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Acuña J, Situ-LaCasse E, Yarnish AA, McNinch NL, Adhikari S. Does Size Matter? A Prospective Study on the Feasibility of Using a Handheld Ultrasound Device in Place of a Cart-Based System in the Evaluation of Trauma Patients. J Emerg Med 2024; 66:e483-e491. [PMID: 38429215 DOI: 10.1016/j.jemermed.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND As emergency physicians are looking at handheld devices as alternatives to the traditional, cart-based systems, concerns center around whether they are forsaking image quality for a lower price point and whether the handheld can be trusted for medical decision making. OBJECTIVE We aimed to determine the feasibility of using a handheld ultrasound device in place of a cart-based system during the evaluation of trauma patients using the Focused Assessment with Sonography for Trauma (FAST) examination. METHODS This was a prospective study of adult trauma patients who received a FAST examination as part of their evaluation. A FAST examination was performed using a cart-based machine and a handheld device. The results of the examinations were compared with computed tomography imaging. Images obtained from both ultrasound devices were reviewed by an expert for image quality. RESULTS A total of 62 patients were enrolled in the study. The mean (SD) time to perform a FAST examination using the handheld device was 307.3 (65.3) s, which was significantly less (p = 0.002) than the 336.1 (86.8) s with the cart-based machine. There was strong agreement between the examination results of the handheld and cart-based devices and between the handheld and computed tomography. Image quality scores obtained with the handheld device were lower than those from the cart-based system. Most operators and reviewers agreed that the images obtained from the handheld were adequate for medical decision making. CONCLUSIONS Data support that it is feasible to use the handheld ultrasound device for evaluation of the trauma patient in place of the cart-based system.
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Affiliation(s)
- Josie Acuña
- Department of Emergency Medicine, The University of Arizona, College of Medicine, Tucson, Arizona
| | - Elaine Situ-LaCasse
- Department of Emergency Medicine, The University of Arizona, College of Medicine, Tucson, Arizona
| | - Adrienne A Yarnish
- Department of Emergency Medicine, The University of Arizona, College of Medicine, Tucson, Arizona
| | | | - Srikar Adhikari
- Department of Emergency Medicine, The University of Arizona, College of Medicine, Tucson, Arizona
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2
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Johnson KN, Vacek J, Carter S. Applications for ultrasound in pediatric surgery. Semin Pediatr Surg 2024; 33:151383. [PMID: 38190770 DOI: 10.1016/j.sempedsurg.2024.151383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Ultrasound (US) use within pediatric surgery is expanding rapidly. While US guidance for central line placement has been common practice for many years now, advances in the quality of images, portability of US machines, and a lack of radiation associated with imaging has led to broader application in many other aspects of surgery, ranging from diagnostics to performing operations under the direction of point-of-care ultrasound (POCUS). The relatively short learning curve for providers along with excellent image quality in children due to their small size provides an easy, effective imaging modality with diverse applications. Discussed here is a broad overview of the spectrum of US use within current pediatric surgical practices.
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Affiliation(s)
- Kevin N Johnson
- Assistant Professor of Pediatric Surgery, Monroe Carell Jr. Children's Hospital, Vanderbilt University, 2200 Children's Way, Nashville TN 37232, United States.
| | - Jonathan Vacek
- Pediatric Surgery Fellow, Division of Pediatric Surgery, Norton Children's Hospital, University of Louisville, Louisville KY, United States
| | - Stewart Carter
- Assistant Professor of Pediatric Surgery, Norton Children's Hospital, University of Louisville, Louisville KY, United States
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Polyzogopoulou E, Velliou M, Verras C, Ventoulis I, Parissis J, Osterwalder J, Hoffmann B. Point-of-Care Ultrasound: A Multimodal Tool for the Management of Sepsis in the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1180. [PMID: 37374384 DOI: 10.3390/medicina59061180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Sepsis and septic shock are life-threatening emergencies associated with increased morbidity and mortality. Hence, early diagnosis and management of both conditions is of paramount importance. Point-of-care ultrasound (POCUS) is a cost-effective and safe imaging modality performed at the bedside, which has rapidly emerged as an excellent multimodal tool and has been gradually incorporated as an adjunct to physical examination in order to facilitate evaluation, diagnosis and management. In sepsis, POCUS can assist in the evaluation of undifferentiated sepsis, while, in cases of shock, it can contribute to the differential diagnosis of other types of shock, thus facilitating the decision-making process. Other potential benefits of POCUS include prompt identification and control of the source of infection, as well as close haemodynamic and treatment monitoring. The aim of this review is to determine and highlight the role of POCUS in the evaluation, diagnosis, treatment and monitoring of the septic patient. Future research should focus on developing and implementing a well-defined algorithmic approach for the POCUS-guided management of sepsis in the emergency department setting given its unequivocal utility as a multimodal tool for the overall evaluation and management of the septic patient.
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Affiliation(s)
- Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | - Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | - Christos Verras
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
- National Centre of Emergency Care (EKAB), 11527 Athens, Greece
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | | | - Beatrice Hoffmann
- Department of Emergency Medicine BIDMC, One Deaconess Rd, WCC2, Boston, MA 02215, USA
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4
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Arredondo AR, Wilkinson M, Barber RB, Gilmartin T, Levine MC. Ultrasonographic Evaluation of Physiologic Free Intraperitoneal Fluid in Healthy Children: A Prospective Observational Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1061-1067. [PMID: 34338342 DOI: 10.1002/jum.15787] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/26/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The detection of intraperitoneal free fluid (FF) is an important finding in the sonographic evaluation of the pediatric abdomen, especially in the context of blunt abdominal trauma. One specific challenge is differentiating physiologic from pathologic FF. The purpose of this study was to determine with ultrasound the prevalence, location, and volume of intraperitoneal FF in healthy pediatric patients and its relation to pubertal status and gender. METHODS Healthy children between the ages of 1 and 17 years who presented to the emergency department with non-abdominal complaints were evaluated for physiologic intra-abdominal fluid. Point-of-Care Ultrasound (POCUS) was performed, utilizing the Focused Assessment with Sonography in Trauma (FAST) examination. RESULTS A total of 325 pediatric patients were analyzed. Intraperitoneal FF was found in 52 children (16.0%, 95% CI: 12.0-20.0%). The pelvis was the only region where FF was located. The prevalence of FF was nearly equivalent between male and female children (15.4% vs 16.7%, P = .76). There was a higher prevalence of FF identified in the prepubertal subgroup compared to the pubertal group (20.0% vs 11.3%, P = .03). Seventy-seven percent of children with FF had a fluid volume of less than 1 mL. CONCLUSIONS Physiologic FF of less than 1 mL within the pelvis is a common finding in the pediatric population. There was no difference in the rate of FF identified by gender, but there was a higher prevalence of FF among prepubertal children.
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Affiliation(s)
- Anthony R Arredondo
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew Wilkinson
- Department of Pediatric Emergency Medicine, UT Austin Dell Medical School, Austin, Texas, USA
| | - Richard B Barber
- Department of Pediatrics, UT Austin Dell Medical School, Austin, Texas, USA
| | - Thomas Gilmartin
- Department of Pediatrics, UT Austin Dell Medical School, Austin, Texas, USA
| | - Marla C Levine
- Division of Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University, Nashville, Tennessee, USA
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Kornblith AE, Addo N, Plasencia M, Shaahinfar A, Lin-Martore M, Sabbineni N, Gold D, Bellman L, Berant R, Bergmann KR, Brenkert TE, Chen A, Constantine E, Deanehan JK, Dessie A, Elkhunovich M, Fischer J, Gravel CA, Kharasch S, Kwan CW, Lam SHF, Neal JT, Pade KH, Rempell R, Shefrin AE, Sivitz A, Snelling PJ, Tessaro MO, White W. Development of a Consensus-Based Definition of Focused Assessment With Sonography for Trauma in Children. JAMA Netw Open 2022; 5:e222922. [PMID: 35302632 PMCID: PMC8933745 DOI: 10.1001/jamanetworkopen.2022.2922] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/30/2022] [Indexed: 11/14/2022] Open
Abstract
Importance The wide variation in the accuracy and reliability of the Focused Assessment With Sonography for Trauma (FAST) and the extended FAST (E-FAST) for children after blunt abdominal trauma reflects user expertise. FAST and E-FAST that are performed by experts tend to be more complete, better quality, and more often clinically valuable. Objective To develop definitions of a complete, high-quality, and accurate interpretation for the FAST and E-FAST in children with injury using an expert, consensus-based modified Delphi technique. Design, Setting, and Participants This consensus-based qualitative study was conducted between May 1 to June 30, 2021. It used a scoping review and iterative Delphi technique and involved 2 rounds of online surveys and a live webinar to achieve consensus among a 26-member panel. This panel consisted of international experts in pediatric emergency point-of-care ultrasonography. Main Outcomes and Measures Definitions of complete, high-quality, and accurate FAST and E-FAST studies for children after injury. Results Of the 29 invited pediatric FAST experts, 26 (15 men [58%]) agreed to participate in the panel. All 26 panelists completed the 2 rounds of surveys, and 24 (92%) participated in the live and asynchronous online discussions. Consensus was reached on FAST and E-FAST study definitions, and the panelists rated these 5 anatomic views as important and appropriate for a complete FAST: right upper-quadrant abdominal view, left upper-quadrant abdominal view, suprapubic views (transverse and sagittal), and subxiphoid cardiac view. For E-FAST, the same FAST anatomic views with the addition of the lung or pneumothorax view were deemed appropriate and important. In addition, the panelists rated a total of 32 landmarks as important for assessing completeness. Similarly, the panelists rated 14 statements on quality and 20 statements on accurate interpretation as appropriate. Conclusions and Relevance This qualitative study generated definitions for complete FAST and E-FAST studies with high image quality and accurate interpretation in children with injury. These definitions are similar to those in adults with injury and may be used for future education, quality assurance, and research. Future research may focus on interpretation of trace volumes of abdominal free fluid and the use of serial FAST.
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Affiliation(s)
- Aaron E. Kornblith
- Department of Pediatrics, University of California, San Francisco, San Francisco
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Newton Addo
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Monica Plasencia
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco
- Department of Bioengineering, University of California, Berkeley, Berkeley
| | - Ashkon Shaahinfar
- Department of Pediatrics, University of California, San Francisco, San Francisco
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Margaret Lin-Martore
- Department of Pediatrics, University of California, San Francisco, San Francisco
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Naina Sabbineni
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Delia Gold
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Lily Bellman
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency Medicine, Harbor-UCLA (University of California, Los Angeles) Medical Center, California Pacific Medical Center, Los Angeles
| | - Ron Berant
- Department of Emergency Medicine, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Kelly R. Bergmann
- Department of Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis
| | - Timothy E. Brenkert
- Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Aaron Chen
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Erika Constantine
- Division of Pediatric Emergency Medicine, Hasbro Children’s Hospital, Rhode Island Hospital, Providence
| | - J. Kate Deanehan
- Division of Pediatric Emergency Medicine, Johns Hopkins Children’s Center, Baltimore, Maryland
| | - Almaz Dessie
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Marsha Elkhunovich
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
| | - Jason Fischer
- Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia A. Gravel
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Sig Kharasch
- Department of Pediatrics, Massachusetts General Hospital, Boston
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Charisse W. Kwan
- Department of Pediatric Emergency Medicine, London Health Sciences Centre Children's Hospital, Western University, London, Ontario, Canada
| | - Samuel H. F. Lam
- Department of Emergency Medicine, Sutter Medical Center Sacramento, Sacramento, California
| | - Jeffrey T. Neal
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Kathyrn H. Pade
- Department of Emergency Medicine, Rady Children’s Hospital, University of California, San Diego, San Diego
| | - Rachel Rempell
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Allan E. Shefrin
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Adam Sivitz
- Department of Pediatric Emergency Medicine, Children’s Hospital of New Jersey, Newark Beth Israel Medical Center, Newark
| | - Peter J. Snelling
- Department of Pediatric Emergency Medicine, Gold Coast University Hospital, Griffith University, Brisbane, Queensland, Australia
| | - Mark O. Tessaro
- Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - William White
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency Medicine, Harbor-UCLA (University of California, Los Angeles) Medical Center, California Pacific Medical Center, Los Angeles
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Abstract
ABSTRACT Blunt abdominal trauma (BAT) accounts for most trauma in children. Although the focused assessment with sonography in trauma (FAST) is considered standard of care in the evaluation of adults with traumatic injuries, there is limited evidence to support its use as an isolated evaluation tool for intra-abdominal injury as a result of BAT in children. Although a positive FAST examination could obviate the need for a computed tomography scan before OR evaluation in a hemodynamically unstable patient, a negative FAST examination cannot exclude intra-abdominal injury as a result of BAT in isolation. In this article, we review the evaluation of BAT in children, describe the evaluation for free intraperitoneal fluid and pericardial fluid using the FAST examination, and discuss the limitations of the FAST examination in pediatric patients.
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Affiliation(s)
- Marci J Fornari
- From the Clinical Instructor and Pediatric Emergency Medicine Fellow
| | - Simone L Lawson
- Assistant Professor of Pediatrics and Emergency Medicine, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC
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7
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Riera A, Hayward H, Torres Silva C, Chen L. Reevaluation of FAST Sensitivity in Pediatric Blunt Abdominal Trauma Patients: Should We Redefine the Qualitative Threshold for Significant Hemoperitoneum? Pediatr Emerg Care 2021; 37:e1012-e1019. [PMID: 31356479 DOI: 10.1097/pec.0000000000001877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The utility of the focused assessment with sonography in trauma (FAST) examination in hemodynamically stable pediatric blunt abdominal trauma (BAT) patients is controversial.We report our 3-year experience with FAST performance to detect greater than physiologic amounts of intraperitoneal fluid after BAT. METHODS We performed a retrospective chart review of all FAST examinations performed from July 2015 to June 2018 at a level I pediatric trauma center. The main outcome of interest was the performance of a concerning FAST (cFAST) compared with a computed tomography scan diagnosis for greater than physiologic levels of free fluid (FF) and clinical follow-up. A cFAST was defined by the presence of any FF in the upper abdomen or by a moderate to large amount of FF present in the pelvis. The interobserver reliability of cFASTwas assessed with Cohen κ coefficient. Locations of FF were assessed. RESULTS A total of 448 FAST cases were eligible for review. The median age was 11 years with 64% male. Thirty-one FAST examinations (6.9%) were positive for some amount of FF; 18 (4.0%) were cFASTs. In the cFAST group, 11 patients (61%) were hemodynamically stable. The cFAST had a sensitivity of 89% (95% confidence interval [CI], 65%-99%), specificity of 99% (95% CI, 98%-100%), positive predictive value of 89% (95% CI, 67%-97%), and negative predictive value of 99% (95% CI, 98%-100%). The positive and negative likelihood ratios were 191 (95% CI, 47-769) and 0.11 (95% CI, 0.03-0.41). The κ coefficient for cFASTwas 0.72 with 86% agreement. Free fluid on cFAST cases was observed in the pelvis (78%), right upper quadrant (44%), and left upper quadrant (44%). CONCLUSIONS In pediatric BAT patients, a cFAST has acceptable sensitivity and remains a highly specific test to rule in greater than physiologic quantities of FF with confidence.
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Affiliation(s)
- Antonio Riera
- From the Section of Pediatric EmergencyMedicine, Department of Pediatrics
| | | | - Cicero Torres Silva
- Section of Pediatric Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Lei Chen
- From the Section of Pediatric EmergencyMedicine, Department of Pediatrics
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Cheng CY, Chiu IM, Hsu MY, Pan HY, Tsai CM, Lin CHR. Deep Learning Assisted Detection of Abdominal Free Fluid in Morison's Pouch During Focused Assessment With Sonography in Trauma. Front Med (Lausanne) 2021; 8:707437. [PMID: 34631730 PMCID: PMC8494971 DOI: 10.3389/fmed.2021.707437] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The use of focused assessment with sonography in trauma (FAST) enables clinicians to rapidly screen for injury at the bedsides of patients. Pre-hospital FAST improves diagnostic accuracy and streamlines patient care, leading to dispositions to appropriate treatment centers. In this study, we determine the accuracy of artificial intelligence model-assisted free-fluid detection in FAST examinations, and subsequently establish an automated feedback system, which can help inexperienced sonographers improve their interpretation ability and image acquisition skills. Methods: This is a single-center study of patients admitted to the emergency room from January 2020 to March 2021. We collected 324 patient records for the training model, 36 patient records for validation, and another 36 patient records for testing. We balanced positive and negative Morison's pouch free-fluid detection groups in a 1:1 ratio. The deep learning (DL) model Residual Networks 50-Version 2 (ResNet50-V2) was used for training and validation. Results: The accuracy, sensitivity, and specificity of the model performance for ascites prediction were 0.961, 0.976, and 0.947, respectively, in the validation set and 0.967, 0.985, and 0.913, respectively, in the test set. Regarding feedback prediction, the model correctly classified qualified and non-qualified images with an accuracy of 0.941 in both the validation and test sets. Conclusions: The DL algorithm in ResNet50-V2 is able to detect free fluid in Morison's pouch with high accuracy. The automated feedback and instruction system could help inexperienced sonographers improve their interpretation ability and image acquisition skills.
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Affiliation(s)
- Chi-Yung Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - I-Min Chiu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Ming-Ya Hsu
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Hsiu-Yung Pan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Min Tsai
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Hung Richard Lin
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
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Leenellett E, Rieves A. Occult Abdominal Trauma. Emerg Med Clin North Am 2021; 39:795-806. [PMID: 34600638 DOI: 10.1016/j.emc.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Occult abdominal injuries are common and can be associated with increased risk of morbidity and mortality. Patients with a delayed presentation to care or who are multiply injured are at increased risk of this type of injury, and a high index of suspicion must be maintained. A careful combination of history, physical examination, laboratory, and imaging can be quite helpful in mitigating the risk of a missed occult abdominal injury.
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Affiliation(s)
- Elizabeth Leenellett
- Department of Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, Room 1505, Cincinnati, OH 45267-0769, USA.
| | - Adam Rieves
- Department of Emergency Medicine, Washington University in Saint Louis, 660 South Euclid Avenue, BC 8072, Saint Louis, MO 63110, USA
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10
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Sweeney DA, Wiley BM. Integrated Multiorgan Bedside Ultrasound for the Diagnosis and Management of Sepsis and Septic Shock. Semin Respir Crit Care Med 2021; 42:641-649. [PMID: 34544181 DOI: 10.1055/s-0041-1733896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite decades of research, the mortality rate of sepsis and septic shock remains unacceptably high. Delays in diagnosis, identification of an infectious source, and the challenge of providing patient-tailored resuscitation measures routinely result in suboptimal patient outcomes. Bedside ultrasound improves a clinician's ability to both diagnose and manage the patient with sepsis. Indeed, multiple point-of-care ultrasound (POCUS) protocols have been developed to evaluate and treat various subsets of critically ill patients. These protocols mostly target patients with undifferentiated shock and have been shown to improve clinical outcomes. Other studies have shown that POCUS can improve a clinician's ability to identify a source of infection. Once a diagnosis of septic shock has been made, serial POCUS exams can be used to continuously guide resuscitative efforts. In this review, we advocate that the patient with suspected sepsis or septic shock undergo a comprehensive POCUS exam in which sonographic information across organ systems is synthesized and used in conjunction with traditional data gleaned from the patient's history, physical exam, and laboratory studies. This harmonization of information will hasten an accurate diagnosis and assist with hemodynamic management.
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Affiliation(s)
- Daniel A Sweeney
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Brandon M Wiley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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11
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Teeter WA, Scalea T. Evolution of Point-Of-Care Ultrasound in Surgical Management. Adv Surg 2021; 55:273-297. [PMID: 34389096 DOI: 10.1016/j.yasu.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- William A Teeter
- Department of Emergency Medicine, University of Maryland School of Medicine, Program in Trauma and Critical Care, R Adams Cowley Shock Trauma Center, 22 S. Greene Street, T1R51, Baltimore, MD 21201, USA.
| | - Thomas Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Program in Trauma, University of Maryland School of Medicine, 22 S. Greene Street, T1R51, Baltimore, MD 21201, USA
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12
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Stone BS, Muruganandan KM, Tonelli MM, Dugas JN, Verriet IE, Pare JR. Impact of point-of-care ultrasound on treatment time for ectopic pregnancy. Am J Emerg Med 2021; 49:226-232. [PMID: 34146921 DOI: 10.1016/j.ajem.2021.05.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/13/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is useful in the evaluation of early pregnancy by confirming intrauterine pregnancy and recognizing hemorrhage from ectopic pregnancy. We sought to determine whether transabdominal POCUS by itself or in conjunction with consultative radiology ultrasound (RADUS), reduces Emergency Department (ED) treatment time for patients with ectopic pregnancy requiring operative care, when compared to RADUS alone. A secondary objective was to determine whether the incorporation of POCUS reduces time to operative care for patients with ruptured ectopic pregnancy specifically, when compared to RADUS alone. METHODS We performed a retrospective review of patients admitted for operative management of ectopic pregnancy. We excluded patients with known ectopic pregnancy and/or imaging prior to arriving to the treatment area, found not to have an ectopic pregnancy, or did not undergo operative care. Descriptive statistics, classical and nonparametric statistical analysis, and linear regression were performed. RESULTS There were 220 patients admitted with ectopic pregnancy, 111 met exclusion criteria, yielding 109 for analysis. Of 109, 36 received POCUS (23/36 also had RADUS), while 73 received RADUS only. Among the POCUS group 31/36 (86%) were classified as ruptured versus 47/73 (64%) in the RADUS group. The average ED treatment time in the POCUS group for all admitted ectopic pregnancies was 157.9 min (standard deviation [SD] 101.3) versus 206.3 min (SD 76.6) in the RADUS group (p = 0.0141). The median time to operating room (OR) for ruptured ectopic pregnancies was 203.0 min (interquartile range [IQR] 159.0) in the POCUS group versus 293.0 min (IQR 139.0) in the RADUS group (p = 0.0002). Regression analysis of the primary outcome was limited by multiple interactions and sample size. When controlling for race, positive shock index and ED visit time, POCUS was found to be associated with a significantly shorter time to OR among ruptured ectopic pregnancies compared to RADUS (p = 0.0052). CONCLUSION Compared to RADUS alone, incorporation of POCUS was associated with significantly faster ED treatment time for all ectopic pregnancies and significantly faster time to OR for ruptured ectopic pregnancies, even when combined with RADUS. When controlling for clinical differences, time to OR was still faster for patients who underwent POCUS. The integration of POCUS should be considered to expedite care for patients with ectopic pregnancy requiring operative care.
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Affiliation(s)
- Bethsabee S Stone
- Pediatric Emergency Department, Boston Medical Center, Boston University School of Medicine, 1 Boston Medical Center Place, Boston, MA 02118, United States of America.
| | - Krithika M Muruganandan
- Emergency Department, Boston Medical Center, Boston University School of Medicine, 1 Boston Medical Center Place, Boston, MA 02118, United States of America
| | - Melinda M Tonelli
- Emergency Department, Boston Medical Center, Boston University School of Medicine, 1 Boston Medical Center Place, Boston, MA 02118, United States of America
| | - Julianne N Dugas
- Emergency Department, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, United States of America
| | - Ivy E Verriet
- Pediatric Emergency Department, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, United States of America
| | - Joseph R Pare
- Emergency Department, Boston Medical Center, Boston University School of Medicine, 1 Boston Medical Center Place, Boston, MA 02118, United States of America
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Critical decision points in the management of acute trauma: a practical review. Int Anesthesiol Clin 2021; 59:1-9. [PMID: 33560038 DOI: 10.1097/aia.0000000000000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Hahn M, Ray J, Hall MM, Coe I, Situ-LaCasse E, Waterbrook AL. Ultrasound in Trauma and Other Acute Conditions in Sports, Part I. Curr Sports Med Rep 2020; 19:486-494. [DOI: 10.1249/jsr.0000000000000774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Kornblith AE, Graf J, Addo N, Newton C, Callcut R, Grupp‐Phelan J, Jaffe DM. The Utility of Focused Assessment With Sonography for Trauma Enhanced Physical Examination in Children With Blunt Torso Trauma. Acad Emerg Med 2020; 27:866-875. [PMID: 32159909 DOI: 10.1111/acem.13959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/02/2020] [Accepted: 03/10/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Computed tomography (CT), the reference standard for diagnosis of intraabdominal injury (IAI), carries risk including ionizing radiation. CT-sparing clinical decision rules for children have relied heavily on physical examination, but they did not include focused assessment with sonography for trauma (FAST), which has emerged into widespread use during the past decade. We sought to determine the independent associations of physical examination, laboratory studies, and FAST with identification of IAI in children and to compare the test characteristics of these diagnostic variables. We hypothesized that FAST may add incremental utility to a physical examination alone to more accurately identify children who could forgo CT scan. METHODS We reviewed a large trauma database of all children with blunt torso trauma presenting to a freestanding pediatric emergency department during a 20-month period. We used logistic regression to evaluate the association of FAST, physical examination, and selected laboratory data with IAI in children, and we compared the test characteristics of these variables. RESULTS Among 354 children, 50 (14%) had IAI. Positive FAST (odds ratio [OR] = 14.8, 95% confidence interval [CI] = 7.5 to 30.8) and positive physical examination (OR = 15.2, 95% CI = 7.7 to 31.7) were identified as independent predictors for IAI. Physical examination and FAST each had sensitivities of 74% (95% CI = 60% to 85%). Combining FAST and physical examination as FAST-enhanced physical examination (exFAST) improved sensitivity and negative predictive value (NPV) over either test alone (sensitivity = 88%, 95% CI = 76% to 96%) and NPV of 97.3% (95% CI = 94.5% to 98.7%). CONCLUSIONS In children, FAST and physical examinations each predicted the identification of IAI. However, the combination of the two (exFAST) had greater sensitivity and NPV than either physical examination or FAST alone. This supports the use of exFAST in refining clinical predication rules in children with blunt torso trauma.
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Affiliation(s)
- Aaron E. Kornblith
- From the Department of Emergency Medicine and PediatricsUniversity of California San Francisco CA
| | | | - Newton Addo
- the Department of Emergency MedicineUniversity of California San Francisco CA
| | | | - Rachael Callcut
- and the Department of Surgery University of California San Francisco CA
| | - Jacqueline Grupp‐Phelan
- From the Department of Emergency Medicine and PediatricsUniversity of California San Francisco CA
| | - David M. Jaffe
- the Department of Emergency MedicineUniversity of California San Francisco CA
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Manson WC, Kirksey M, Boublik J, Wu CL, Haskins SC. Focused assessment with sonography in trauma (FAST) for the regional anesthesiologist and pain specialist. Reg Anesth Pain Med 2019; 44:540-548. [DOI: 10.1136/rapm-2018-100312] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/10/2019] [Accepted: 02/20/2019] [Indexed: 11/04/2022]
Abstract
This article in our point-of-care ultrasound (PoCUS) series is dedicated to the role the focused assessment with sonography in trauma (FAST) exam plays for the regional anesthesiologist and pain specialists in the perioperative setting. The FAST exam is a well-established and extensively studied PoCUS exam in both surgical and emergency medicine literature with over 20 years demonstrating its benefit in identifying the presence of free fluid in the abdomen following trauma. However, only recently has the FAST exam been shown to be beneficial to the anesthesiologist in the perioperative setting as a means to identify the extravasation of free fluid into the abdomen from the hip joint following hip arthroscopy. In this article, we will describe how to obtain the basic FAST views (subcostal four-chamber view, perihepatic right upper quadrant view, perisplenic left upper quadrant view, and pelvic view in the longitudinal and short axis) as well as cover the relevant sonoanatomy. We will describe pathological findings seen with the FAST exam, primarily free fluid in the peritoneal space as well as in the pericardial sac. As is the case with any PoCUS skill, the application evolves with understanding and utilization by new clinical specialties. Although this article will provide clinical examples of where the FAST exam is beneficial to the regional anesthesiologist and pain specialist, it also serves as an introduction to this powerful PoCUS skill in order to encourage clinical practitioners to expand the application of the FAST exam within the scope of regional anesthesia and pain management practice.
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17
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Cho J, Jensen TP, Reierson K, Mathews BK, Bhagra A, Franco-Sadud R, Grikis L, Mader M, Dancel R, Lucas BP, Soni NJ. Recommendations on the Use of Ultrasound Guidance for Adult Abdominal Paracentesis: A Position Statement of the Society of Hospital Medicine. J Hosp Med 2019; 14:E7-E15. [PMID: 30604780 PMCID: PMC8021127 DOI: 10.12788/jhm.3095] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
1. We recommend that ultrasound guidance should be used for paracentesis to reduce the risk of serious complications, the most common being bleeding. 2. We recommend that ultrasound guidance should be used to avoid attempting paracentesis in patients with an insufficient volume of intraperitoneal free fluid to drain. 3. We recommend that ultrasound guidance should be used with paracentesis to improve the success rates of the overall procedure. 4. We recommend that ultrasound should be used to assess the volume and location of intraperitoneal free fluid to guide clinical decision making of where paracentesis can be safely performed. 5. We recommend that ultrasound should be used to identify a needle insertion site based on size of the fluid collection, thickness of the abdominal wall, and proximity to abdominal organs. 6. We recommend that the needle insertion site should be evaluated using color flow Doppler ultrasound to identify and avoid abdominal wall blood vessels along the anticipated needle trajectory. 7. We recommend that a needle insertion site should be evaluated in multiple planes to ensure clearance from underlying abdominal organs and detect any abdominal wall blood vessels along the anticipated needle trajectory. 8. We recommend that a needle insertion site should be marked with ultrasound immediately before performing the procedure, and the patient should remain in the same position between marking the site and performing the procedure. 9. We recommend that using real-time ultrasound guidance for paracentesis should be considered when the fluid collection is small or difficult to access. 10. We recommend that dedicated training sessions, including didactics, supervised practice on patients, and simulation-based practice, should be used to teach novices how to perform ultrasound-guided paracentesis. 11. We recommend that simulation-based practice should be used, when available, to facilitate acquisition of the required knowledge and skills to perform ultrasoundguided paracentesis. 12. We recommend that competence in performing ultrasound-guided paracentesis should be demonstrated prior to independently performing the procedure on patients.
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Affiliation(s)
- Joel Cho
- Department of Hospital Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.
| | - Trevor P Jensen
- Division of Hospital Medicine, University of California San Francisco Medical Center at Parnassus, San Francisco, California, USA
| | - Kreegan Reierson
- Department of Hospital Medicine, HealthPartners Medical Group, Regions Hospital, St. Paul, Minnesota, USA
| | - Benji K Mathews
- Department of Hospital Medicine, HealthPartners Medical Group, Regions Hospital, St. Paul, Minnesota, USA
- Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Anjali Bhagra
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ricardo Franco-Sadud
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Loretta Grikis
- White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Michael Mader
- Divisions of General and Hospital Medicine and Pulmonary and Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Ria Dancel
- Division of Hospital Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brian P Lucas
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | | | - Nilam J Soni
- Divisions of General and Hospital Medicine and Pulmonary and Critical Care Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
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Abstract
Technology has the potential to both distract and reconnect providers with their patients. The widespread adoption of electronic medical records in recent years pulls physicians away from time at the bedside. However, when used in conjunction with patients, technology has the potential to bring patients and physicians together. The increasing use of point-of-care ultrasound by physicians is changing the bedside encounter by allowing for real-time diagnosis with the treating physician. It is a powerful example of the way technology can be a force for refocusing on the bedside encounter.
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Affiliation(s)
- Andre Kumar
- Department of Medicine, Division of Hospital Medicine, Stanford University, mail code 5209, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Gigi Liu
- Department of Medicine, Johns Hopkins University, 600 North Wolfe Street, Meyer Building 8th Floor, Room 147, Baltimore, MD 21204, USA
| | - Jeff Chi
- Department of Medicine, Division of Hospital Medicine, Stanford University, mail code 5209, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - John Kugler
- Department of Medicine, Division of Hospital Medicine, Stanford University, mail code 5209, 300 Pasteur Drive, Stanford, CA 94305, USA.
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19
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Millington SJ, Koenig S. Better With Ultrasound: Paracentesis. Chest 2018; 154:177-184. [PMID: 29630894 DOI: 10.1016/j.chest.2018.03.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/18/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022] Open
Abstract
Paracentesis is a commonly performed procedure and generally considered to be low risk. Despite its overall favorable safety profile, use of ultrasound has been demonstrated to reduce the incidence of complications, especially in higher risk patients. Many individual ultrasound techniques have been described in the literature, each with the goal of making paracentesis safer. This article presents a systematic approach for incorporating many of these tools into bedside practice and includes a series of illustrative figures and narrated video presentations to demonstrate the techniques described.
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Affiliation(s)
- Scott J Millington
- Intensive Care Unit, University of Ottawa/The Ottawa Hospital, Ottawa, ON, Canada.
| | - Seth Koenig
- Division of Pulmonary, Critical Care, and Sleep Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY
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20
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Imaging Patterns of Injuries After the 2015 Amtrak Philadelphia Train Derailment. AJR Am J Roentgenol 2018; 210:948-961. [PMID: 29489405 DOI: 10.2214/ajr.17.18832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the injury patterns observed in the 2015 Philadelphia Amtrak train derailment. CONCLUSION Fractures accounted for most observed injuries, but uncommon and potentially serious injuries included posterior sternoclavicular dislocation and mesenteric contusion. Imaging plays a critical role in the triage of patients during mass-casualty events, and familiarity with the injury patterns associated with high-velocity unrestrained blunt force trauma will aid diagnosis in any future similar occurrence.
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21
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Notfallsonographie in einem präklinischen Setting. Notf Rett Med 2018. [DOI: 10.1007/s10049-017-0302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Desai N, Harris T. Extended focused assessment with sonography in trauma. BJA Educ 2017; 18:57-62. [PMID: 33456811 DOI: 10.1016/j.bjae.2017.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- N Desai
- Department of Anaesthetics, St George's Hospital, London, UK
| | - T Harris
- Emergency Medicine, Barts Health NHS Trust and the Queen Mary University of London, Royal London Hospital, Whitechapel, London, UK
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23
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Kleinman J, Strumwasser A, Rosen D, Hardin J, Inaba K, Demetriades D. The Dangers of Equivocal FAST in Trauma Resuscitation. Am Surg 2017. [DOI: 10.1177/000313481708301023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Equivocal focused abdominal sonography for trauma (FAST) examinations confound decision-making for trauma surgeons. We sought to determine whether the equivocal FAST (defined as any nonconcordant result) has a deleterious effect on trauma outcomes. A 2-year review (2014–2015) of all trauma activations at our Level I trauma center was performed. Patients were matched at baseline and FAST results were compared. Outcomes included resuscitation time (h), ventilation days (d), hospital length of stay (HLOS-d), ICU length-of-stay, and survival (%). In addition, skill level of the sonographer was stratified by novice (postgraduate year (PGY) years 1–3) or expert skill levels (PGY-4/fellow or attending). A total of 1,027 patients were included. Compared with concordant FAST examinations, equivocal FASTs were associated with increased HLOS (14.1 vs 10.6, P = 0.05), higher mortality (9.8 vs 3.7%, P = 0.02), decreased positive predictive value in the right upper quadrant (RUQ) (55 vs 79%, P = 0.02) and left upper quadrant (LUQ) (50 vs 83%, P < 0.01) and significantly decreased specificity in the thoracic (83 vs 98%), RUQ (80 vs 98%), LUQ (86 vs 99%), and pelvic (88 vs 98%) windows (P < 0.01 for all). A trend of greater positive predictive value in the thoracic window (100 vs 81%, P = 0.09) among PGY-4/fellow and attending providers compared with PGY levels 1–3 was observed. Equivocal FASTs portend worse outcomes than concordant FASTs because of high false-negative rates, specifically in the thoracic region and the upper quadrants. Lower thresholds for intervention are recommended.
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Affiliation(s)
- John Kleinman
- Division of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California
| | - Aaron Strumwasser
- Division of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California
| | - David Rosen
- Division of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California
| | - Jeremy Hardin
- Division of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California
| | - Kenji Inaba
- Division of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California
| | - Demetrios Demetriades
- Division of Trauma and Acute Care Surgery, LAC+USC Medical Center, Los Angeles, California
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24
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Brenkert TE, Adams C, Vieira RL, Rempell RG. Peritoneal fluid localization on FAST examination in the pediatric trauma patient. Am J Emerg Med 2017; 35:1497-1499. [DOI: 10.1016/j.ajem.2017.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/13/2017] [Indexed: 11/28/2022] Open
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25
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Savatmongkorngul S, Wongwaisayawan S, Kaewlai R. Focused assessment with sonography for trauma: current perspectives. Open Access Emerg Med 2017; 9:57-62. [PMID: 28794661 PMCID: PMC5536884 DOI: 10.2147/oaem.s120145] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Focused assessment with sonography for trauma (FAST) is a part of resuscitation of trauma patients recommended by international panel consensus. The purpose of FAST is to identify free fluid, which necessarily means blood in acute trauma patients. In this article, the authors focused on various aspects of FAST in the emergency department, prehospital care, pediatric setting, training and general pearls/pitfalls. Detailed techniques and interpretation of FAST are beyond the scope of this article.
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Affiliation(s)
| | - Sirote Wongwaisayawan
- Division of Emergency Radiology, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rathachai Kaewlai
- Division of Emergency Radiology, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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26
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Richards JR, McGahan JP. Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can Learn. Radiology 2017; 283:30-48. [DOI: 10.1148/radiol.2017160107] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- John R. Richards
- From the Departments of Emergency Medicine (J.R.R.) and Radiology (J.P.M.), University of California, Davis Medical Center, 4860 Y St, Sacramento, CA 95817
| | - John P. McGahan
- From the Departments of Emergency Medicine (J.R.R.) and Radiology (J.P.M.), University of California, Davis Medical Center, 4860 Y St, Sacramento, CA 95817
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Lobo V, Hunter-Behrend M, Cullnan E, Higbee R, Phillips C, Williams S, Perera P, Gharahbaghian L. Caudal Edge of the Liver in the Right Upper Quadrant (RUQ) View Is the Most Sensitive Area for Free Fluid on the FAST Exam. West J Emerg Med 2017; 18:270-280. [PMID: 28210364 PMCID: PMC5305137 DOI: 10.5811/westjem.2016.11.30435] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction The focused assessment with sonography in trauma (FAST) exam is a critical diagnostic test for intraperitoneal free fluid (FF). Current teaching is that fluid accumulates first in Morison’s pouch. The goal of this study was to evaluate the “sub-quadrants” of traditional FAST views to determine the most sensitive areas for FF accumulation. Methods We analyzed a retrospective cohort of all adult trauma patients who had a recorded FAST exam by emergency physicians at a Level I trauma center from January 2012 – June 2013. Ultrasound fellowship-trained faculty with three emergency medicine residents reviewed all FAST exams. We excluded studies if they were incomplete, of poor image quality, or with incorrect medical record information. Positive studies were assessed for FF localization, comparing the traditional abdominal views and on a sub-quadrant basis: right upper quadrant (RUQ)1 - hepato-diaphragmatic; RUQ2 - Morison’s pouch; RUQ3 - caudal liver edge and superior paracolic gutter; left upper quadrant (LUQ)1 - splenic-diaphragmatic; LUQ2 - spleno-renal; LUQ3 – around inferior pole of kidney; suprapubic area (SP)1 - bilateral to bladder; SP2 - posterior to bladder; SP3 – posterior to uterus (females). FAST results were confirmed by chart review of computed tomography results or operative findings. Results Of the included 1,008 scans, 48 (4.8%) were positive. The RUQ was the most positive view with 32/48 (66.7%) positive. In the RUQ sub-quadrant analysis, the most positive view was the RUQ3 with 30/32 (93.8%) positive. Conclusion The RUQ is most sensitive for FF assessment, with the superior paracolic gutter area around the caudal liver edge (RUQ3) being the most positive sub-quadrant within the RUQ.
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Affiliation(s)
- Viveta Lobo
- Stanford University Medical Center, Department of Emergency Medicine, Palo Alto, California
| | | | - Erin Cullnan
- Stanford University Medical Center, Department of Emergency Medicine, Palo Alto, California
| | - Rebecca Higbee
- Stanford University Medical Center, Department of Emergency Medicine, Palo Alto, California
| | - Caleb Phillips
- University of Colorado, Department of Computer Science, Boulder, Colorado
| | - Sarah Williams
- Stanford University Medical Center, Department of Emergency Medicine, Palo Alto, California
| | - Philips Perera
- Stanford University Medical Center, Department of Emergency Medicine, Palo Alto, California
| | - Laleh Gharahbaghian
- Stanford University Medical Center, Department of Emergency Medicine, Palo Alto, California
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Sargin MA, Yassa M, Taymur BD, Çelik A, Aydin S, Orhan E, Tug N. A Clinical Experience of Ectopic Pregnancies with Initial Free Intraperitoneal Fluid. J Clin Diagn Res 2016; 10:QC22-6. [PMID: 27656512 DOI: 10.7860/jcdr/2016/20363.8376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/06/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Extra-uterine pregnancy or Ectopic Pregnancy (EP) is a major health problem for pregnant women, presenting as a potentially life-threatening emergency in the first trimester. There are three major options for the treatment of EP: expectant management, surgical treatment and medical management. The presence of free intraperitoneal fluid in EP-diagnosed patients is crucial for treatment planning and evaluation. AIM To compare the outcomes of both the expectant man-agement and medical treatment with methotrexate (MTX) in ectopic pregnancies with free intraperitoneal fluid. MATERIALS AND METHODS This retrospective cohort study inclu-ded a total of 91 ectopic pregnancies with or without rupture in which the women had initial free intraperitoneal fluid and were haemodynamically stable. Serial β-HCG measurements were used to assess the outcome of expectant management and medical treatment with MTX. For the statistical analysis, the SPSS statistical software package, version 22.0 (Chicago, IL, USA), was used. For the quantitative variables that were not distributed normally, the Kruskal-Wallis test and the Mann-Whitney U test were performed for the evaluation of differences between the groups. RESULTS It was observed that the success rate with expectant management was 81% (initial β HCG concentration 626±443 mIU/mL). With a single dose of MTX, it was 76% (initial β HCG concentration 2124±1647 mIU/mL) and with a total single or double dose of MTX, it was 88% (initial β HCG concentration 2252±78 mIU/mL) from among EP with or without rupture in women with initial free intraperitoneal fluid during diagnosis. There was no significant difference between the groups with regard to ultrasonography findings. CONCLUSION Expectant management or medical treatment with methotrexate should be the first line treatment for ectopic pregnancies with initial free intraperitoneal fluid, albeit with rupture, in patients who are haemodynamically stable, along with β-HCG follow-up.
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Affiliation(s)
- Mehmet Akif Sargin
- Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey
| | - Murat Yassa
- Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey
| | - Bilge Dogan Taymur
- Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey
| | - Ayhan Çelik
- Lecturer, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey
| | - Sibel Aydin
- Lecturer, Department of Obstetrics and Gynecology, Umraniye Training and Research Hospital , İstanbul, Turkey
| | - Emrah Orhan
- Student, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey
| | - Niyazi Tug
- Associate Professor, Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital , İstanbul, Turkey
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Shiloh AL, Adrish M. A Man in His 60s With Cirrhosis, Encephalopathy, and Shock. Chest 2015; 148:e5-e7. [PMID: 26149567 DOI: 10.1378/chest.14-2201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ariel L Shiloh
- Jay B. Langner Critical Care Service, Montefiore Medical Center, Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.
| | - Muhammad Adrish
- Jay B. Langner Critical Care Service, Montefiore Medical Center, Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
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30
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Shuster M, Abu-Laban RB, Boyd J, Gauthier C, Mergler S, Shepherd L, Turner C. Focused abdominal ultrasound for blunt trauma in an emergency department without advanced imaging or on-site surgical capability. CAN J EMERG MED 2015; 6:408-15. [PMID: 17378959 DOI: 10.1017/s1481803500009404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT:Objectives:To determine whether focused abdominal sonogram for trauma (FAST) in a rural hospital provides information that prompts immediate transfer to a tertiary care facility for patients with blunt abdominal trauma who would otherwise be discharged or held for observation.Methods:Prior to the study, participating emergency physicians underwent a minimum of 30 hours of ultrasound training. All patients who presented with blunt abdominal trauma to our rural hospital between Mar. 1, 2002, and Apr. 30, 2003, were eligible for study. Following a history and physical examination, the emergency physician documented his or her disposition decision. A FAST was then performed, and the disposition reconsidered in light of the FAST results.Results:Sixty-seven FAST exams were performed on 65 patients. Three examinations (4.5%) were true-positive (95% confidence interval [CI] 0.9%–12.5%); 60 (89.6%) were true-negative (95% CI 79.7%–95.7%), 4 (6%) were false-negative (95% CI 1.7%–14.6%) and none (0%) were false-positive (95% CI 0%–5.4%). These values reflect sensitivity, specificity, negative predictive value and positive predictive values of 43%, 100%, 94% and 100% respectively. FAST results did not alter the decision to transfer any patient (0%: 95% CI 0.0%–5.4%), although one positive FAST may have led to an expedited transfer. One of 38 patients who was discharged after a negative FAST study returned 24 hours later because of worsening symptoms, and was ultimately found to have splenic and pancreatic injuries.Conclusions:This study failed to demonstrate that FAST improves disposition decisions for patients with blunt abdominal trauma who are evaluated in a hospital without advanced imaging or on-site surgical capability. However, the study is not sufficiently powered to rule out a role for FAST in these circumstances, and our data suggest that up to 5.4% of transfer decisions could be influenced by FAST. Rural emergency physicians should not allow a negative FAST study to override a clinical indication for transfer to a trauma centre; however, positive FAST studies can be used to accelerate transfer for definitive treatment.
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Affiliation(s)
- Michael Shuster
- Department of Emergency Medicine, Mineral Springs Hospital, Banff, Alberta, Canada.
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Wastl D, Helwig K, Dietrich CF. Untersuchungskonzepte und Untersuchungsabläufe in der Notfallsonographie. Med Klin Intensivmed Notfmed 2015; 110:231-9; quiz 240-1. [PMID: 25895123 DOI: 10.1007/s00063-015-0026-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/08/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
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Daghfous A, Bouzaïdi K, Abdelkefi M, Rebai S, Zoghlemi A, Mbarek M, Rezgui Marhoul L. Contribution of imaging in the initial management of ballistic trauma. Diagn Interv Imaging 2015; 96:45-55. [DOI: 10.1016/j.diii.2014.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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O’Brien K, Stolz U, Stolz L, Adhikari S. LUQ view and the FAST exam: helpful or a hindrance in the adult trauma patient? Crit Ultrasound J 2014. [PMCID: PMC4101358 DOI: 10.1186/2036-7902-6-s1-a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Williams SR, Perera P, Gharahbaghian L. The FAST and E-FAST in 2013: trauma ultrasonography: overview, practical techniques, controversies, and new frontiers. Crit Care Clin 2014; 30:119-50, vi. [PMID: 24295843 DOI: 10.1016/j.ccc.2013.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article reviews important literature on the FAST and E-FAST examinations in adults. It also reviews key pitfalls, limitations, and controversies. A practical "how-to" guide is presented. Lastly, new frontiers are explored.
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Affiliation(s)
- Sarah R Williams
- Division of Emergency Medicine, Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive Alway Building, M121, Stanford, CA 93405, USA.
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Fox JC, Schlang JR, Maldonado G, Lotfipour S, Clayman RV. Proactive medicine: the "UCI 30," an ultrasound-based clinical initiative from the University of California, Irvine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:984-989. [PMID: 24826849 DOI: 10.1097/acm.0000000000000292] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article discusses the benefits of integrating point-of-care diagnostic ultrasound into the four-year medical school curriculum. Handheld ultrasound devices have been used to teach medical students at the University of California (UC), Irvine, since August 2010, and the article explains how the use of this inexpensive, safe, and noninvasive tool enhances the ability of a physician conducting a standard physical exam to confirm suspected findings and uncover other suspected pathology at a reasonable cost. The authors describe the ultrasound curriculum at UC Irvine and the process of its implementation. In the appendix to the article, the authors describe the specific diagnostic benefits of using a handheld ultrasound device for each element of the Stanford 25 physical exam. Their ultrasound-enhanced approach to the physical exam is referred to as the "UCI 30." They make recommendations for how and when to integrate ultrasound into the physical exam. The article points out that early training of medical students in the use of ultrasound can avoid the diagnostic problems of ultrasound by maximizing students' comfort and ability to obtain accurate ultrasound images for diagnostic and procedural purposes.
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Affiliation(s)
- J Christian Fox
- Dr. Fox is director of instructional ultrasound, assistant dean of student affairs, and professor of clinical emergency medicine, Department of Emergency Medicine, University of California, Irvine School of Medicine, Irvine, California. Ms. Schlang is a fourth-year medical student, University of California, Irvine School of Medicine, Irvine, California. Ms. Maldonado is a first-year medical student, University of California, Irvine School of Medicine, Irvine, California. Dr. Lotfipour is associate dean for clinical science education, professor of emergency medicine, and director, Emergency Medicine Research Associates Program, Department of Emergency Medicine, University of California, Irvine School of Medicine, Irvine, California. Dr. Clayman is dean, School of Medicine, and professor of urology, University of California, Irvine School of Medicine, Irvine, California
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Ennis J, Schultz G, Perera P, Williams S, Gharahbaghian L, Mandavia D. Ultrasound for Detection of Ascites and for Guidance of the Paracentesis Procedure: Technique and Review of the Literature. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijcm.2014.520163] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Ultrasound guidance has become the standard of care for many bedside procedures, owing to its portability, ease of use, and significant reduction in complications. This article serves as an introduction to the use of ultrasonography in several advanced procedures, including pericardiocentesis, thoracentesis, paracentesis, lumbar puncture, regional anesthesia, and peritonsillar abscess drainage.
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Affiliation(s)
- Nicholas Hatch
- Department of Emergency Medicine, Maricopa Medical Center, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA.
| | - Teresa S Wu
- EM Residency Program, Department of Emergency Medicine, Maricopa Medical Center, University of Arizona College of Medicine-Phoenix, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
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Surgical Considerations in the Emergent Small Animal Patient. Vet Clin North Am Small Anim Pract 2013; 43:899-914. [DOI: 10.1016/j.cvsm.2013.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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[Management of penetrating abdominal trauma: what we need to know?]. ACTA ACUST UNITED AC 2013; 32:104-11. [PMID: 23402982 DOI: 10.1016/j.annfar.2012.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 12/13/2012] [Indexed: 12/25/2022]
Abstract
Penetrating traumas are rare in France and mainly due to stabbing. Knives are less lethal than firearms. The initial clinical assessment is the cornerstone of hospital care. It remains a priority and can quickly lead to a surgical treatment first. Urgent surgical indications are hemorrhagic shock, evisceration and peritonitis. Dying patients should be immediately taken to the operating room for rescue laparotomy or thoracotomy. Ultrasonography and chest radiography are performed before damage control surgery for hemodynamic unstable critical patients. Stable patients are scanned by CT and in some cases may benefit from non-operative strategy. Mortality remains high, initially due to bleeding complications and secondarily to infectious complications. Early and appropriate surgery can reduce morbidity and mortality. Non-operative strategy is only possible in selected patients in trained trauma centers and with intensive supervision by experienced staff.
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Perera P, Mailhot T, Riley D, Mandavia D. The RUSH Exam 2012: Rapid Ultrasound in Shock in the Evaluation of the Critically Ill Patient. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.cult.2011.12.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Felipe Catán G, Diva Villao M, Cristián Astudillo D. Ecografía fast en la evaluación de pacientes traumatizados. REVISTA MÉDICA CLÍNICA LAS CONDES 2011. [DOI: 10.1016/s0716-8640(11)70475-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Simanovsky N, Hiller N, Lubashevsky N, Rozovsky K. Ultrasonographic evaluation of the free intraperitoneal fluid in asymptomatic children. Pediatr Radiol 2011; 41:732-5. [PMID: 21184057 DOI: 10.1007/s00247-010-1927-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 10/22/2010] [Accepted: 11/12/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Free intraperitoneal fluid can be an important sign in an abdominal inflammatory process or abdominal trauma. It is often present in children with abdominal pain, but it is a nonspecific finding. A minimal amount of free intraperitoneal fluid is considered normal. OBJECTIVE The purpose of this study was to evaluate the incidence, location and volume of free fluid in the abdomen and pelvis in a population of asymptomatic children. MATERIALS AND METHODS In this prospective study, we performed clinically indicated abdominal and pelvic sonography, using high-resolution transducers, in 200 asymptomatic children: 104 (52%) girls, 96 (48%) boys; ages 6 days-15 years (mean 3 years 8 months). US studies were performed and prospectively evaluated by two experienced pediatric radiologists. Patients with any condition that could result in the accumulation of free intraperitoneal fluid as well as postpubertal girls were excluded from the study. RESULTS Free intraperitoneal fluid was seen in 12 children (6%), only in the pelvis. Fluid volume never exceeded 1 ml. CONCLUSION Our study suggests that 1 ml or less of free intraperitoneal fluid detected in the pelvis is probably insignificant.
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Affiliation(s)
- Natalia Simanovsky
- Department of Medical Imaging, Hadassah Medical Center, Hebrew University Medical Center, P.O.B. 12000, Kiryat Hadassah, Jerusalem, Israel.
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Yekuo L, Shasha W, Xiansheng Z, Qi C, Guoxin L, Feng H. Contrast-enhanced ultrasound for blunt hepatic trauma: an animal experiment. Am J Emerg Med 2010; 28:828-33. [DOI: 10.1016/j.ajem.2009.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 07/29/2009] [Accepted: 07/30/2009] [Indexed: 12/26/2022] Open
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Verguts J, Timmerman D, Bourne T, Lewi P, Koninckx P. Accuracy of peritoneal fluid measurements by transvaginal ultrasonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:589-592. [PMID: 20229519 DOI: 10.1002/uog.7632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the accuracy of the assessment of peritoneal fluid volumes of up to 1 L by transvaginal ultrasonography and to re-evaluate the formula used to calculate total volume from the dimensions of the largest pocket. METHODS Patients (n = 13) enrolled for a minor laparoscopic procedure were prospectively recruited. At the end of the procedure, with the patient in the 30 degrees anti-Trendelenburg position, Ringer's lactate was instilled into the abdomen in discrete steps up to 1 L. Following equilibration the diameters of the single pocket of fluid were measured by transvaginal ultrasonography in order to calculate the volume, and regression models were used to determine the relationship between this and the instilled volume. The body mass index (BMI) of the patient was evaluated as a parameter for predicting the instilled volume more accurately. RESULTS The intra-abdominal fluid volume could be calculated from the measured volume using a quadratic regression equation with an overall coefficient of variation of 19%. In individual patients, changes in volume could be assessed with a coefficient of variation of 7.3%. BMI was not found to be a significant parameter in relating the measured to the instilled volume. CONCLUSION Transvaginal ultrasound in a standardized setting can accurately estimate the volume of peritoneal fluid, with the accuracy consistent for small and large volumes. Changes in peritoneal fluid volume over time in the same individual can be measured more accurately than the total volume present.
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Affiliation(s)
- J Verguts
- Department of Obstetrics and Gynecology, University Hospital Leuven, Campus Gasthuisberg, Leuven, Belgium.
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Abstract
The evolving relationship between emergency and palliative medicine is expected to benefit patients of each. Two collaborative care encounters involving home hospice patients are discussed. Portable bedside ultrasound was performed in the home to diagnose ascites and to guide palliative paracentesis. Specific interventions and outcomes are reported. The interface of emergency and palliative care and the use of paracentesis in cancer palliation are briefly reviewed. It is concluded that home-performed ultrasound and ultrasound-guided procedures are promising palliative modalities for care at the end of life.
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Affiliation(s)
- Peter J Mariani
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
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Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Emerg Med Clin North Am 2010; 28:29-56, vii. [PMID: 19945597 DOI: 10.1016/j.emc.2009.09.010] [Citation(s) in RCA: 349] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The RUSH exam (Rapid Ultrasound in SHock examination), presented in this article, represents a comprehensive algorithm for the integration of bedside ultrasound into the care of the patient in shock. By focusing on a stepwise evaluation of the shock patient defined here as "Pump, Tank, and Pipes," clinicians will gain crucial anatomic and physiologic data to better care for these patients.
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Affiliation(s)
- Phillips Perera
- New York Presbyterian Hospital, Columbia University Medical Center, Division of Emergency Medicine, 622 West 168th Street, New York, NY 10032, USA.
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Körner M, Krötz MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U. Current Role of Emergency US in Patients with Major Trauma. Radiographics 2008; 28:225-42. [PMID: 18203940 DOI: 10.1148/rg.281075047] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In patients with major trauma, focused abdominal ultrasonography (US) often is the initial imaging examination. US is readily available, requires minimal preparation time, and may be performed with mobile equipment that allows greater flexibility in patient positioning than is possible with other modalities. It also is effective in depicting abnormally large intraperitoneal collections of free fluid, which are indirect evidence of a solid organ injury that requires immediate surgery. However, because US has poor sensitivity for the detection of most solid organ injuries, an initial survey with US often is followed by a more thorough examination with multidetector computed tomography (CT). The initial US examination is generally performed with a FAST (focused assessment with sonography in trauma) protocol. Speed is important because if intraabdominal bleeding is present, the probability of death increases by about 1% for every 3 minutes that elapses before intervention. Typical sites of fluid accumulation in the presence of a solid organ injury are the Morison pouch (liver laceration), the pouch of Douglas (intraperitoneal rupture of the urinary bladder), and the splenorenal fossa (splenic and renal injuries). FAST may be used also to exclude injuries to the heart and pericardium but not those to the bowel, mesentery, and urinary bladder, a purpose for which multidetector CT is better suited. If there is time after the initial FAST survey, the US examination may be extended to extra-abdominal regions to rule out pneumothorax or to guide endotracheal intubation, vascular puncture, or other interventional procedures.
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Affiliation(s)
- Markus Körner
- Department of Clinical Radiology, University Hospital Munich, Nussbaumstr 20, 80336 Munich, Germany.
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Herold LV, Devey JJ, Kirby R, Rudloff E. Clinical evaluation and management of hemoperitoneum in dogs. J Vet Emerg Crit Care (San Antonio) 2008. [DOI: 10.1111/j.1476-4431.2007.00265.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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