval is currently pending. Results: We plan to share: (1) the survey questions, (2) data obtained using POCUS from the last academic years class cohort and the current class (specifically relating to their use of POCUS to calculate and interpret bladder volume) to highlight the variability in these assessments, (3) exam question analyses for the last 2-years (as assessment outcomes), (4) survey responses from the current class, (5) correlations of student perceived confidence and determined understanding. Conclusion: The introduction of POCUS utilization during the physiology courses in the first year of Osteopathic and Podiatry pre-clinical years reinforces key concepts covered in didactic lectures. We hypothesize student perceptions of these workshops will be largely positive and will improve student confidence in POCUS use. No Funding. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Bridging the gap: understanding Belgian anesthesiologists’ proficiency and training demands in gastric point-of-care ultrasound, a case-based survey

BackgroundPulmonary aspiration syndrome remains a significant complication of general anesthesia, particularly in unfasted patients. Gastric point-of-care ultrasound (POCUS) allows for both qualitative and quantitative assessment of gastric content, providing a safe and reliable method to assess gastric emptying and reduce the risk of aspiration during general anesthesia.MethodsThe survey was distributed to Belgian certified anesthesiologists and trainees between April 2020 and June 2021. Participants received a simulated clinical case of a patient at risk of gastric aspiration, created and approved by two certified anesthesiologists trained to perform gastric POCUS. The objectives of this study were to assess recognition of high-risk clinical situations for gastric aspiration, awareness of the gastric POCUS and its indications, and knowledge of the technical and practical conditions of the procedure among respondents trained in the technique. Furthermore, the study assessed the state of training in gastric POCUS, the desire for education, and the practical availability of ultrasound equipment. The survey used conditional branching to ensure unbiased responses to POCUS-related questions. It included multiple-choice questions, quantitative variables, and 5-point Likert scales. The margin of error was calculated using Daniel’s formula, corrected for a finite population.ResultsThe survey was conducted among 323 anesthesiologists. Only 20.8% (27) recognized the risk of a full stomach based on the patient’s history. Anesthesiologists who recognized the indication for gastric POCUS and were trained in the procedure demonstrated good recall of the practical conditions for performing the procedure and interpreting the results. Only 13.08% (31) of all respondents had received training in gastric POCUS, while 72.57% (172) expressed interest in future training. Furthermore, 80.17% (190) of participants had access to adequate ultrasound equipment and 78.90% (187) supported teaching gastric POCUS to anesthesia trainees.ConclusionsThis survey offers insight into the epidemiology, clinical recognition, knowledge, and utilization of gastric POCUS among Belgian anesthesia professionals. The results emphasize the significance of proper equipment and training to ensure the safe and effective implementation of gastric POCUS in anesthesia practice. Additional efforts should focus on improving training and promoting the integration of gastric POCUS into daily clinical practice.

Use of Point-of-care Ultrasound to Diagnose Rectus Abdominis Strain in the Acute Setting: A Case Report.

Rectus abdominis muscle strains are common and can be debilitating in both professional and amateur athletes who engage in strenuous activity. We report a rare case of rectus abdominis muscle tear in an amateur bodybuilder diagnosed by point-of-care ultrasound (POCUS) in the emergency department (ED). The patient had presented to the ED three separate times after strenuous exercise, received costly diagnostic workups, and ultimately was diagnosed on the third visit with grade 2 bilateral rectus abdominis tear. The patient was given appropriate education and sports medicine follow-up. He underwent rehabilitation focused on trunk and core stability. At eight-week follow-up, the patient had made a full recovery. To our knowledge, a case of bilateral rectus abdominis tear diagnosed by ultrasound in the emergency setting has not been previously published. Our case report highlights the utility of POCUS in diagnosing musculoskeletal pathology and preventing costly bounce-back visits.

Seeing beneath the surface: Harnessing point-of-care ultrasound for internal jugular vein evaluation.

Point-of-care ultrasound (POCUS) of the internal jugular vein (IJV) offers a non-invasive means of estimating right atrial pressure (RAP), especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery. While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein, this method lacks sensitivity. The utilization of POCUS significantly enhances the visualization of the vein, leading to a more accurate identification. It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation. This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein, drawing upon existing data.

Cranial Point-of-Care Ultrasound for Neonatal Providers: A Feasibility Study.

Despite strong evidence for its utility in clinical management and diagnosis of intracranial hemorrhage (ICH), the use of neonatal cranial point-of-care ultrasound (POCUS) has not been standardized in neonatal intensive care units (NICUs) in the United States. The primary aim of this study was to evaluate the feasibility of training NICU providers to perform cranial POCUS by tracking the quality of image acquisition following training. Observational single-center cohort study of cranial POCUS images obtained by trained neonatal practitioners (attendings, fellows, and advanced practice providers) using a protocol developed by a radiologist and neonatologist. Exams were performed on infants born ≤1250 g and/or ≤30 weeks gestation within the first 3 days after birth. A survey to assess attitudes regarding cranial POCUS was given before each of three training sessions. Demographic and clinical data collection were portrayed with descriptive statistics. Metrics of image quality were assessed by a radiologist and sonographer independently. Analysis of trends in quality of POCUS images over time was performed using a multinomial Cochran-Armitage test. Eighty-two cranial POCUS scans were performed over a 2-year period. Infant median age at exam was 14 hours (IQR 7-22 hours). Metrics of image quality depicted quarterly demonstrated a significant improvement in depth (P = .01), gain (P = .048), and quality of anatomy images captured (P < .001) over time. Providers perceived increased utility and safety of cranial POCUS over time. Cranial POCUS image acquisition improved significantly following care team training, which may enable providers to diagnose ICH at the bedside.

Evolving the Scope of Cardiac Point-of-Care Ultrasound in the Current Era.

Point-of-care ultrasound (POCUS) has become a flexible and multifaceted diagnostic instrument in the realm of cardiac care, transforming the landscape of cardiovascular assessment. This review aims to explore the extensive scope of POCUS applications in cardiac care, highlighting its diverse utility across various medical specialties. POCUS, conducted at the patient's bedside, offers real-time insights into cardiac anatomy and function, providing a valuable adjunct to traditional diagnostic methods. In critically ill patients, POCUS has demonstrated its effectiveness in the rapid evaluation of the left and right ventricular function, identification of pericardial effusion and tamponade, assessment of volume status, and detection of valvular lesions. Its role as an adjunct to the physical examination has been particularly impactful, leading to early diagnoses and significantly influencing medical management decisions. The review also discusses the current limitations of POCUS technology. As the utilization of POCUS continues to expand across diverse medical disciplines, its ability to offer timely and accurate diagnostic information is poised to reshape the standard of care in cardiac medicine. This comprehensive review provides insights into the evolving role of POCUS in cardiac care and underscores its potential to enhance patient outcomes through rapid and informed decision-making at the point of care.

The Role of Pocus in Acute Respiratory Failure: A Narrative Review on Airway and Breathing Assessment

Acute respiratory failure (ARF) is a challenging condition that clinicians, especially in emergency settings, have to face frequently. Especially in emergency settings, many underlying diseases can lead to ARF and life-threatening conditions have to be promptly assessed and correctly treated to avoid unfavorable outcomes. In recent years, point-of-care ultrasound (POCUS) gained growing consideration due to its bedside utilization, reliability and reproducibility even in emergency settings especially in unstable patients. Research on POCUS application to assess ARF has been largely reported mainly with observational studies showing heterogeneous results from many different applications. This narrative review describes the wide potentiality of POCUS to face airways and breathing life-threatening conditions such as upper airway management, pulmonary and pleural pathologies and diaphragm impairment. We conducted extensive research of the literature to report from major studies to case reports deemed useful in practical clinical utilization of POCUS in ARF. Due to the huge amount of the literature found, we focused on airways and breathing assessment trying to systematize the evidence according to clinical care of ARF in emergency settings. Further studies, possibly trials, should determine how POCUS is crucial in clinical practice in terms of standard of care improvements, patient safety and cost-benefit analysis.

Utility of Cardiac POCUS in the Evaluation of Pediatric Chest Pain in the Emergency Department

Background/Objective:Chest pain in children is rarely caused by a life-threatening pathology. Despite the rarity of potentially life-threatening disease, most children presenting to EDs are evaluated with chest radiographs and laboratory tests without yielding helpful information that significantly changes immediate management. While the utilization of cardiac Point-of-Care Ultrasound (POCUS) by adult emergency physicians has become standard of practice, the data in pediatric emergency departments (PED) is not as robust. This study aims to describe practice patterns in the evaluation of pediatric chest pain presenting in a PED and determine clinical outcomes.&#x0D; Methods:We reviewed charts of previously healthy children aged &lt;18 years old who presented to Riley Children’s Hospital from January 2019 to July 2020 with a chief complaint of chest pain. Patients with known medical history, prior evaluations by a pediatric cardiologist, transfers from other hospital with existing workup were excluded. Patient demographics, laboratory tests and imaging ordered while in the ED, electrocardiography (EKG), consults with subspecialties, disposition and follow up plans were analyzed. We categorized clinical significance of PED interventions as minor, moderate, or major.&#x0D; Results:Out of three hundred and nineteen patients included in the study, 79.6% (254) received chest radiographs, 93.4% (298) underwent EKG, and 4.1% (13) received cardiac POCUS. The findings of these orders prompted minor interventions in 92.8% (296) of patients, moderateintervention in 4.7% (15) of patients, and major intervention in 2.5% (8) of patients.&#x0D; Conclusion and Implications:These results show a lack of use for POCUS in pediatric patients presenting with chest pain while chest radiography is preferred in the ED. Additionally, POCUS did not result in any moderate or major significant clinical outcomes.