scholarly journals Ultrasound Utility in the Diagnosis of a Morel-Lavallée Lesion

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Scott LaTulip ◽  
Rameshwar R. Rao ◽  
Alan Sielaff ◽  
Nik Theyyunni ◽  
John Burkhardt
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Imaging Technique ◽  
Point Of Care ◽  
Cost Effective ◽  
Rapid Diagnosis ◽  
Point Of Care Ultrasound ◽  
Ultrasound Findings ◽  
Specialized Equipment ◽  
Improve Patient

Morel-Lavallée lesions are uncommon injuries that can be associated with significant comorbidities if not detected early. Rapid diagnosis in the Emergency Department could significantly improve patient outcomes. We describe the diagnosis of such a lesion through the use of ultrasound imaging in the Emergency Department to utilize a fast, cost-effective imaging technique that does not subject the patient to radiation exposure. Our patient received surgical consultation but improved with conservative management. Ultrasound findings associated with this lesion do not require specialized equipment and should be considered when evaluating soft tissue lesions using point of care ultrasound.

scholarly journals MP05: Diagnostic accuracy of point of care ultrasound in undifferentiated hypotension presenting to the emergency department: a systematic review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S43-S44 ◽  
Author(s):  
L. Richardson ◽  
O. Loubani ◽  
P. Atkinson
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Full Article ◽  
Diagnostic Accuracy ◽  
Patient Outcomes ◽  
Primary Outcome ◽  
Point Of Care ◽  
Initial Assessment ◽  
Point Of Care Ultrasound ◽  
Strong Conclusion

Introduction: Undifferentiated hypotension remains one of the most life-threatening presentations to emergency departments (ED) around the world. An accurate and rapid initial assessment is essential, as shock carries a high mortality with multiple unique etiologies and management plans. Point of care ultrasound (PoCUS) has emerged as a promising tool to improve these diagnostic and management challenges, yet its reliability in this setting remains unclear. Methods: We performed a systematic review of Medline, EMBASE, CINAHL, Cochrane, and clinicaltrials.gov databases from inception to June 8, 2018. Databases were reviewed by two independent researchers and all languages were included. The methodological quality of included studies were evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Our primary outcome was diagnostic accuracy of PoCUS in hypotension, with secondary outcomes including patient outcomes and changes to management. Results: Our literature search revealed 5345 articles after duplicates were removed, leaving 235 articles for full article review. Following full article review, 9 studies remained and were included in the systematic review. There were 2 randomized control trials, 6 prospective cohort trials, and 1 retrospective cohort trial. For our primary outcome of diagnostic accuracy, eight studies were included; we extracted Kappa values ranging from 0.70 to 0.971, pooled sensitivity ranging from 69% to 88%, and pooled specificity ranging from 88% to 96%. Four studies reported on management change including results reporting shorter time to disposition, change in diagnostic test ordering (18% to 31%), change in consultation (13.6%), change in admission location (12%) and change in management plan (25% to 40%). Only one study reported on patient outcomes, which revealed no survival or length of stay benefit. Conclusion: When assessing for the diagnostic accuracy of PoCUS in the setting of undifferentiated hypotension presenting to the emergency department, we found fair consistency between PoCUS and final diagnosis with high Kappa values, fair to good pooled sensitivities, and good to excellent specificities. There was no strong evidence indicating improved outcomes. However, the large amount of heterogeneity amongst studies has limited our ability to make a strong conclusion except that future research should focus on a uniform study design and patient focused outcomes.

scholarly journals Point-of-care ultrasound findings in unselected patients in an emergency department —results from a prospective observational trial

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Jesper Weile ◽  
Christian B. Laursen ◽  
Christian A. Frederiksen ◽  
Ole Graumann ◽  
Erik Sloth ◽  
...  
Keyword(s):  
Emergency Department ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Observational Trial ◽  
Ultrasound Findings

Implementing Point-of-Care Testing in the Emergency Department to Improve Patient Outcomes

2008 ◽  
Vol 7 (3) ◽  
pp. 143
Author(s):  
Elizabeth-Lee Lewandrowski ◽  
James Flood ◽  
Donna MacMillan ◽  
Leonard Tochka ◽  
Kent Lewandrowski
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Improve Patient

Point-of-care haemostasis monitoring during liver transplantation is cost effective

2019 ◽  
Vol 57 (6) ◽  
pp. 883-890 ◽  
Author(s):  
Antonio Leon-Justel ◽  
Ana I. Alvarez-Rios ◽  
Jose A. Noval-Padillo ◽  
Miguel A. Gomez-Bravo ◽  
Manuel Porras ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Point Of Care ◽  
Health Benefit ◽  
Cost Effective ◽  
Red Blood Cell Transfusion ◽  
Management Approach ◽  
New Approach ◽  
Transfusion Requirements ◽  
Transfusion Volume ◽  
Improve Patient

Abstract Background Optimal haemostasis management in orthotropic liver transplant (OLT) could reduce blood loss and transfusion volume, improve patient outcomes and reduce cost. Methods We performed a study including 336 OLTs to evaluate the clinical and cost effectiveness of a new point-of-care (POC)-based haemostatic management approach in OLT patients. Results In terms of health benefit we found that the new approach showed a significant reduction in transfusion requirements (red blood cell transfusion units were reduced from 5.3±4.6 to 2.8±2.9 [p<0.001], free frozen plasma from 3.1±3.3 to 0.4±1.0 [p<0.001] and platelets from 2.9±3.9 to 0.4±0.9 [p<0.001], transfusion avoidance, 9.7% vs. 29.1% [p<0.001] and massive transfusion, 14.5% vs. 3.8% [p=0.001]); we also found a significant improvement in patient outcomes, such, reoperation for bleeding or acute-kidney-failure (8.3% vs. 2.4%, p=0.015; 33.6% vs. 5.4%, p<0.001), with a significant reduction in the length of the hospital total stay (40.6±13.8 days vs. 38.2±14.4 days, p=0.001). The lowest cost incurred was observed with the new approach (€73,038.80 vs. €158,912.90) with significant patient saving associated to transfusion avoidance (€1278.36), ICU-stay (€3037.26), total-stay (€3800.76) and reoperation for bleeding (€80,899.64). Conclusions POC haemostatic monitoring during OLT is cost effective.

scholarly journals Point-of-Care Airway Ultrasonography Prior to an Emergency Cricothyroidotomy: Case report

2018 ◽  
Vol 18 (2) ◽  
pp. 219 ◽  
Author(s):  
Mohamad Iqhbal ◽  
Julina M. Noor ◽  
Nur A. Karim ◽  
Izzat Ismail ◽  
Halim Sanib ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Critical Care ◽  
Case Report ◽  
Imaging Technique ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Vocal Cords ◽  
Emergency Tracheostomy ◽  
Airway Ultrasound

The use of ultrasonography in acute and critical care medicine is becoming increasingly common. However, use of an airway ultrasound as an adjunct to determine the type of intervention needed and assess complications is not common practice. We report a 56-year-old male who presented to the Emergency Department of the Sungai Buloh Hospital, Selangor, Malaysia, in 2015 with hoarseness, stridor and impending respiratory failure. A point-of-care ultrasound performed to assess the neck and vocal cords indicated a heterogeneous echogenic mass in the larynx, thus ruling out a cricothyroidotomy. The patient was therefore referred for an emergency tracheostomy. This case highlights the importance of point-of-care airway ultrasonography in the assessment of patients with stridor. This imaging technique not only helps to detect the cause of the stridor, but also to determine the feasibility of a cricothyroidotomy in emergency cases.Keywords: Emergency Medicine; Stridor; Ultrasonography; Airway Management; Tracheostomy; Case Report; Malaysia.

scholarly journals Point-of-Care Testing in Microbiology: A Mechanism for Improving Patient Outcomes

2019 ◽  
Vol 66 (1) ◽  
pp. 124-137 ◽  
Author(s):  
Glen T Hansen
Keyword(s):  
Patient Outcomes ◽  
Clinical Microbiology ◽  
Point Of Care ◽  
Diagnostic Testing ◽  
Healthcare Delivery ◽  
Cost Effective ◽  
Rapid Diagnosis ◽  
Rapid Diagnostics ◽  
Patient Centered ◽  
Delivery Of Care

Abstract BACKGROUND Increasingly, demands for improved health and quality of life conflict with the realities of delivering healthcare in an environment of higher expenditures, adherence to test utilization, and patient-centered experience. Patient-centered care is commonly identified as a goal of healthcare delivery, and yet healthcare systems struggle with delivery of care to patients, often failing to identify the seriously ill and capitalize on the predictive qualities of diagnostic testing. Point-of-care (POC) testing provides access to rapid diagnosis and predictive value key to realizing patient outcomes. An evaluation of cost-effective models and the clinical impact of POC testing for clinical microbiology is needed. CONTENT Accurate and rapid diagnostics have the potential to affect healthcare decisions to a degree well out of proportion to their cost. Contemporary healthcare models increasingly view POC testing as a mechanism for efficient deployment of healthcare. POC testing can deliver rapid diagnosis in environments where testing results can be used to direct management during patient visits and in areas where centralized laboratory testing may limit access to care. Nucleic acid assays, designed for POC testing, can match, or exceed, the sensitivity of conventional laboratory-based testing, eliminating the need for confirmation testing. Here, the goals of POC testing for microbiology, applications, and technologies, as well as outcomes and value propositions, are discussed. SUMMARY The combination of rapid reporting, an increasing array of organisms capable of causing disease, actionable resulting, and improved patient outcomes is key in the evolution of POC testing in clinical microbiology.

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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