scholarly journals Feasibility of emergency department point-of-care ultrasound for rib fracture diagnosis in minor thoracic injury

CJEM ◽  
2016 ◽  
Vol 19 (3) ◽  
pp. 213-219 ◽  
Author(s):  
Élizabeth Lalande ◽  
Chantal Guimont ◽  
Marcel Émond ◽  
Marc Charles Parent ◽  
Claude Topping ◽  
...  
Keyword(s):  
Emergency Department ◽  
Point Of Care ◽  
Rib Fracture ◽  
Thoracic Injury ◽  
Limiting Factor ◽  
Point Of Care Ultrasound ◽  
Median Score ◽  
Emergency Physicians ◽  
X Ray ◽  
Fracture Diagnosis

ABSTRACTObjectivesThe main objective of this study was to evaluate the feasibility of emergency department (ED) point-of-care ultrasound (PoCUS) for rib fracture diagnosis in patients with minor thoracic injury (mTI). Secondary objectives were to 1) evaluate patients’ pain during the PoCUS procedure, 2) identify the limitations of the use of PoCUS technique, and 3) compare the diagnosis obtained with PoCUS to radiography results.MethodsAdult patients who presented with clinical suspicion of rib fractures after mTI were included. All patients underwent PoCUS performed by emergency physicians (EPs) prior to a rib view X-ray. A visual analogue scale (VAS) ranging from 0 to 100 was used to ascertain feasibility, patients’ pain and clinicians’ degree of certitude. Feasibility was defined as a score of more than 50 on the VAS. We documented the radiologists’ interpretation of rib view X-ray. Radiologists were blinded to the PoCUS results.ResultsNinety-six patients were included. A majority (65%) of EPs concluded that the PoCUS technique to diagnose rib fracture was feasible (VAS score > 50). Median score for feasibility was 63. Median score was 31 (Interquartile range [IQR] 5–57) for patients’ pain related to the PoCUS. The main limiting factor of the PoCUS technique was pain during patient examination (15%).ConclusionPoCUS examination appears to be a feasible technique for a rib fracture diagnosis in the ED.

scholarly journals P073: Feasibility of emergency department targeted ultrasound for rib fracture diagnosis in minor thoracic injury

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S102-S103
Author(s):  
E. Lalande ◽  
C. Guimont ◽  
M. Émond ◽  
M. Parent ◽  
B. Batomen Kuimi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Daily Practice ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Thoracic Injury ◽  
Limiting Factor ◽  
Median Score ◽  
X Ray ◽  
Targeted Ultrasound ◽  
Fracture Diagnosis

Introduction: Rib fractures represent a frequent condition associated with Minor Thoracic Injury (MTI). Since the last decade, ultrasound have become an important part of emergency physician’s (EP) daily practice, and its applications have become numerous. The main objective of this study was to evaluate the feasibility of Emergency Department Targeted Ultrasound (EDTU) for rib fracture diagnosis in patients with MTI. Secondary objectives were to 1) evaluate patients’ pain during the EDTU procedure, 2) assess clinicians’ degree of certitude over rib fracture diagnosis made by EDTU, 3) identify the limitations of the use of EDTU technique, and 4) compare the diagnosis obtained with EDTU to radiography results. Methods: Adult patients who presented with clinical suspicion of rib fractures after MTI were included. All patients underwent EDTU performed by emergency physicians (EP) prior to a rib view X-ray. Visual Analogue Scale (VAS) ranging from 0 to 100 was used to ascertain feasibility, patients’ pain and clinicians’ degree of certitude. Feasibility was defined as a score of more than 50 on the VAS. We also documented the radiologists’ interpretation of rib view X-ray. Radiologists were blinded to the EDTU results. Results: Ninety-six patients were included. A majority (65%) of EP concluded that the EDTU technique to diagnose rib fracture was feasible (VAS score > 50). Median score for feasibility was 63. Median score was 31 (Interquartile range (IQR) 5-57) for patients’ pain related to the EDTU examination and 72 (IQR 32-92) for the degree of certitude over the diagnosis made by EDTU. The main limiting factor of the EDTU technique was pain during patient examination (15%). Conclusion: EDTU examination appears to be a feasible technique for rib fractures diagnosis in the ED.

scholarly journals Simple Pneumonia or Something More?: A Case Report and Discussion of Unexpected Empyema Identified by Point-of-Care Ultrasound

CJEM ◽  
2015 ◽  
Vol 18 (5) ◽  
pp. 391-394
Author(s):  
Michael Romano ◽  
Tomislav Jelic ◽  
Jordan Chenkin
Keyword(s):  
Emergency Department ◽  
Point Of Care ◽  
Fluid Collection ◽  
Chest Ct ◽  
Point Of Care Ultrasound ◽  
X Ray ◽  
Level Of Consciousness ◽  
Chest X Ray ◽  
Ultrasound Assessment ◽  
Higher Sensitivity

AbstractThere is evidence to suggest that point-of-care ultrasound assessment of the lungs has a higher sensitivity and specificity than chest radiography for the diagnosis of pneumonia. It is unknown if the same is true for pneumonia complications. We present and discuss the case of a 61-year-old woman who presented to the emergency department with confusion, decreased level of consciousness, and signs of sepsis. A chest x-ray revealed a right sided infiltrate. An ultrasound of the patient’s lungs was performed, and revealed a complex loculated fluid collection consistent with an empyema. A chest CT confirmed the diagnosis, and immediate percutaneous drainage was performed.

Abstract 17571: Use of Goal Directed Transesophageal Echocardiography in the Arresting Patient

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shoeb Ahsan ◽  
Robert Arntfield
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Transesophageal Echocardiography ◽  
Point Of Care ◽  
Fluid Management ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
And Function ◽  
Management Changes

Background: With outcomes from cardiac arrest remaining generally poor, there is an urgency to evaluate interventions that allow physicians to manage cardiac arrest more effectively. Transesophageal echocardiography (TEE) can be used at the point of care in a goal-directed manner and can rapidly provide a flurry of data on cardiac structure and function. TEE in the arrested patient is unobtrusive to resuscitation and can provide vital information regarding the potential etiology of arrest, guidance of certain procedures and prognosis. As such, some centers, including our own, have adopted increasingly routine use of TEE in this context. Given the paucity of data in this area, we sought to examine the influence of point-of-care TEE conducted by emergency physicians or intensivists at our institution for patients in or immediately after cardiac arrest. Methods: Goal-directed TEE in the emergency department (ED) or intensive care units (ICU) and their reports were archived in a dedicated point-of-care ultrasound imaging database. We conducted a search of all TEE examinations archived between December 2012 and April 2015 in the peri-arrest period (in or immediately after cardiac arrest). The details from reports were abstracted. TEE-directed management changes were noted when recommendation(s) regarding initiation/escalation of inotropes, fluid administration, termination of resuscitation or surgical procedure were featured in the TEE report. Results: A total of 57 peri-arrest TEE exams were identified (21 in ICUs and 36 in EDs). Goal-directed TEE changed management in 61.4% of cases. TEE facilitated the escalation/initiation of inotropes (35.3%), decision to terminate resuscitation (32.4%), guided fluid management (23.5%) and surgical procedures (8.8%). TEE studies altered management in 66.7% of cases in the Intensive Care Unit and in 58.3% of cases in the Emergency Department. Conclusions: Goal-directed TEE performed by emergency physicians or intensivists has an impact on management on patients in the peri-arrest setting the majority of the time. Given the lack of reliable diagnostic and therapeutic options in arresting patients, a larger study examining the influence of goal-directed TEE on patient outcomes in cardiac arrest should be carried out.

scholarly journals Timely Diagnosis of Pneumoperitoneum by Point-of-care Ultrasound in the Emergency Department: A Case Series

2021 ◽  
Vol 5 (4) ◽  
pp. 377-380
Author(s):  
Jung Yum ◽  
Taryn Hoffman ◽  
Leily Naraghi
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Elderly Patients ◽  
Point Of Care ◽  
Case Series ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Hollow Viscus ◽  
Timely Diagnosis ◽  
Life Threatening

Introduction: Pneumoperitoneum is a life-threatening diagnosis that requires timely diagnosis and action. We present a case series of patients with perforated hollow viscus who were accurately diagnosed by emergency physicians using point-of-care ultrasound (POCUS) while in the emergency department (ED). Case Series: Three elderly patients presented to the ED with the complaints of syncope, abdominal pain with constipation, and unresponsiveness. The emergency physicians used POCUS to diagnose and then expedite the necessary treatment. Conclusion: Point-of-care ultrasound can be used by emergency physicians to diagnose pneumoperitoneum in the ED.

scholarly journals Spontaneous ruptured of splenic artery aneurysm: Another reason for fatal syncope and shock(Case report and literature review)

2021 ◽  
Author(s):  
Feng Yuan ◽  
Liudang He ◽  
Zhengbin Yao ◽  
Yong Long ◽  
Shugen Xu
Keyword(s):  
Emergency Department ◽  
Splenic Artery ◽  
Point Of Care ◽  
Artery Aneurysm ◽  
Splenic Artery Aneurysm ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Abdominal Aneurysm ◽  
Diagnostic Challenge ◽  
Contrast Enhanced Ct

Abstract Background: Splenic artery aneurysm(SAA) is a rare condition, however, it is one of the most common intra-abdominal aneurysm. In the emergency department, due to an uncommon cause of shock and syncope in SAA , it poses a great diagnostic challenge for emergency physicians. Here we reported the case of a spontaneous ruptured of splenic artery aneurysm, which was detected by point-of-care ultrasound (POCUS), in a 47-year-old man with syncope and shock. The diagnosis was further confirmed with a computed tomography scan and surgery.Case presentation: A 47-year-old man presented to the emergency department(ED) for syncope and shock. As he had unstable hemodynamic so we gave him fluid resuscitation and point-of-care ultrasound (POCUS), free intraperitoneal fluid was identified on ultrasound, then a diagnostic abdominal paracentesis was performed and hemorrhagic ascites were identified. The rare but life-threatening diagnosis of spontaneous ruptured of splenic artery aneurysm was confirmed by contrast-enhanced CT and surgery.Conclusions: Spontaneous splenic artery aneurysm ruptured is a rare fatal condition needs immediately diagnosis and management to achieve a favorable outcome. Though there is no risk factors, emergency physicians should considered SAA in the differential diagnosis of sudden collapse. As an emergency physicians, it is very important to be master first aid skills such as POCUS.

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.

scholarly journals The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Matthew G. Hanson ◽  
Barry Chan
Keyword(s):  
Pericardial Effusion ◽  
Point Of Care ◽  
Physical Exam ◽  
Right Atrial ◽  
Point Of Care Ultrasound ◽  
X Ray ◽  
Average Systolic Blood Pressure ◽  
Time To Diagnosis ◽  
Clinically Significant ◽  
The Impact

Abstract Background Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). In extreme cases, misdiagnosis can evolve into decompensated cardiac tamponade, a life-threatening obstructive shock. The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. Methods In a retrospective chart review, we looked at all patients between 2002 and 2018 at a major Canadian academic hospital who had a pericardiocentesis for clinically significant PCE. We extracted the rate of presenting complaints, physical exam findings, X-ray findings, ECG findings, time-to-diagnosis, and time-to-pericardiocentesis and how these were impacted by POCUS. Results The most common presenting symptom was dyspnea (64%) and the average systolic blood pressure (SBP) was 120 mmHg. 86% of people presenting had an effusion > 1 cm, and 89% were circumferential on departmental echocardiogram (ECHO) with 64% having evidence of right atrial systolic collapse and 58% with early diastolic right ventricular collapse. The average time-to-diagnosis with POCUS was 5.9 h compared to > 12 h with other imaging including departmental ECHO. Those who had the PCE identified by POCUS had an average time-to-pericardiocentesis of 28.1 h compared to > 48 h with other diagnostic modalities. Conclusion POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention.

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