Use Of POCUS Research Articles

Cystic lymphangioma, incidental finding after pocus in outpatient pediatrics consultation

Cystic lymphangioma is a malformation of the lymphatic system, generally asymptomatic and rare in paediatric age. We present the case of a 14-year-old girl who underwent a bedside ultrasound (POCUS: Point of Care Ultrasound) from the primary care paediatrics’ consultation. A hypoechoic and septate cystic mass was found in the hypogastrium. She was diagnosed of cystic lymphangioma after completing the study with magnetic resonance imaging (MRI). Treatment consisted of sclerotherapy without recurrence after 2 years of follow-up. The routine use of POCUS from primary care can contribute to the early detection of asymptomatic abdominal lesions.

Motivations, barriers, and professional engagement: a multisite qualitative study of internal medicine faculty\u2019s experiences learning and teaching point-of-care ultrasound

BackgroundPoint-of-care ultrasound (POCUS) graduate medical education is expanding across many specialties, but a lack of trained faculty is a common barrier. Even well-designed faculty development programs struggle with retention, yet little is known about the experiences of practicing physicians learning POCUS. Our objective is to explore the experiences of clinician-educators as they integrate POCUS into their clinical and teaching practices to help inform curriculum design.MethodsQualitative study using instrumental case study design to analyze interview data from 18 internal medicine clinician-educators at 3 academic health centers. Interviewees were recruited by program directors at each site to include participants with a range of POCUS use patterns. Interviews took place from July–August 2019.ResultsAnalysis yielded 6 themes: teaching performance, patient care, curriculum needs, workflow and access, administrative support, and professional engagement. Participants felt POCUS enhanced their teaching skills, clinical decision making, and engagement with patients. The themes highlighted the importance of longitudinal supervision and feedback, streamlined integration of POCUS into clinical workflow, and administrative support of time and resources. Interviewees reported learning and teaching POCUS helped combat burn-out and enhance their sense of professional engagement.ConclusionsLearning POCUS as a practicing clinician-educator is a complicated endeavor that must take into account mastery of psychomotor skills, existing practice habits, and local institutional concerns. Based upon the themes generated from this study, we make recommendations to help guide POCUS faculty development curriculum design. Although this study focused on internists, the findings are likely generalizable to other specialties with growing interest in POCUS education.

Potential for Use of Portable Ultrasound Devices in Rural and Remote Settings in Australia and Other Developed Countries: A Systematic Review.

IntroductionPoint of care ultrasound (POCUS) has become more common for rapid evaluation. Applications are limited by lack of training of users, difficulty maintaining ultrasound competencies, access to equipment for optimal imaging, and limitations in quality control. Such barriers exist in low-resource, underserved health care settings.ObjectiveThe aim was to explore the use of POCUS in under-resourced health care settings, such as rural and remote locations in Australia and other countries. Key variables include health outcomes, quality of care, service availability, examinations types performed, equipment used, who performs the examinations, and the ultrasound training received.MethodsLiterature was identified via CINAHL, Cochrane, Embase, Medline, PubMed, SCOPUS, and Web of Science, plus grey literature. Recommended guidelines were followed, and only research-based articles were included, with searches limited to English language and 2010–present.ResultsAfter screening, 23 articles were reviewed. No studies had low risk of bias and, overall, the quality was poor and only two studies used random sampling. The majority were from developing countries, with only one performed in Australia. Echocardiographic screening in schools was common. Others included emergency department (ED) patients, abdominal aorta screening, obstetric scans, and intensive care unit (ICU) management. Operators included ED doctors, medical students, nurses, community healthcare workers and general practitioners, who received limited training in protocol-driven scanning, often monitored by experts. In comparison to clinical assessment, standard ultrasound or other imaging, accuracy was of the order of 70–95%, depending on the condition, with high efficacy in improving patient care.ConclusionLack of studies of POCUS in Australia and other developed countries suggests a need for further research. Current evidence supports use of limited ultrasound using portable machines in locations with limited access to diagnostic ultrasound performed by sonographers, which has the potential to improve health outcomes in under-resourced communities in Australia and elsewhere.

Point-of-Care Ultrasound Curriculum for Endotracheal Tube Confirmation for Pediatric Critical Care Transport Team Through Remote Learning and Teleguidance

ObjectivePoint-of-care ultrasound (POCUS) is used to manage patients in real time. This study aimed to teach pediatric critical care team members to use POCUS for endotracheal tube (ETT) placement confirmation. A secondary aim was to assess the feasibility of a remote curriculum for this purpose. MethodsThe Kern 6-step approach was used. The curriculum involved virtual didactics, asynchronous learning modules, and remote hands-on sessions using teleguidance with the Butterfly IQ+ probe, Butterfly Network, Inc, Guilford, CT. Participants learned direct and indirect methods of ETT placement confirmation and were directed to practice independently. Outcomes included attitudes and satisfaction, knowledge and skills acquisition and retention, and the use of POCUS on shift. ResultsTen participants completed the curriculum. The average knobology and quiz scores improved by 29.3% and 20.8%, respectively. Improvement was sustained at re-evaluation. Seven of 10 participants performed independent scans. At the 3-month reassessment, most demonstrated mastery of thoracic scans. All required prompting for satisfactory tracheal scans. All felt positively toward POCUS and the remote curriculum. ConclusionPediatric critical care team members acquired and retained knowledge and skills for POCUS basics and ETT placement confirmation through a remote curriculum. Participants were satisfied with the course. Further studies are needed to reassess longer-term knowledge and skill retention and the effects on patient outcomes.

A point-of-care thoracic ultrasound protocol for hospital medical emergency teams (METUS) improves diagnostic accuracy

BackgroundPoint-of-care ultrasound (POCUS) has proven itself in many clinical situations. Few data on the use of POCUS during Medical Emergency Team (MET) calls exist. In this study, we hypothesized that the use of POCUS would increase the number of correct diagnosis made by the MET and increase MET’s certainty.MethodsSingle-center prospective observational study on adult patients in need for MET assistance. Patients were included in blocks (weeks). During even weeks, the MET physician performed a clinical assessment and registered an initial diagnosis. Subsequently, the POCUS protocol was performed and a second diagnosis was registered (US+). During uneven weeks, no POCUS was performed (US−). A blinded expert reviewed the charts for a final diagnosis. The number of correct diagnoses was compared to the final diagnosis between both groups. Physician’s certainty, mortality and possible differences in first treatment were also evaluated.ResultsWe included 100 patients: 52 in the US + and 48 in the US− group. There were significantly more correct diagnoses in the US+ group compared to the US− group: 78 vs 51% (P = 0.006). Certainty improved significantly with POCUS (P < 0.001). No differences in 28-day mortality and first treatment were found.ConclusionsThe use of thoracic POCUS during MET calls leads to better diagnosis and increases certainty.Trial registration. ClinicalTrials.gov. Registered 12 July 2017, NCT03214809 https://www.clinicaltrials.gov/ct2/show/NCT03214809?term=metus&cntry=NL&draw=2&rank=1

Point of Care Ultrasound during the Medical Teaching Rounds in the COVID-19 Era -The Hospitalist Perspective-

In Internal Medicine, POCUS is gaining significant favorability. An increasing number of clinicians are interested in being trained for POCUS. The newer portable ultrasounds are small and can be transported easily during rounds. Their design is now for a more intuitive use. Training of Internists now involves assessing patients utilizing POCUS technology in residency. Here at Danbury Hospital, we have formal POCUS training. Attending internists are now attempting to incorporate POCUS training as a part of continuing medical education. POCUS in the hospitalist or general practitioner world has not been completely defined. Generally, the patient seen in the medical ward is not ill as the patients seen in intensive care units (ICU), Emergency Department (ED), and other high acute-care settings. However, from time to time, internists need to treat high acuity patients on the medical floors before transferring them to a higher level of care or when they are required to cover an open ICU or Progressive Care Unit (step-down unit). The role of POCUS while managing stable patients may differ significantly compared to the role in more acute patients. A well-defined spectrum for the use of POCUS does not currently exist. However, there are efforts in this regard. &#x0D; POCUS is an emerging and exciting diagnostic modality in the medical ward. We believe that the pandemic has given it a new meaning for the hospitalist and general practitioner, and we expect that its use and significance will only grow in the few years ahead.

512 Bedside Transthoracic echography volume Assessment in the BICU

Abstract Introduction Point-of-Care Ultrasound (POCUS) has been shown to be a useful adjunct in assessment of various shock states and utilized to guide resuscitative and post-resuscitation de-escalation efforts. POCUS use for guiding resuscitation in burn injured patient has not be described. Objectives characterize the use of bedside ultrasound examinations performed by advance practice providers and treating physicians in a regional burn intensive care unit Methods Daily beside ultrasound examinations were performed utilizing a bedside ultrasound device by an advanced practice provider prior to rounds POCUS examinations consist of: Ultrasound images were archived to a centralized image repository and reviewed daily during multi-disciplinary rounds. Ultrasonographic volume assessment compared to clinical volume assessment made during daily multidisciplinary rounds. Results 100 examinations were performed of those 32 were within the initial 72 hour window: Conclusions Our results demonstrate that bedside ultrasound aides in guidance of both resuscitative and post-resuscitative efforts. We identified a cohort of patients who appeared hypervolemic clinically but US findings supported hypovolemia, we refer to as pseudohypervolemia US volume assessment provides information that changes management. We believe point of care ultrasound is a viable tool in preventing over-resuscitation as well as to guide post-resuscitative diuresis.

A Case Report on Distinguishing Emphysematous Pyelitis and Pyelonephritis on Point-of-care Ultrasound.

IntroductionPoint-of-care ultrasound (POCUS) in the emergency department (ED) is being performed with increasing frequency. The objective of this study was to demonstrate how utilization of POCUS can help the emergency physician recognize emphysematous pyelitis (EP) and emphysematous pyelonephritis (EPN).Case ReportA 60-year-old female presented to the ED with normal vital signs and intermittent left-sided flank pain that radiated to her groin. She also had a history of obstructive nephrolithiasis. Within 20 minutes of arrival she became febrile (101.2°Fahrenheit), tachycardic (114 beats per minute), tachypneic (21 breaths per minute), and had a blood pressure of 114/82 millimeters mercury. POCUS was conducted revealing heterogeneous artifact with “dirty shadowing” within the renal pelvis, which was strongly suggestive of air. The emergency physician ordered a computed tomography (CT) to confirm the suspicion for EP and started the patient on broad-spectrum antibiotics. The CT showed a 1.3-centimeter calculus and hydronephrosis with foci of air. The patient received intravenous antibiotics and had an emergent nephrostomy tube placed. Urine cultures tested positive for pan-sensitive Escherichia Coli. Urology was consulted and a repeat CT was obtained to show correct drainage and decreased renal pelvis dilation.ConclusionDistinctly different forms of treatment are used for EP and EPN, despite both having similar pathophysiology. In EP, air can be seen in the renal pelvis on POCUS, as in this case study, which distinguishes it from EPN. In the case of our patient, the use of POCUS was useful to aid in rapid differentiation between EP and EPN.

Point-of-care ultrasonography in nephrology: a cross-sectional national survey among Brazilian nephrologists.

Introduction: Point-of-care ultrasonography (US) (POCUS) has been used in several specialties, particularly in medical emergency. Despite the confirmation of its numerous benefits, the use of POCUS is still timid in nephrology. In the present study, we aim to investigate the use of POCUS by Brazilian nephrologists.Methods: A survey carried out among the members of the Brazilian Society of Nephrology, through institutional e-mail, using the SurveyMonkey platform. We included 12 self-administered questions, which answers were given anonymously.Results: It was evident that the majority (64%) of the participants did not have the opportunity to practice US during their nephrological training in their residency, specialization, or even in internships; those with experience with US use the method mainly for implanting central vascular accesses (68%), performing a renal biopsy (58%) and evaluating renal morphology (50%); and the main barriers for nephrologists who do not yet use US are the high price of US machines (26%) and the lack of time to learn about US (23%). Also, POCUS use for examinations of other organs, such as the lung (31%) and heart (18%), which are fundamental in the cardiovascular and volume assessment of patients with kidney diseases, is even more limited. However, 95% of the participants expressed an interest in learning POCUS for use in their medical practice.Conclusion: Most of the Brazilian nephrologists interviewed were not trained in US; however, almost all of the research participants expressed an interest in learning to use POCUS in nephrological practice.

The Use of Point-of-care Ultrasound in Emergency Medical Centers in Korea: a National Cross-sectional Survey.

BackgroundPoint-of-care ultrasound (POCUS) is an essential tool in emergency medicine (EM). We aimed to investigate the current status and perception of POCUS use in emergency medical centers in Korea.MethodsA cross-sectional, nationwide survey was conducted using a mobile survey of physicians at emergency medical centers in Korea. The first message was sent on November 27, 2020, and the second message was sent on December 3, 2020 to the non-responders. The questionnaire comprised 6 categories and 24 questionnaires on demographics, current practice, education, perception, and barriers to the use of POCUS.ResultsA total of 467 physicians participated in the survey (a response rate of 32% among 1,458 target physicians), of which 43% were residents and 57% were EM specialists. Most of the respondents (96%) answered that they use POCUS, of which 89% reported using it at least once a week. The most frequently used types of POCUS were focused assessment with sonography for trauma (68%) and echocardiography (66%). Musculoskeletal, male genital, and pediatric scans were rarely performed tests but ranked as of the scans physicians most wanted to learn. About 73% of the respondents received ultrasound education, and 41% received ultrasound education at their own institutions. Nevertheless, education-related barriers are still the biggest deterrent to POCUS use (60%). In addition, multivariate multinomial logistic regression analysis revealed that the greater the number of ultrasound devices and the total number of physicians in the emergency center, the more likely they were to use POCUS every day.ConclusionThis study found that most physicians currently working in emergency medical centers in Korea more frequently perform various types of ultrasound scans compared to those 10 years prior. To further promote the use of POCUS, it is important to have an appropriate number of ultrasound devices and physicians in the emergency center along with systematic POCUS education.

Point-of-care ultrasound in nephrology.

The use of POCUS has grown tremendously with the introduction of innovative, easy-to-carry and maneuver hand-held devices. This review focuses on nephrology-centric applications of POCUS that can be incorporated on a daily basis to make impactful and prompt clinical decisions. We review articles covering use of POCUS in the dialysis unit, the Emergency Department, office, and ICU for assessment of volume status, access issues, stones, obstruction, and to help manage patients with AKI, shock, and heart failure. POCUS is a welcome addition to our bedside diagnostic armamentarium and has great utility in nephrology. Trials are ongoing in evaluating outcomes with POCUS and physicians' clinical experience using it has been extremely positive.

1286: The Use of Bedside POCUS To Customize Dose of TPA In Unstable Acute Pulmonary Embolism

Copyright © 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Uso do ultrassom point-of-care (POCUS) na parada cardiorrespiratória (PCR)

Objetivo: Explanar e discutir criticamente a importância do uso do ultrassom point-of-care (POCUS) na parada cardiorrespiratória (PCR), elucidando particularidades de sua utilização. Revisão Bibliográfica: A ocorrência de PCR apresentando-se como ritmo não chocável tem aumentado nas últimas décadas. É importante atualizar as formas de atender esses pacientes, para melhor prognóstico. O uso do POCUS nos atendimentos de PCR como ferramenta para diagnóstico e prognóstico para pacientes graves tem sido abordado nos protocolos. O uso do ultrassom pode ser considerado durante tais manobras, desde que não interfira no protocolo de ressuscitação cardiopulmonar. O POCUS pode ser utilizado principalmente para a identificação de causas reversíveis, mas há discussões sobre outras utilizações. Um argumento apresentado contra o uso do POCUS durante a PCR é que ele pode afetar adversamente a qualidade da ressuscitação cardiopulmonar. É essencial utilizar o ultrassom no momento correto e seguir rígidos protocolos. Exame físico e histórico permanecem fatores importantes na tomada de decisões, não devendo ser negligenciados. Considerações Finais: O exame mostrou-se útil para identificação de causas reversíveis de PCR, o que causa impacto no prognóstico. Além disso, mostrou outras aplicabilidades como identificação de falsos ritmos não chocáveis, avaliação da qualidade das compressões torácicas e parâmetro para cessação de esforços.

Blinding practices during acute point-of-care ultrasound research: the BLIND-US meta-research study

ObjectivesPoint-of-care ultrasound (POCUS) diagnostic accuracy research has significant variation in blinding practices. This study characterises the blinding practices during acute POCUS research to determine whether research methodology adequately reflects POCUS...

Point-of-Care Ultrasound Use and Monetary Outcomes in a Single-Payer Health Care Setting.

Point-of-care ultrasound (POCUS) is a widely used diagnostic modality in the emergency physician's tool kit. The effect on health care costs is disputed. This study examined whether POCUS was associated with system-level cost savings. Secondary objectives included adverse patient outcomes and the association between POCUS use and diagnostic costs in specific patient groups. The Point-of-Care Ultrasound Use and Monetary Outcomes study was a single-center prospective observational study. A convenience sample of emergency medicine physicians working from July to October 2019 were included after using POCUS as part of their assessment. The cost of patient investigations was compared with those proposed by a control group of physicians simultaneously on shift, who were blinded to the POCUS findings. Ethical approval was obtained from the Queen's University Health Sciences Research Ethics Board. Fifty patient assessments using POCUS were included. Overall, the median investigation cost in United States dollars in the POCUS group was $102.00 (interquartile range [IQR], $39.80-$167.90) versus $122.40 (IQR, $70.96-$175.60) in controls (P=.08). When stratified by disposition, POCUS use in patients discharged home resulted in a median expenditure of $71.80 (IQR, $36.48-$116.70) versus $122.70 (IQR, $71.18-$183.20; P < .001). Significant cost savings were also found in flank pain presentations (median, $138.90; IQR, $136.60-$186.10; P=.01). There were no differences in the quantity of investigations ordered, the patient emergency department repeated presentation rate, or safety outcomes at 7 days. Point-of-care ultrasound use was not associated with significant cost savings in our overall population. The subgroup analysis revealed significant POCUS-associated cost savings in patients discharged home and those presenting with flank pain. Notably, POCUS was not associated with an increase in adverse patient safety outcomes.

Retention of Point-of-Care Ultrasound Skills Among Practicing Physicians: Findings of the VA National POCUS Training Program

BackgroundPoint-of-care ultrasound (POCUS) use continues to increase in many specialties, but lack of POCUS training is a known barrier among practicing physicians. Many physicians are obtaining POCUS training through postgraduate courses, but the impact of these courses on skill retention and frequency of POCUS use post-course is unknown. The purpose of this study was to assess the change in POCUS knowledge, skills, and frequency of use after 6-9 months of participating in a brief training course. MethodsCourse participants’ POCUS knowledge and hands-on technical skills were tested pre-course using an online, 30-question knowledge test and a directly observed skills test, respectively. The same knowledge and skills tests were repeated immediately post-course and after 6-9 months using remote tele-ultrasound software. Course participants completed a survey on their POCUS use pre-course and after 6-9 months post-course. ResultsThere were 127 providers who completed the POCUS training course from October 2016 to November 2017. Knowledge test scores increased from a median of 60% to 90% immediately post-course followed by a slight decrease to 87% after 8 months post-course. Median skills test scores for 4 common POCUS applications (heart, lung, abdomen, vascular access) increased 36-74 points from pre-course to immediately post-course with a 2–7-point decrease after 8 months. Providers reported more frequent POCUS use post-course, which suggests application of their POCUS knowledge and skills in clinical practice. More frequent use of cardiac POCUS applications was associated with significantly greater retention of cardiac skills at 8 months. ConclusionsPracticing physicians can retain POCUS knowledge and hands-on skills 8 months after participating in a 2.5-day POCUS training course, regardless of frequency of POCUS use post-course.

Ultrasonography in the Critical Care Unit.

Purpose of ReviewThis article summarizes the utility and evidence supporting the use of ultrasound exams in the intensive care unit.Recent FindingsPoint-of-care ultrasonography (POCUS) is widely used by intensivists managing critically ill patients whereby they can accurately and rapidly assess for many pathologies such as pneumothorax, pulmonary edema, hydronephrosis, hemoperitoneum, and deep vein thrombosis among others. Basic and advanced critical care echocardiography, including transesophageal echocardiography, are routinely performed to determine the etiology of hemodynamic instability in undifferentiated shock and to guide subsequent therapy. The use of POCUS in the assessment of volume status is controversial with studies demonstrating that respiratory variation of the IVC is not reliable and with analysis of aortic blood flow velocity after passive leg raising maneuvers being the most promising.SummaryPoint-of-care ultrasonography allows frontline clinicians to make real-time diagnoses and treatment decisions. This article will provide the reader with a broad overview of this important topic.Electronic supplementary materialThe online version of this article (10.1007/s11886-020-01393-z) contains supplementary material, which is available to authorized users.

Point of care ultrasound for all by all: A multidisciplinary survey across a large quaternary care medical system.

We sought to understand current POCUS practices and comfort as well as assess opinions about POCUS across our medical system via a survey to guide program development. This study was conducted as a 19 question RedCap survey with multiple parts. Respondents were queried for demographics as well as experience with, attitudes toward, and clinical use of POCUS in common critical care scenarios. The survey was completed by 343 individuals, a response rate of 30%. Most respondents "agreed" that POCUS is a needed skill and helped them provide safer care (78% and 86% agreement). Most faculty and trainees reported some POCUS training (62% and 88%) and at least weekly use. Trainees rated themselves more comfortable than faculty for most exam types. The majority of faculty rated their POCUS education as inadequate while trainees had mixed responses. POCUS is a frequently used tool, yet users are less confident in their skills than expected. POCUS applications are viewed as needed for future practice but there is a substantial need for improved education among faculty and trainees. Pooling resources and sharing educational initiatives across multiple specialties may help improve POCUS implementation.

Clinical Progress Note: Point-of-Care Ultrasound Applications in COVID-19.

COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, was declared a pandemic on March 11, 2020. Although most patients (81%) develop mild illness, 14% develop severe illness, and 5% develop critical illness, including acute respiratory failure, septic shock, and multiorgan dysfunction.1 Point-of-care ultrasound (POCUS), or bedside ultrasound performed by a clinician caring for the patient, is being used to support the diagnosis and serially monitor patients with COVID-19. We performed a literature search of electronically discoverable peer-reviewed publications on POCUS use in COVID-19 from December 1, 2019, to April 10, 2020. We review key POCUS applications that are most relevant to frontline providers in the care of COVID-19 patients.

COVID-19 - More Lung Pocus and Sparing Use of Stethoscope, Chest X-Ray and Lung CT

COVID-19 - More Lung Pocus and Sparing Use of Stethoscope, Chest X-Ray and Lung CT Abstract. For an optimal management of COVID-19 (Coronary Virus Disease) we depend on a fast and reliable diagnosis and severity assessment. The gold standard so far is RT-PCR (reverse transcriptase polmerase chain reaction) from the nasopharyngeal smear. Current tests have a sensitivity of 60-90 %. As a consequence, we must expect 10-40 % false negative results. In addition to oxygen saturation for severity classification, stethoscope, chest X-ray and lung computer tomography are routinely used. However, the standard methods stethoscope and chest X-ray are unreliable. Moreover, all three diagnostic examination techniques expose physicians, support staff and subsequent patients to an additional risk of exposure. In view of the contagiousness of SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona Virus), lung point-of-care ultrasound (Lu-PoCUS) is a still underutilized valuable alternative, especially when using pocket devices. In this review the current value and role of stethoscope, pulsoxymetry, chest x ray, lung computer tomography and lung point-of-care ultrasound will be determined based on the available literature.