On table POCUS assessment for the IVC following abdominal packing: how I do it

Past and Present of Point-of-Care Ultrasound (PoCUS): A Narrative Review

This article aims to conduct a literature review to gain insight into point-of-care ultrasound (PoCUS). PoCUS is a rapid, accurate, non-invasive, and radiation-free imaging modality that can be used in stable and unstable patients. PoCUS can be performed parallel to physical examination, resuscitation, and stabilization; repeated exams in critical patients are essential for improving sensitivity. The review highlights how PoCUS, which was initially used to detect free intraperitoneal fluid in trauma patients, has developed into a life-saving diagnostic tool that could be utilized by treating physicians during various stages of diagnosis, resuscitation, operation, and postoperative critical care when managing sick patients. The review also notes the barriers to the widespread uptake of PoCUS in general internal medicine and the recent commercial availability of "pocket" or handheld probes that have made PoCUS more readily available. This review concludes that adopting a focused binary decision-making approach can maximize PoCUS's value in many clinical settings, including emergency departments, intensive care units, and operation theatres. Overall, the review emphasizes the importance of awareness of common indications, limitations, and strengths of this evolving and promising technology to determine its future trajectory: Providing comprehensive PoCUS training within internal medicine curriculums and supporting trainers to do so.

Prehospital management of earthquake crush injuries: A collective review

Earthquakes are natural disasters which can destroy the rural and urban infrastructure causing a high toll of injuries and death without advanced notice. We aim to review the prehospital medical management of earthquake crush injuries in the field. PubMed was searched using general terms including rhabdomyolysis, crush injury, and earthquake in English language without time restriction. Selected articles were critically evaluated by three experts in disaster medicine, emergency medicine, and critical care. The medical response to earthquakes includes: (1) search and rescue; (2) triage and initial stabilization; (3) definitive care; and (4) evacuation. Long-term, continuous pressure on muscles causes crush injury. Ischemia-reperfusion injury following the relieving of muscle compression may cause metabolic changes and rhabdomyolysis depending on the time of extrication. Sodium and water enter the cell causing cell swelling and hypovolemia, while potassium and myoglobin are released into the circulation. This may cause sudden cardiac arrest, acute extremity compartment syndrome, and acute kidney injury. Recognizing these conditions and treating them timely and properly in the field will save many patients. Majority of emergency physicians who have worked in the field of the recent Kahramanmaraş 2023, Turkey, earthquakes, have acknowledged their lack of knowledge and experience in managing earthquake crush injuries. We hope that this collective review will cover the essential knowledge needed for properly managing seriously crushed injured patients in the earthquake field.

The changing epidemiology of trauma in child-bearing age women

BACKGROUND

In the last two decades, there have been major improvements in the trauma system in the United Arab Emirates (UAE). We aimed to study the changes in the incidence, type, severity, and outcome of trauma of hospitalized child-bearing age women in Al-Ain City, UAE, during that time.

METHODS

Data from two separate trauma registries of Al-Ain Hospital, which were prospectively collected from March 2003 to March 2006 and January 2014 to December 2017, were analyzed retrospectively. All women aged 15-49 years were studied. The two periods were compared.

RESULTS

Trauma incidence of hospitalized child-bearing age women was reduced by 47% during the second period. There were no significant differences in the mechanism of injury between the two periods. Road traffic collision was the main cause of injury (44% and 42%, respectively) followed by fall down (26.1% and 30.8%, respectively). The location of injury was significantly different (p = 0.018), with a strong trend of more home injuries in the second period (52.8% compared with 44%, p = 0.06). There was a strong statistical trend of mild traumatic brain injury (GCS 13-15) in the second period (p = 0.067, Fisher's Exact test). Those who had normal GCS of 15 were significantly higher in the second period compared with those in the first period (95.3% compared with 86.4%, p < 0.001, Fisher's Exact test) despite having more anatomical injury severity of the head (AIS 2 (1-5) compared with 1 (1-5), p = 0.025). The NISS was significantly higher in the second period (median (range) NISS 5 (1-45) compared with 4 (1-75), p = 0.02). Despite that, mortality was the same (1.6% compared with 1.7%, p = 0.99) while the length of hospital stay was significantly less (mean (SD) 5.6 (6.3) days compared with 10.6 (13.6) days, p < 0.0001).

CONCLUSIONS

The incidence of trauma in hospitalized child-bearing-age women was reduced by 47% over the last 15 years. Road traffic collisions and falls are the leading cause of injury in our setting. Home injuries increased over time. The mortality remained stable despite the increased severity of injured patients. More injury prevention efforts should target home injuries.

Trauma system developments reduce mortality in hospitalized trauma patients in Al-Ain City, United Arab Emirates, despite increased severity of injury

Background

Trauma is a leading cause of death in the United Arab Emirates (UAE). There have been major developments in the trauma system in Al-Ain City during the last two decades. We aimed to study the effects of these developments on the trauma pattern, severity, and clinical outcome of hospitalized trauma patients in Al-Ain City, United Arab Emirates.

Methods

This is a retrospective analysis of two separate sets of prospectively collected trauma registry data of Al-Ain Hospital. Data were collected over two periods: from March 2003 to March 2006 and from January 2014 to December 2017. Demography, injury mechanism, injury location, and clinical outcomes of 2573 trauma patients in the first period were compared with 3519 patients in the second period.

Results

Trauma incidence decreased by 38.2% in Al-Ain City over the last 10 years. Trauma to females, UAE nationals, and the geriatric population significantly increased over time (p < 0.0001, Fisher’s exact test for each). Falls on the same level significantly increased over time, while road traffic collisions and falls from height significantly decreased over time (p < 0.0001, Fisher’s exact test for each). Mortality significantly decreased over time (2.3% compared with 1%, p < 0.0001, Fisher’s exact test).

Conclusions

Developments in the trauma system of our city have reduced mortality in hospitalized trauma patients by 56% despite an increased severity of injury. Furthermore, the injury incidence in our city decreased by 38.2% over the last decade. This was mainly in road traffic collisions and work-related injuries. Nevertheless, falls on the same level in the geriatric population continue to be a significant problem that needs to be addressed.

Kunafa knife and play dough is an efficient and cheap simulator to teach diagnostic Point-of-Care Ultrasound (POCUS)

Background

Point-of-Care Ultrasound (POCUS) is a useful diagnostic tool. Nevertheless, it needs proper training to reach its required level of competency. Educators who work in low-income countries find it difficult to purchase expensive training computer-based simulators. We aim in this communication to describe the methods to build up and use an efficient, simple, and cheap simulator which can be used for teaching POCUS globally.

Methods

It took our group 2 years to develop the simulator to its current form. The required material for the simulator includes a Kunafa knife, a carton gift box and its cover and colored play dough. The Kunafa knife with its blade is an excellent simulator for the small print convex array probe (3–5 MHz) and its ultrasound sections. It is useful to teach two important principles. First, the three basic hand movements used to control the ultrasound probe (fanning, tilting, and shifting). Second, the thin blade of the knife (1 mm thick) simulates the shape of the two-dimensional ultrasound images. The play dough is used to simulate different organs to be cut in different directions like the aorta and inferior vena cava.

Results

The simulator was used to teach 88 fifth year medical students during the period of November 2017 to November 2018 at the College of Medicine and Health Sciences, UAE University. The simulator was valid, simple, portable, and sustainable. The students greatly enjoyed its use. The cost of the simulator is less than 10 US dollars.

Conclusions

Surgical educators who work in low-income countries are encouraged to develop their educational tools that are tailored to their own needs. Our simulator can help our colleagues who want to teach POCUS and cannot purchase expensive mannequins and computer-based simulators.

Diagnostic point-of-care ultrasound (POCUS) for gastrointestinal pathology: state of the art from basics to advanced

The use of point-of-care ultrasound (POCUS) by non-radiologists has dramatically increased. POCUS is completely different from the routine radiological studies. POCUS is a Physiological, On spot, extension of the Clinical examination, that is Unique, and Safe. This review aims to lay the basic principles of using POCUS in diagnosing intestinal pathologies so as to encourage acute care physicians to learn and master this important tool. It will be a useful primer for clinicians who want to introduce POCUS into their clinical practice. It will cover the basic physics, technical aspects, and simple applications including detection of free fluid, free intraperitoneal air, and bowel obstruction followed by specific POCUS findings of the most common intestinal pathologies encountered by acute care physicians including acute appendicitis, epiploic appendagitis, acute diverticulitis, pseudomembranous colitis, intestinal tuberculosis, Crohn’s disease, and colonic tumours. Deep understanding of the basic physics of ultrasound and its artefacts is the first step in mastering POCUS. This helps reaching an accurate POCUS diagnosis and avoiding its pitfalls. With increased skills, detailed and accurate POCUS findings of specific intestinal pathologies can be achieved and properly correlated with the clinical picture. We have personally experienced and enjoyed this approach to a stage that an ultrasound machine is always accompanying us in our clinical on calls and rounds.

Ultrasound diagnosis of fractures in mass casualty incidents

The role of point-of-care ultrasound in mass casualty incidents (MCIs) is still evolving. Occasionally, hospitals can be destroyed by disasters resulting in large number of trauma patients. CAVEAT and FASTER ultrasound protocols, which are used in MCIs, included extremity ultrasound examination as part of them. The literature supports the use of ultrasound in diagnosing extremity fractures both in hospitals and MCIs. The most recent systematic review which was reported by Douma-den Hamer et al in 2016 showed that the pooled ultrasound sensitivity and specificity for detecting distal forearm fractures was 97% and 95% respectively. Nevertheless, majority of these studies were in children and they had very high heterogeneity. The portability, safety, repeatability, and cost-effectiveness of ultrasound are great advantages when treating multiply injured patients in MCIs. Its potential in managing fractures in MCIs needs to be further defined. The operator should master the technique, understand its limitations, and most importantly correlate the sonographic findings with the clinical ones to be useful. This editorial critically reviews the literature on this topic, describes its principles and techniques, and includes the author’s personal learned lessons so that trauma surgeons will be encouraged to use ultrasound to diagnose fractures in their own clinical practice.