Utility Of Point-of-care Ultrasound Research Articles

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 < 0.001). Independent predictors of more frequent POCUS use in OHCA included EM fellowship status (p = 0.005), receiving training on this issue (p < 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 <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 <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.

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.

Diagnosis of fat embolism syndrome using point‐of‐care ultrasound

AbstractFat embolism (FES) is a condition that can lead to severe organ effects and death in patients with long bone fractures. Diagnosis is challenging due to multiple criteria. This case report presents the use of point‐of‐care ultrasound (POCUS) in diagnosing right ventricular dysfunction associated with fat embolism syndrome. A 36‐year‐old patient with a history of obesity presented with multiple fractures and respiratory failure after a road accident. Bedside echocardiography showed evidence of dilated right chambers, right ventricular outflow tract shortened acceleration time, and mild tricuspid insufficiency. Venous ultrasonography showed microembolic signals (MES) interpreted as fat embolism. The patient was treated with fracture reduction and osteosynthesis, which showed improvement in right ventricular dysfunction and the disappearance of MES. FES is a clinical syndrome that occurs after an identifiable bone injury. This case highlights the utility of POCUS in the diagnosis of FES.

Lung ultrasound for the sick child: less harm and more information than a radiograph.

In the realm of emergency medicine, the swift adoption of lung ultrasound (LU) has extended from the adult population to encompass pediatric and neonatal intensivists. LU stands out as a bedside, replicable, and cost-effective modality, distinct in its avoidance of ionizing radiations, a departure from conventional chest radiography. Recent years have witnessed a seamless adaptation of experiences gained in the adult setting to the neonatal and pediatric contexts, underscoring the versatility of bedside Point of care ultrasound (POCUS). This adaptability has proven reliable in diagnosing common pathologies and executing therapeutic interventions, including chest drainage, and central and peripheral vascular cannulation. The surge in POCUS utilization among neonatologists and pediatric intensivists is notable, spanning economically advanced Western nations with sophisticated, high-cost intensive care facilities and extending to low-income countries. Within the neonatal and pediatric population, POCUS has become integral for diagnosing and monitoring respiratory infections and chronic and acute lung pathologies. This, in turn, contributes to a reduction in radiation exposure during critical periods of growth, thereby mitigating oncological risks. Collaboration among various national and international societies has led to the formulation of guidelines addressing both the clinical application and regulatory aspects of operator training. Nevertheless, unified guidelines specific to the pediatric and neonatal population remain lacking, in contrast to the well-established protocols for adults. The initial application of POCUS in neonatal and pediatric settings centered on goal-directed echocardiography. Pivotal developments include expert statements in 2011, the UK consensus statement on echocardiography by neonatologists, and European training recommendations. The Australian Clinician Performed Ultrasound (CPU) program has played a crucial role, providing a robust academic curriculum tailored for training neonatologists in cerebral and cardiac assessment. Notably, the European Society for Paediatric and Neonatal Intensive Care (ESPNIC) recently disseminated evidence-based guidelines through an international panel, delineating the use and applications of POCUS in the pediatric setting. These guidelines are pertinent to any professional tending to critically ill children in routine or emergency scenarios. In light of the burgeoning literature, this paper will succinctly elucidate the methodology of performing an LU scan and underscore its primary indications in the neonatal and pediatric patient cohort. The focal points of this review comprise as follows: (1) methodology for conducting a lung ultrasound scan, (2) key ultrasonographic features characterizing a healthy lung, and (3) the functional approach: Lung Ultrasound Score in the child and the neonate. Conclusion:the aim of this review is to discuss the following key points: 1. How to perform a lung ultrasound scan 2. Main ultrasonographic features of the healthy lung 3. The functional approach: Lung Ultrasound Score in the child and the neonate What is Known: • Lung Ultrasound (LUS) is applied in pediatric and neonatal age for the diagnosis of pneumothorax, consolidation, and pleural effusion. • Recently, LUS has been introduced into clinical practice as a bedside diagnostic method for monitoring surfactant use in NARDS and lung recruitment in PARDS. What is New: • Lung Ultrasound (LUS) has proven to be useful in confirming diagnoses of pneumothorax, consolidation, and pleural effusion. • Furthermore, it has demonstrated effectiveness in monitoring the response to surfactant therapy in neonates, in staging the severity of bronchiolitis, and in PARDS.

Point-of-care ultrasound to diagnose acute cholecystitis in the emergency department: A scoping review.

Ultrasound is the first-line imaging modality for suspected acute cholecystitis. This can be radiology-performed ultrasound or point-of-care ultrasound (POCUS). POCUS can potentially streamline patient assessment in the emergency department (ED). The primary objective was to evaluate the literature for the diagnostic accuracy of POCUS performed for acute cholecystitis in the ED. Secondary objectives were to assess the effect of POCUS operator training on diagnostic accuracy for acute cholecystitis, utility of POCUS measurement of the common bile duct and POCUS impact on resource utilisation. A systematic scoping review of articles was conducted using Medline, Embase, CENTRAL and CINAHL. Original studies of adults with POCUS performed for the diagnosis of acute cholecystitis in the ED were included. The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist (PRISMA-ScR). A total of 1090 publications were identified. Forty-six met the eligibility criteria. Studies were thematically grouped into categories according to specified objectives. Point-of-care ultrasound was of acceptable but variable accuracy, contributed to by the absence of a consistent reference standard and uniform training requirements. It may positively impact ED resource utilisation through reduced ED length of stay and radiology-performed imaging, whilst improving patient experience. This review highlights the heterogeneity of existing research, emphasising the need for standardisation of training and reference standards in order to precisely define the utility of POCUS for acute cholecystitis in the ED and its benefits on ED resource utilisation.

Impact of Didactic Instruction on the Utilization of Point-of-Care Ultrasound in Family Medicine Residents.

Background and Objectives In 2014, the Council of Academic Family Medicine released recommendations for the education of family medicine residents in point-of-care ultrasound (POCUS) curricula for Family Medicine Residency programs. One barrier to resident education in POCUSis the lack of access to equipment. This pilot study evaluates whether introducing didactic education on POCUSwithin a Family Medicine Residency program, with limited access to equipment, correlated with increased utilization of ultrasound by residents. Methods Sixteen family medicine residents participated in the intervention, consisting of a four-hour didactic ultrasound session. Resident confidence in POCUS was evaluated utilizing a Likert scale. Resident utilization of POCUS in a clinical setting was also evaluated by review and analysis of resident procedure logs in the New Innovations database. Results The resident confidence in all skills increased immediately after the completion of the didactic teaching session. Residents demonstrated improved confidence in needle guidance immediately and six weeks after the session (p < 0.001). A review of resident activity two years after the intervention revealed a 9.6% increase in the proportion of resident ultrasounds performed compared to the academic year before the intervention. Conclusions Access to equipment is an ongoing barrier to Family Medicine Residency programs in providing education on POCUS. The results of this study indicate that introducing the basics of POCUS via a didactic teaching session not only increased resident confidence in basic ultrasound but also correlated with increased utilization of POCUS. This increased utilization occurred despite residents not having access to ultrasound in their home clinics.

Optimizing Care for High-Risk Multiple Pregnancy with POCUS – A Case of Quadruplet Pregnancy Early Diagnosis

Managing multiple pregnancies is challenging and requires careful evaluation. Point of care ultrasound (POCUS) has emerged as a potentially crucial tool in assessing suspected first-trimester pregnancies. However, its role in evaluating multiple pregnancies remains uncertain. We present the case of a 36-year-old Ghanaian female who presented with acute vaginal bleeding after undergoing in vitro fertilization. A bedside transabdominal POCUS identified four intrauterine gestations with fetal poles and cardiac activity, suggesting a quadruplet viable pregnancy. A subsequent transvaginal ultrasound confirmed the findings. The patient was discharged with a follow-up appointment with an Obstetrician-Gynecologist. This case highlights the significance of POCUS in early pregnancy diagnosis, facilitating accurate identification and appropriate referral for further management. It also demonstrates the utility of POCUS in determining gestational age and viability. To our knowledge, no published case reports specifically address the diagnosis of a quadruplet pregnancy, emphasizing the role of POCUS in optimizing care for high-risk multiple pregnancies.

Pediatric Profound Dengue Shock Syndrome and Use of Point-of-Care Ultrasound During Mechanical Ventilation to Guide Treatment: Single-Center Retrospective Study, 2013-2021.

Profound dengue shock syndrome (DSS) complicated by severe respiratory failure necessitating mechanical ventilation (MV) accounts for high case fatality rates among PICU-admitted patients. A major challenge to management is the assessment of intravascular volume, which can be hampered by severe plasma leakage and the use of MV. Retrospective cohort, from 2013 to 2021. Sixty-seven children with profound DSS supported by MV, some of whom underwent bedside point-of-care ultrasound (POCUS) for assessment and monitoring of hemodynamics and fluid administration. PICU of the tertiary Children's Hospital No. 2 in Vietnam. None. We analyzed data clinical and laboratory data during PICU stay. In particular, during use of MV (i.e., at times 0-, 6-, and 24-hr after commencement) and fluid resuscitation. The primary study outcome was 28-day in-hospital mortality, and the secondary outcomes were associations with changes in hemodynamics, blood lactate, and vasoactive-inotrope score (VIS). Patients had a median age of 7 years (interquartile range, 4-9). Use of POCUS during fluid management (39/67), as opposed to not using (28/67), was associated with lower mortality (6/39 [15%] vs. 18/28 [64%]; difference 49 % [95% CI, 28-70%], p < 0.001). Use of POCUS was associated with lower odds of death (adjusted odds ratio 0.17 [95% CI, 0.04-0.76], p = 0.02). The utilization of POCUS, versus not, was associated with greater use of resuscitation fluid, and reductions in VIS and pediatric logistic organ dysfunction (PELOD-2) score at 24 hours after MV and PICU discharge. In our experience of pediatric patients with profound DSS and undergoing MV (2013-2021), POCUS use was associated with lower odds of death, a higher volume of resuscitation fluid, and improvements in the blood lactate levels, VIS, and PELOD-2 score.

Point-of-Care Ultrasonography in Internal Medicine: Limitations and Pitfalls for Novice Users.

Point-of-care ultrasound (POCUS) is increasingly being adopted in the field of internal medicine, leading to the development of POCUS curricula in undergraduate and postgraduate medical education programs. Prominent internal medicine societies and organizations worldwide recognize the expanding utilization of POCUS by internal medicine physicians, emphasizing the need for practitioners to be aware of both its benefits and limitations. Despite the growing enthusiasm for POCUS, clinicians, particularly those with limited clinical experience, must be cautious regarding its inherent limitations and the potential impact on their clinical practice. This review aims to outline the limitations and potential drawbacks of POCUS for medical students, residents, and internists who wish to stay abreast of the escalating use of POCUS in internal medicine and have a desire, or have already commenced, to incorporate POCUS into their practice. Additionally, it provides recommendations for enhancing POCUS proficiency to mitigate these limitations.

A Real-World Experience: Retrospective Review of Point-of-Care Ultrasound Utilization and Quality in Community Emergency Departments.

Point-of-care ultrasound (POCUS) is commonly used in the emergency department (ED) as a rapid diagnostic tool. Emergency medicine (EM) has been an early adopter of POCUS with indications expanding over the last 10 years. While the literature describes widespread use among academic sites, there is little data on clinical POCUS utilization at non-academic EDs. We sought to describe community emergency physician (EP) use of POCUS by quantifying the number and type of studies performed, characteristics of the performing physician, and quality metrics. Prior to the study period, all EPs underwent a standardized training and credentialing program. A retrospective review of all POCUS studies across 11 non-academic EDs from October 1, 2018-September 30, 2020 was performed by fellowship-trained physicians, who identified physician, exam type, and residency graduation year. The studies were then cross-referenced with quality review reports that assessed image acquisition, image interpretation, and image labeling. We performed descriptive statistics. During the study period, 5,099 POCUS studies were performed by 170 EPs. Exams most frequently performed were cardiac (24%), focused assessment of sonography in trauma (21.7%), and pregnancy (16.2%). Recent EM residency graduates (<10 years) were higher utilizers of POCUS with a group mean of 1.3 exams per 100 patients. Of the studies done, 86% had no quality issues. Community POCUS demonstrates a heavy focus on core exams performed by recent EM residency graduates with minimal quality issues after a standardized training program. This study is the first to quantify actual community POCUS use in multiple EDs and may impact credentialing and skills maintenance requirements.

Point-of-Care Ultrasound for the Evaluation and Management of Posterior Cruciate Ligament Injuries: A Systematic Review.

Posterior cruciate ligament (PCL) injuries, though less common than other knee ligament injuries, pose significant management challenges. This study aimed to systematically review and analyze the current evidence on the use of point-of-care ultrasound (POCUS) for the evaluation and management of PCL injuries. It was hypothesized that POCUS has comparable diagnostic accuracy to magnetic resonance imaging (MRI) and that the use of POCUS improves patient outcomes and reduces healthcare costs. A comprehensive systematic review of articles published up to April 2023 was conducted using PubMed, Web of Science, Cochrane, and Scopus databases and adhered to the PRISMA guidelines. Studies were selected based on relevance to the research question, with a focus on diagnostic accuracy, reliability, clinical utility, and cost-effectiveness of POCUS in PCL injuries. Seven studies, analyzing a total of 242 patients with PCL injuries, were included. The reported sensitivity and specificity of POCUS for diagnosing PCL injuries ranged from 83.3% to 100% and 86.7% to 100%, respectively, across the studies. In one study, POCUS demonstrated a positive predictive value (PPV) of 87.9% and a negative predictive value (NPV) of 82.4%. Additionally, three studies reported 100% accuracy in PCL injury detection using POCUS, suggesting a substantial potential for cost savings by eliminating the need for MRI. This systematic review supports the use of POCUS in the evaluation and management of PCL injuries, suggesting that POCUS is a reliable, cost-effective tool with high diagnostic accuracy comparable to that of MRI, offering the potential to improve patient outcomes and reduce healthcare costs. The data collated in this review can inform clinical practice and guide future research in the field.

Point of Care Ultrasound (POCUS) Utilization and Barriers by Senior Emergency Medicine and Critical Care Residents at Two Teaching Referral Hospitals, Addis Ababa, Ethiopia.

POCUS has become an integral part of the practice of emergency medicine. POCUS is a highly focused, limited, goal-directed exam with the expressed purpose of answering selected questions used at the bedside for critically ill patients who are not stable. We aimed to assess POCUS utilization and barriers by senior-year emergency medicine and critical care residents at two tertiary academic and referral hospitals in Addis Ababa, Ethiopia. Methodology. A cross-sectional study was conducted from June 1 to August 30, 2022 in St Paul's Hospital Millennium Medical College and Tikur Anbessa Specialized Hospital using an electronic survey of senior-year (second and third years) emergency medicine and critical care residents. Data were collected using Goggle form, exported to SPSS version 24, and then analyzed. Seventy-six residents out of 78 (97.4%) responded to the online survey. The mean age was 29.9 years with an SD of 2.87. Fifty-six residents (73.7%) were male and 45 (59.2%) were year 2 residents. Sixty-one (76.3%) had previous POCUS training. Fifty residents (82.0%) received training from the classroom. Twenty-seven residents (35.5%) rated their current level of knowledge as good for sterile transducer techniques, 28 (36.8%) rated fair for their knobology, and 27 (35.5%) rated very good for their transducer selection knowledge. Thirty-two (42.1%) rated very good about their ability to interpret IVC. 26 (34.2%) responded that they had good ability to interpret FAST/EFAST. Forty-nine (64.5%) residents claimed lack of an ultrasound machine followed by 33 (43.4%) lack of organized curriculum were the main barriers to POCUS utilization. Forty-two (55.3%) residents preferred to complete face-to-face teaching, while 33 (43.4%) preferred blended learning both face-to-face and online. POCUS is performed by the majority of EMCC residents. The most frequent scans performed by residents were FAST, IVC, and lung scans. Lack of ultrasound machine and organized curriculum was the main barrier to US utilization. Availability of equipment, face-to-face training, and having an organized curriculum are recommended by residents to improve their skills in the future.