[Recommendations for Education in Sonography in Prehospital Emergency Medicine (pPOCUS): Consensus paper of DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI and DGIIN]

Point-of-care sonography is a precondition in acute and emergency medicine for the diagnosis and initiation of therapy for critically ill and injured patients. While emergency sonography is a mandatory part of the training for clinical acute and emergency medicine, it is not everywhere required for prehospital emergency medicine. Although some medical societies in Germany have already established their own learning concepts for emergency ultrasound, a uniform national training concept for the use of emergency sonography in the out-of-hospital setting is still lacking. Experts of several professional medical societies have therefore joined forces and developed a structured training concept for emergency sonography in the prehospital setting. The consensus paper serves as quality assurance in prehospital emergency sonography.

[Recommendations for Education in Sonography in Prehospital Emergency Medicine (pPOCUS): Consensus paper of DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI and DGIIN]

Point-of-care sonography is a precondition in acute and emergency medicine for the diagnosis and initiation of therapy for critically ill and injured patients. While emergency sonography is a mandatory part of the training for clinical acute and emergency medicine, it is not everywhere required for prehospital emergency medicine. Although some medical societies in Germany have already established their own learning concepts for emergency ultrasound, a uniform national training concept for the use of emergency sonography in the out-of-hospital setting is still lacking. Experts of several professional medical societies have therefore joined forces and developed a structured training concept for emergency sonography in the prehospital setting. The consensus paper serves as quality assurance in prehospital emergency sonography.

Empfehlungen zur Sonografieausbildung in der prähospitalen Notfallmedizin (pPOCUS): Konsensuspapier von DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI und DGIIN

Die Point-of-Care-Sonografie ist in der Akut- und Notfallmedizin ein fester Bestandteil der Diagnostik und Therapieeinleitung von kritisch kranken und verletzten Patienten. Während die Notfallsonografie im Rahmen der Zusatzweiterbildung für klinische Akut- und Notfallmedizin vorausgesetzt wird, wird diese für die prähospitale Notfallmedizin lediglich im (Muster-)Kursbuch Allgemeine und spezielle Notfallbehandlung als Weiterbildungsinhalt definiert. Obwohl einige Fachgesellschaften in Deutschland bereits eigene Lernkonzepte für die Notfallsonografie etabliert haben, fehlt bis dato ein einheitliches nationales Ausbildungskonzept für den Einsatz der Notfallsonografie im prähospitalem Umfeld. Experten mehrerer Fachgesellschaften haben daher als Empfehlung für die notfallmedizinische Weiterbildung ein Kurskonzept für die spezielle Ausbildung in der prähospitalen Notfallsonografie erarbeitet, welche gleichermaßen zu deren Qualitätssicherung beitragen soll.

[Standardized contrast-enhanced ultrasound (CEUS) in clinical acute and emergency medicine and critical care (CEUS Acute) : Consensus statement of DGIIN, DIVI, DGINA, DGAI, DGK, ÖGUM, SGUM and DEGUM]

The present document describes the possible applications of contrast-enhanced ultrasound (CEUS) in emergency examinations. Guidelines on contrast medium ultrasound in acute and emergency care and intensive care medicine have not yet been published. Evidence-based CEUS guidelines were first provided by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and the World Federation for Ultrasound in Medicine and Biology (WFUMB). The presented recommendations describe the possible applications and protocols of CEUS in acute care.

[Risk stratification through implementation and evaluation of a COVID-19 score : A retrospective diagnostic study]

Hintergrund

Die COVID-19-Erkrankung (Coronavirus Disease 2019) ist in ihrer klinischen Manifestation unspezifisch und sehr variabel, wodurch die Diskriminationsfähigkeit zu anderen (Virus‑)Infekten erschwert ist. Weder Einzelbefunde noch Befundkombinationen sind spezifisch genug, um eine COVID-19-Erkrankung mit hoher Sicherheit diagnostizieren zu können. Ziel war es, in der Notaufnahme durch Anwendung eines Scores frühzeitig Patienten identifizieren zu können, die ein Risiko für eine COVID-19-Erkrankung haben und somit präemptiv isoliert werden müssen.

Methode

Entwicklung und Implementierung eines symptombasierten COVID-19-Scores anhand einer multizentrischen retrospektiven Diagnostikstudie in 3 deutschen Notaufnahmen vom 09.03. bis 30.04.2020 an Patienten mit Verdacht auf COVID-19 und anschließender SARS-CoV-2-PCR-Diagnostik.

Ergebnisse

Das Studienkollektiv umfasste 697 Patienten, bei 9,4 % dieser Patienten wurde eine COVID-19-Infektion diagnostiziert. Ein COVID-19-Score ≥5 Punkte ging mit einer deutlich erhöhten Erkrankungswahrscheinlichkeit einher. Die Sensitivität des Scores lag bei 98,4 % bei einer allerdings mäßigen Spezifität von 48,3 %.

Schlussfolgerung

Der während der Ersteinschätzung einfach zu erhebende Score unterstützt im Rahmen der Risikostratifizierung die Beurteilung der Vortestwahrscheinlichkeit für eine COVID-19-Infektion und kann frühzeitig den Behandlungspfad bezüglich präemptiver Isolation, PCR-Testung und weiterer Behandlungsoptionen beeinflussen. Aufgrund der unspezifischen Symptomatik der Erkrankung muss allerdings in Kauf genommen werden, dass für das Ziel einer hohen Sensitivität eine relativ geringe Spezifität des Scores resultiert.

[German recommendations on lung and thoracic ultrasonography in patients with COVID-19]

Lung and chest ultrasound are further examination modalities in addition to computed tomography and laboratory diagnostics in patients with COVID-19. It extends the clinical-physical examination because it can examine lung surface sensitively. Lung surface pattern changes have been found in sonograms of patients with COVID-19 pneumonia and during the course of the disease. German specialist societies of clinical acute, emergency and intensive care medicine as well as imaging, which are concerned with the care of patients with SARS-CoV‑2 infection and COVID-19, have coordinated recommendations for lung and thorax sonography. This document has been created within a transparent process, led by the German Society of Interdisciplinary Emergency and Acute Medicine e. V. (DGINA), and worked out by an expert panel and delegates from the societies. Sources of the first 200 cases were summarized. Typical thorax sonographic findings are presented. International sources or standards that were available in PubMed until May 24, 2020 were included. Using case studies and multimedia content, the document is intended to not only support users but also demonstrate quality features and the potential of chest and lung sonography. The German Society for Ultrasound in Medicine (DEGUM) is carrying out a multicenter study (study coordination at the TU Munich).

[Alveolar proteinosis--therapy concept with a modified BAL]

BACKGROUND/PATIENTS: This report is about two patients (male, 48 and 35 years old) with a primary alveolar proteinosis where the indication for therapeutic lavage was given. The standard is lavage with up to 50 litres fluid.

METHODS

We preferred a modified therapy with the so called "ambu-lavage". With this kind of Lavage, first described by Kronenberger et al., one lung is filled with one litre warm (37 degrees C) NaCl-fluid. Then this fluid is mixed up with an ambu-bellows for three minutes and then the fluid is removed of the lung. More cycles with 500 ml fluid follow until the lung is lavaged with five litres. In summary every lung was lavaged two to three times. The protein concentration was checked in every lavage portion.

RESULTS

Both patients tolerated these procedures well, in anaesthesia with a double-lumen-tube. There were no complications. The pulmonary function test and blood-gas-analysis could be improved significantly. Dyspnoea disappeared.

CONCLUSION

This case-report shows two cases of alveolar-proteinosis which were treated well with the "ambu-lavage" which takes less time than the standard-lavage.

[MR-guided biopsies of undetermined liver lesions: technique and results]

PURPOSE

To evaluate safety and precision of liver tumor biopsies performed in an open low field system using different sequence techniques.

MATERIALS AND METHODS

In 47 patients with liver tumors, MR-guided biopsies were performed in a low field system (0.2 Tesla, Magnetom Open, Siemens) using two different sequences. The procedure was monitored with T1-weighted FLASH sequences (TR/TE = 100/9; 70(3)) in all patients and with FISP-Rotated-Keyhole-sequence (TR/TE = 18/8; 90(3)) in additional 20 patients. After positioning of the needle tip in the tumors, 166 biopsy specimens were acquired with 16 G cutting needles (Somatex*). The diameter of the biopsied lesions ranged from 1 to 10 cm (mean diameter 3.2 cm). Visibility of the needles and precision of the biopsies were evaluated.

RESULTS

All interventional biopsies were performed without vascular or organ injuries. Adequate specimens for histologic interpretation were obtained in 42 cases (89.3%). The biopsy results were non-specific in 2 patients (4.2%) and the lesions missed in 3 patients (6.3%). Mean in-room time was 35 minutes and the intervention time was 8.3 minutes. T1-weighted FLASH images proved optimal for confirming needle-tip placement during the biopsies or punctures. Organs, tumors and vessels were easily identified. The FISP sequence proved to be inferior in visualizing vessels and tumors.

CONCLUSION

MR-guided liver biopsies are safely and precisely performed using T1-weighted FLASH-sequences with sufficient visualization of the lesions and might be complementary to US- or CT-guided biopsies.