scholarly journals P119: B-mode point-of-care ultrasound without doppler may help include or exclude significant carotid stenosis in stroke and transient ischemic attack patients - a prospective pilot study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S118-S118
Author(s):  
R. Simard ◽  
S. Socransky
Keyword(s):  
Emergency Department ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Transient Ischemic Attack ◽  
Emergency Physician ◽  
Point Of Care ◽  
External Carotid ◽  
Point Of Care Ultrasound ◽  
Flow Measurements ◽  
Ischemic Attack

Introduction: Emergency physicians can use B-mode Point-of-Care Ultrasound (POCUS) to identify a patient’s carotid vasculature including the common carotid artery (CCA), and carotid bulb (CB) as well as carotid bifurcation into the internal carotid artery (ICA) and external carotid artery (ECA). Radiology performed carotid ultrasound (RPCU) is performed using both B-mode and spectral Doppler ultrasound, a combination termed “duplex” ultrasound where first arteries are evaluated for stenosis using B-mode ultrasound, which is followed by flow measurements using Doppler. Performing flow measurements using Doppler may add a significant amount of time to the ultrasound, which makes it impractical for an emergency physician in a busy emergency department. Some institutional practices include arranging for outpatient RPCU to assess patients with Transient Ischemic Attack (TIA) and have them follow up in an outpatient TIA clinic. This study explored whether B-mode POCUS without Doppler may help identify Stroke or TIA patients in the emergency department with significant carotid stenosis (CS) by measuring the CCA, CB, and ICA lumen. Methods: Adult patients with an emergency physician diagnosis of stroke or TIA who were sent for RPCU were included in this study. An emergency medicine resident in their POCUS fellowship training performed a B-mode POCUS of the patient’s right and left CCA, CB and ICA with the patient sitting 90 degrees. Three measurements of each of the 3 sections were obtained and the mean calculated. This was then compared to the results from the RPCU as CS >50% or CS <50%. Results: 38 patients were included in the study between February and June 2013. We observed a correlation between absolute differences in comparing the right side of the carotid vasculature to the left side of the carotid vasculature with CS >50%. Also, in one case, the absolute lumen diameter with B-mode POCUS without Doppler predicted near complete CS which was confirmed on the RPCU. Conclusion: B-mode POCUS without Doppler may be useful in identifying patients with CS above and below 50% and may help identify patients who need expedited referrals for CS. However, further research is required before this method can be recommended.

scholarly journals Female with Vaginal Bleeding

2020 ◽  
Vol 4 (4) ◽  
pp. 636-637
Author(s):  
Mark Quilon ◽  
Alec Glucksman ◽  
Gregory Emmanuel ◽  
Josh Greenstein ◽  
Barry Hahn
Keyword(s):  
Emergency Department ◽  
Emergency Physician ◽  
Vaginal Bleeding ◽  
Point Of Care ◽  
First Trimester ◽  
Yolk Sac ◽  
Pregnant Female ◽  
Point Of Care Ultrasound ◽  
Fetal Demise ◽  
Case Presentation

Case Presentation: A 24-year-old pregnant female presented to the emergency department with lower abdominal cramping and vaginal bleeding. A point-of-care ultrasound demonstrated a calcified yolk sac. Discussion: When identified, calcification of the yolk sac in the first trimester is a sign of fetal demise. It is important for an emergency physician to be aware of the various signs and findings on point-of-care ultrasound and be familiar with the management of these pathologies.

scholarly journals Cough-induced transient ischemic attack treated with revascularization of the external carotid artery

2014 ◽  
Vol 60 (6) ◽  
pp. 1657-1660 ◽  
Author(s):  
Shirling Tsai ◽  
M. Shadman Baig ◽  
Fatima Abrantes-Pais ◽  
R. James Valentine
Keyword(s):  
Carotid Artery ◽  
Transient Ischemic Attack ◽  
External Carotid Artery ◽  
External Carotid ◽  
Ischemic Attack

scholarly journals LIMB-SHAKING SEBAGAI MANIFESTASI YANG JARANG DARI TRANSIENT ISCHEMIC ATTACK AKIBAT STENOSIS BERAT ARTERI KAROTIS

2017 ◽  
Vol 35 (1) ◽  
Author(s):  
Kumara Tini
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Transient Ischemic Attack ◽  
Resonance Imaging ◽  
Rare Manifestation ◽  
Magnetic Resonance Imaging Mri ◽  
Ischemic Attack ◽  
Limb Shaking

  LIMB-SHAKING AS A RARE MANIFESTATION OF TRANSIENT ISCHEMIC ATTACK ASSOCIATED WITH SEVERE CAROTID ARTERI STENOSISABSTRACTLimb-shaking is a rare manifestation of Transient Ischemic Attack (TIA), commonly occurs when a severe carotid stenosis causes a cerebral hypoperfusion. Male 53 years of age experienced repeated limb-shaking within a week of left hand and arm accompanied by a vision of light sparks. Brain Magnetic Resonance Imaging (MRI) and Magentic Resonace Angiography (MRA) showed chronic watershed infarct at right fronto-parietal lobes and 80-90% severe stenosis of right internal carotid artery with digital subtraction angiography (DSA) showed 70% stenosis at the same site. Carotid Artery and Stenting (CAS) was done a week after and symptoms disappeared subsequently. Recognizing this rare symptom of severe carotid stenosis is very important since appropriate management can minimized the risk of future stroke.Keyword: Carotid stenosis, Limb-shaking, TIAABSTRAKLimb-shaking adalah manifestasi yang jarang dari transient ischemic attack (TIA), biasanya terjadi akibat hipoperfusi serebri pada stenosis berat arteri karotis. Laki-laki 53 tahun mengalami limb-shaking berulang dalam seminggu pada lengan dan tangan kiri disertai melihat percikan sinar. Magnetic resonance imaging (MRI) dan magnetic resonance agiography (MRA) kepala menunjukkan infark di area watershed lobus fronto-parietal kanan dan stenosis 80-90% di arteri karotis interna kanan, serta digital substraction angiography (DSA) menunjukkan stenosis 70% pada lokasi yang sama. Keluhan hilang setelah pasien dilakukan tindakan revaskularisasi carotid artery and stenting (CAS) seminggu kemudian. Pengenalan gejala yang jarang dari stenosis berat arteri karotis ini sangat penting, karena dengan penanganan yang tepat dapat mengurangi terjadinya stroke.Kata kunci:  Limb-shaking, stenosis karotis, TIA 

Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 13-14
Author(s):  
Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽  
Maryam Al Ali, MBBS
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Critical Care Unit ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

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