scholarly journals LO88: Bedside sonography performed by emergency physicians to detect acute appendicitis in the pediatric emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S58
Author(s):  
M. Nicole ◽  
J. Gravel ◽  
M. Desjardins
Keyword(s):  
Sensitivity And Specificity ◽  
Point Of Care ◽  
Tertiary Care ◽  
Training Session ◽  
Lower Sensitivity ◽  
Point Of Care Ultrasound ◽  
Practical Training ◽  
Emergency Physicians ◽  
Primary Analysis ◽  
Bowel Sonography

Introduction: Previous studies have suggested that emergency physicians (EP) highly experienced in point-of-care ultrasound (POCUS) have similar performance to formal ultrasound to identify appendicitis in children. The aim of this study was to evaluate the ability of EP with various levels of POCUS experience to detect appendicitis with POCUS among children visiting a pediatric ED. Methods: A prospective cohort study was conducted in an urban, tertiary care pediatric ED. Children aged 2 to 18 years old who presented to the ED with acute abdominal pain suggesting appendicitis were included. Patients were excluded if they had a history of appendectomy, hemodynamic instability requiring resuscitation, or were transferred with proven diagnosis of appendicitis. Participating EP had various levels of POCUS experience. Four of the 22 physicians were experienced in bowel sonography (EDU 2 level and higher) while the others were inexperienced in bowel sonography (EDU 1). All the participants received a 1-hour didactical and practical training session on appendix ultrasound. The treating physician performed all POCUS following initial physical exam, before further radiological evaluation. Final outcomes were determined by pathology and/or operative reports for surgical cases, and telephone follow-up at 3 weeks for those who did not have surgery. The primary analysis was a simple proportion for sensitivity and specificity for POCUS. Expecting a sensitivity of 80% based on previous studies, we calculated that a sample size of 50 cases would provide a 95%CI ranging from 66 to 90%. Results: We approached 140 patients, of which 121 accepted to participate and were recruited. After excluding 4 patients for missing POCUS data, 117 patients were included in the primary analysis, of which 51 (44%) had appendicitis. Twenty-two EP performed between 1 and 20 POCUS. The POCUS identified 27 out of 51 appendicitis for a sensitivity of 0.53 (95%CI 0.40-0.66). A negative POCUS was reported for 54 out of 66 patients without appendicitis (specificity of 0.82; 95%CI 0.71-0.89). Conclusion: This study shows limited sensitivity and specificity of POCUS when performed by EP with various level of experience for appendicitis in children. While showing lower sensitivity and specificity than previous studies, the inclusion of a large number of physicians solidifies the external validity of our conclusion.

scholarly journals P010: Emergency department performed renal point-of-care ultrasound (POCUS) for the assessment of obstructive uropathy: Impact of a training curriculum and ongoing educational intervention

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S66
Author(s):  
D. Bastien ◽  
D. Thompson ◽  
F. Myslik ◽  
K. Van Aarsen ◽  
J. Serhan ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Point Of Care ◽  
Obstructive Uropathy ◽  
Color Doppler ◽  
Training Session ◽  
Breath Holding ◽  
Control Group ◽  
Point Of Care Ultrasound ◽  
Chi Square ◽  
The Difference

Introduction: Hydronephrosis is the de facto measure of obstructive uropathy (OU) and can be evaluated using renal Point of Care Ultrasound (rPOCUS). This educational initiative aimed to develop an effective one-day rPOCUS curriculum and evaluate if feedback/quality assurance (QA), leads to an improvement in image acquisition and interpretation of hydronephrosis as well as comfort with the technique. Methods: Physicians were randomized into a QA or control group (NQA) and all attended a one day training session which involved acquiring rPOCUS scans with one-on-one instruction. Participants then performed POCUS scans on all ED patients where formal renal US was deemed clinically indicated. The QA group received feedback on every scan from qualified ED physicians. Overall sensitivity and specificity were calculated compared to formal scans using a chi-square test. Written QA was reviewed for future improvements. Crossover occurred at 10 weeks to allow for equal learning opportunity but analyses focused on pre-crossover data. Participants completed surveys at study start and end focusing on initiative effectiveness and barriers/comfort with POCUS measured with a likert scale (Not at all (1)-Very (7)). Results: Fourteen ED physicians participated. The most common cited barrier to utilizing rPOCUS was lack of knowledge/training (78.6%). A total of 63 POCUS scans were reviewed. Common feedback included breath-holding (69.7%), use of color doppler (48.5%) and including a transverse sweep (36.4%). Sensitivity and specificity were better in the QA versus NQA group though the difference was not significant (Se- 75.0% vs 50.0%, 95%CI: −34.0-73.4%; Sp- 89.3% vs 73.9%, 95% CI: 8.2-39.2%). Ten physicians completed the post survey; all reported improved comfort with rPOCUS in assessment of hydronephrosis (median [IQR]: Δ+2 [1-3]). At study end, the comfort rating for using only POCUS and not formal scan remained low (median [IQR]: 3.50 [1.8-4.2]). The training initiative was rated highly with a median [IQR] rating of 5.50 [4.8-7.0]. Conclusion: Although the initiative was rated highly effective and resulted in improved comfort with renal POCUS, physicians did not feel comfortable solely using POCUS without formal scan to diagnose OU. Despite the initiative's success, further educational programs are needed before rPOCUS can be safely used as the primary investigation. In the future, a greater emphasis should be placed on the commonly noted areas of improvement.

scholarly journals Sensitivity of Point of Care Ultrasound in Blunt Trauma Abdomen and Thorax at a Tertiary Care Center in Northern Kerala

2020 ◽  
Vol 7 (46) ◽  
pp. 2680-2684
Author(s):  
Jobin Jose Maprani ◽  
Binoy Xavier K.P ◽  
Nisanth Menon Nedungalaparambil ◽  
Sandra Paulson
Keyword(s):  
Blunt Trauma ◽  
Sensitivity And Specificity ◽  
Thoracic Trauma ◽  
Road Traffic ◽  
Point Of Care ◽  
Care Center ◽  
Tertiary Care ◽  
Screening Tools ◽  
Point Of Care Ultrasound ◽  
Cross Sectional

BACKGROUND Road traffic accidents are the most common cause of thoracic and abdominal trauma. The role of point of care ultrasound especially in developing countries is gaining evidence in management of acutely ill. We wanted to test the reliability of Fast and E-Fast in blunt abdominal and thoracic trauma cases and evaluate their role in the management of RTAs. METHODS A cross sectional study was conducted over a 12-month period among patients presenting at Emergency Medicine Department at Government Medical College, Kannur (then known as Academy of Medical Sciences, Pariyaram). After clinical examination and recording details, fast and E-Fast was done in the emergency department by emergency physicians trained in ATLS using a standard curvilinear probe of 2 - 5 MHz using Sonosite M-Turbo portable ultrasound machine (Fujifilm Sonosite) and compared with the gold standard CT. The CT used was 16 slice Spiral CT scan machine by GE Healthcare (Chicago, Illinois, United States). Results on continuous measurements presented on mean + SD (min-max) and results on categorical measurements were presented in numbers (%). Sensitivity and specificity were computed for analysis. RESULTS The overall sensitivity of Fast is 72.8 % and the specificity is 92 %. The overall sensitivity and specificity of E-Fast are 87 % and 92.3 % respectively. The reliability of point of care ultrasound as a screening tool to triage patients with blunt abdominal and thoracic trauma is 100 %. CONCLUSIONS Fast and E-Fast are quite reliable as screening tools in the management of acutely ill blunt trauma abdomen and chest patients. KEYWORDS Point of Care, Ultrasound, Blunt Trauma, Sensitivity, Fast, E-Fast

scholarly journals Ability of Critical Care Medics to Confirm Endotracheal Tube Placement by Ultrasound

2020 ◽  
Vol 35 (6) ◽  
pp. 629-631
Author(s):  
Michael Joyce ◽  
Jordan Tozer ◽  
Michael Vitto ◽  
David Evans
Keyword(s):  
Critical Care ◽  
Endotracheal Tube ◽  
Life Support ◽  
Point Of Care ◽  
Training Session ◽  
Tube Placement ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Endotracheal Tube Placement ◽  
Bronchial Intubation

AbstractIntroduction:The Advanced Cardiac Life Support (ACLS) guidelines were recently updated to include ultrasound confirmation of endotracheal tube (ETT) location as an adjunctive tool to verify placement. While this method is employed in the emergency department under the guidance of the most recent American College of Emergency Physicians (ACEP; Irving, Texas USA) guidelines, it has yet to gain wide acceptance in the prehospital setting where it has the potential for greater impact. The objective of this study to is determine if training critical care medics using simulation was a feasible and reliable method to learn this skill.Methods:Twenty critical care paramedics with no previous experience with point-of-care ultrasound volunteered for advanced training in prehospital ultrasound. Four ultrasound fellowship trained emergency physicians proctored two three-hour training sessions. Each session included a brief introduction to ultrasound “knobology,” normal sonographic neck and lung anatomy, and how to identify ETT placement within the trachea or esophagus. Immediately following this, the paramedics were tested with five simulated case scenarios using pre-obtained images that demonstrated a correctly placed ETT, an esophageal intubation, a bronchial intubation, and an improperly functioning ETT. Their accuracy, length of time to respond, and comfort with using ultrasound were all assessed.Results:All 20 critical care medics completed the training and testing session. During the five scenarios, 37/40 (92.5%) identified the correct endotracheal placements, 18/20 (90.0%) identified the esophageal intubations, 18/20 (90.0%) identified the bronchial intubation, and 20/20 (100.0%) identified the ETT malfunctions correctly. The average time to diagnosis was 10.6 seconds for proper placement, 15.5 seconds for esophageal, 15.6 seconds for bronchial intubation, and 11.8 seconds for ETT malfunction.Conclusions:The use of ultrasound to confirm ETT placement can be effectively taught to critical care medics using a short, simulation-based training session. Further studies on implementation into patient care scenarios are needed.

Pilot Project: Does formal bedside training of medical students with a FAST exam increase their knowledge and comfort level with ultrasound use in a community family medicine practice setting?

POCUS Journal ◽  
2017 ◽  
Vol 2 (2) ◽  
pp. 15-17
Author(s):  
Rimi Sambi, MD ◽  
Heather Sawula, MD ◽  
Brent Wolfrom, MD ◽  
Joseph Newbigging, MD
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Point Of Care ◽  
Training Session ◽  
Undergraduate Curriculum ◽  
Knowledge Retention ◽  
Comfort Level ◽  
Point Of Care Ultrasound ◽  
Medical Undergraduate ◽  
Fast Exam

As point of care ultrasound (PoCUS) becomes increasingly popular and a standard of care in many clinical settings, the interest for integration in medical undergraduate curriculum is also growing [1]. This project aims to assess whether formal bedside Focused Abdominal Scan for Trauma (FAST) exam training of medical students increases their knowledge and comfort with the use of bedside ultrasound in a family medicine setting at Queen’s University. Third year medical students (n=18) were recruited to participate in a training session involving a 1-hour online video and 2-hour hands-on session. Knowledge based surveys were completed before and after the training. A survey was completed 4 months after the teaching session evaluating knowledge retention, comfort, and application of skills. Student knowledge of PoCUS and FAST increased and was maintained (pre-training 56%±20%, post-training 82%±10%, p<0.001). Self-evaluation of comfort performing a FAST examination (5-point Likert scale) similarly increased post-training session (pre-training 1.4±0.8, post-training 3.8±0.9, p<0.005), but decreased 4 months later (3±1.2, p<0.005). Students in this study were unanimously interested in ultrasound training and the methods used effectively increased theoretical knowledge and comfort with use. Students did not retain their comfort levels with FAST exam 4 months after the training session, nor did they have the opportunity to utilize the skills learned. Further evidence is required to identify the applicability of these results to undergraduate curriculum development.

scholarly journals The Accuracy of Point-of-Care Ultrasound in Detecting Small Bowel Obstruction in Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
A. Pourmand ◽  
U. Dimbil ◽  
A. Drake ◽  
H. Shokoohi
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Imaging Modality ◽  
Point Of Care ◽  
High Sensitivity ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Short Term ◽  
Intestinal Peristalsis

Radiological imaging plays an essential role in the evaluation of a patient with suspected small bowel obstruction (SBO). In a few studies, point-of-care ultrasound (POCUS) has been utilized as a primary imaging modality in patients with suspected SBO. POCUS has been shown to be an accurate tool in the diagnosis of SBO with multiple research studies noting a consistent high sensitivity with a range of 94–100% and specificity of 81–100%. Specific sonographic findings that increase the likelihood of SBO include dilatation of small bowel loops > 25 mm, altered intestinal peristalsis, increased thickness of the bowel wall, and intraperitoneal fluid accumulation. Studies also reported that emergency physicians could apply this technique with limited and short-term ultrasound training. In this article, we aim to review the sensitivity and specificity of ultrasound examinations performed by emergency physicians in patients with suspected SBO.

Accuracy of point-of-care ultrasound by pediatric emergency physicians for testicular torsion

2019 ◽  
Vol 15 (6) ◽  
pp. 608.e1-608.e6 ◽  
Author(s):  
N. Friedman ◽  
Z. Pancer ◽  
R. Savic ◽  
F. Tseng ◽  
M.S. Lee ◽  
...  
Keyword(s):  
Testicular Torsion ◽  
Point Of Care ◽  
Pediatric Emergency ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians

Reliability of Neck Mass Point‐of‐Care Ultrasound by Pediatric Emergency Physicians

2019 ◽  
Vol 38 (11) ◽  
pp. 2893-2900 ◽  
Author(s):  
Nir Friedman ◽  
Felicia Tseng ◽  
Ranko Savic ◽  
Mamadou Diallo ◽  
Kate Fathi ◽  
...  
Keyword(s):  
Point Of Care ◽  
Pediatric Emergency ◽  
Neck Mass ◽  
Mass Point ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians

scholarly journals P005: Regional anesthesia in Canadian emergency departments: Emergency physician practices and impressions

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S66-S66
Author(s):  
D. Wiercigroch ◽  
S. Friedman ◽  
D. Porplycia ◽  
M. Ben-Yakov
Keyword(s):  
Regional Anesthesia ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Physician Practices ◽  
Canadian Association ◽  
Modifiable Factors ◽  
Barriers To Use

Introduction: The use of regional anesthesia (RA) by emergency physicians (EPs) is expanding in frequency and range of application as expertise in point-of-care ultrasound (POCUS) grows, but widespread use remains limited. We sought to characterize the use of RA by Canadian EPs, including practices, perspectives and barriers to use in the ED. Methods: A cross-sectional survey of Canadian EPs was administered to members of the Canadian Association of Emergency Physicians (CAEP), consisting of sixteen multiple choice and numerical responses. Responses were summarized descriptively as percentages and as the median and inter quartile range (IQR) for quantitative variables. Results: The survey was completed by 149/1144 staff EPs, with a response rate of 13%. EPs used RA a median of 2 (IQR 0-4) times in the past ten shifts. The most broadly used applications were soft tissue repair (84.5% of EPs, n = 126), fracture pain management (79.2%, n = 118) and orthopedic reduction (72.5%, n = 108). EPs agreed that RA is safe to use in the ED (98.7%) and were interested in using it more frequently (78.5%). Almost all (98.0%) respondents had POCUS available, however less than half (49.0%) felt comfortable using it for RA. EPs indicated that they required more training (76.5%), a departmental protocol (47.0%), and nursing assistance (30.2%) to increase their use. Conclusion: Canadian EPs engage in limited use of RA but express an interest in expanding their use. While equipment is available, additional training, protocols, and increased support from nursing staff are modifiable factors that could facilitate uptake of RA in the ED.

scholarly journals Simulator-based ultrasound training for identification of endotracheal tube placement in a neonatal intensive care unit using point of care ultrasound

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Khushboo Qaim Ali ◽  
Sajid Bashir Soofi ◽  
Ali Shabbir Hussain ◽  
Uzair Ansari ◽  
Shaun Morris ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Health Care Providers ◽  
Neonatal Intensive Care ◽  
Point Of Care ◽  
Training Session ◽  
Technical Skills ◽  
Neonatal Health ◽  
Point Of Care Ultrasound ◽  
Care Providers

Abstract Background Simulators are an extensively utilized teaching tool in clinical settings. Simulation enables learners to practice and improve their skills in a safe and controlled environment before using these skills on patients. We evaluated the effect of a training session utilizing a novel intubation ultrasound simulator on the accuracy of provider detection of tracheal versus esophageal neonatal endotracheal tube (ETT) placement using point-of-care ultrasound (POCUS). We also investigated whether the time to POCUS image interpretation decreased with repeated simulator attempts. Methods Sixty neonatal health care providers participated in a three-hour simulator-based training session in the neonatal intensive care unit (NICU) of Aga Khan University Hospital (AKUH), Karachi, Pakistan. Participants included neonatologists, neonatal fellows, pediatric residents and senior nursing staff. The training utilized a novel low-cost simulator made with gelatin, water and psyllium fiber. Training consisted of a didactic session, practice with the simulator, and practice with intubated NICU patients. At the end of training, participants underwent an objective structured assessment of technical skills (OSATS) and ten rounds of simulator-based testing of their ability to use POCUS to differentiate between simulated tracheal and esophageal intubations. Results The majority of the participants in the training had an average of 7.0 years (SD 4.9) of clinical experience. After controlling for gender, profession, years of practice and POCUS knowledge, linear mixed model and mixed effects logistic regression demonstrated marginal improvement in POCUS interpretation over repeated simulator testing. The mean time-to-interpretation decreased from 24.7 (SD 20.3) seconds for test 1 to 10.1 (SD 4.5) seconds for Test 10, p < 0.001. There was an average reduction of 1.3 s (β = − 1.3; 95% CI: − 1.66 to − 1.0) in time-to-interpretation with repeated simulator testing after adjusting for the covariates listed above. Conclusion We found a three-hour simulator-based training session had a significant impact on technical skills and performance of neonatal health care providers in identification of ETT position using POCUS. Further research is needed to examine whether these skills are transferable to intubated newborns in various health settings. Trial registration ClinicalTrials.gov Identifier: NCT03533218. Registered May 2018.

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