ABSTRACT
COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.
Subject(s)
COVID-19/diagnostic imaging , Consensus , Echocardiography/standards , Expert Testimony/standards , Internationality , Point-of-Care Systems/standards , COVID-19/therapy , Echocardiography/methods , Expert Testimony/methods , Humans , Lung/diagnostic imaging , Thromboembolism/diagnostic imaging , Thromboembolism/therapy , Triage/methods , Triage/standards , Ultrasonography/standardsABSTRACT
TEXT: The teaching of emergency medicine (EM) and urgent care in Spanish universities is unregulated. This study aimed to analyze how EM is being taught in Spanish medical faculties. We visited the web pages of 46 universities that offer medical degrees. If an EM course was offered, the instructors were contacted. We noted whether the university was a public or private facility, whether a course was required or not and in what year, the duration and number of credits awarded, the distribution of instructional hours, how students were assessed, and the gender and category of the assigned instructors. EM is taught in 65% of Spanish universities. The subject is usually required (in 72.7%), lasts 4 months (87.9%), and is taught in the fifth year (57.6%). Nineteen courses cover EM exclusively, and 14 share the course syllabus with other material. The median number of credits offered is 5, and the distribution of time for theory and practice is similar across the universities. Syllabi are highly varied. Few hours of hospital training are offered, and 75% of the courses require a minimum number of hours of attendance and passing a final exam. Adjunct professors teach 62.3% of the courses, assistants teach 34.3%, and only 11 courses are taught by full professors. Women accounted for 31.9% of the instructors. That percentage decreased as professional category increased. We found that EM is taught in a majority of Spanish universities with medical schools, but not all; nor is the subject managed uniformly. Instructors are not often closely tied to the faculty, syllabi vary greatly and a low number of women teachers, suggesting considerable room for improvement in the future.
TEXTO: En España la enseñanza de la medicina de urgencias y emergencias (MUE) en las universidades no está regulada. El presente estudio analiza la situación de la enseñanza de la MUE en las facultades de medicina de España. Se accedió a la página web de las 46 universidades con facultad de medicina. En caso de existencia de asignatura se contactó con los responsables. Se valoró la titularidad de la universidad y la obligatoriedad, curso, duración, número de créditos, distribución de horas, contenido del programa y tipo de evaluación de la asignatura. Además se detalló el sexo y categoría del profesorado. La MUE está presente en el 65% de las facultades, y se identificaron 33 asignaturas. La asignatura es mayoritariamente obligatoria (72,7%), cuatrimestral (87,9%), y se imparte en quito curso (57,6%). Diecinueve asignaturas son exclusivas de urgencias y 14 comparten programa con otras asignaturas. La mediana de créditos es de 5, con una relación de horas teórico-prácticas similar. Los programas de las asignaturas son muy variados, generalmente con pocas prácticas hospitalarias, y en el 75% de los casos se requiere un mínimo de asistencia y examen para superarla. Se identificaron 385 profesores: un 62,3% de son asociados, un 34,3% colaboradores, y solo hay 11 catedráticos (3%). En cuanto al sexo, las mujeres representan un 31,9% de los docentes, con un porcentaje decreciente a medida que aumenta la categoría profesional. Se concluye que la MUE se enseña en la mayoría de las facultades, pero no es universal ni uniforme, hay poca vinculación de docentes y grandes diferencias de programa y una presencia minoritaria de mujeres docentes, lo que sugiere un gran margen de mejora en el futuro.
Subject(s)
Curriculum , Schools, Medical , Female , Hospital Departments , Humans , UniversitiesABSTRACT
OBJECTIVES: The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. METHODS: 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. RESULTS: A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. CONCLUSIONS: The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.
ABSTRACT
BACKGROUND: Lung ultrasonography has been increasingly recognized has a valuable diagnostic tool. In adult patients with asthma/chronic obstructive pulmonary disease and wheezing, LUS usually presents as an A/nude profile (normal profile, with sliding and A-lines, and without any abnormal findings) or at most reveals a decrease/absence of lung sliding. Therefore, until now simple point-of-care ultrasonography appeared to be unable to assess the severity of airflow limitation. CASE PRESENTATION: We report the case of a woman presenting to the emergency department with an asthma exacerbation. Bedside ultrasound showed the usual A/normal profile, but also an associated vertical pleural displacement, probably secondary to hyperinflation and accessory muscle recruitment. We evaluated the described movement with M-mode and established a comparison index between end-inspiration and end-expiration, using the skin as reference. This index showed improvement and complete normalization during treatment. CONCLUSIONS: Pleural vertical displacement appears to be a sonographic alteration associated to bronchospasm and accessory muscle recruitment. It is easily identifiable and measurable on LUS, thus possibly representing a new method to evaluate bronchospasm and monitoring treatment response. Further research is needed to confirm or refute this finding.
ABSTRACT
BACKGROUND: Necrotizing soft tissue infections are associated with high morbidity and mortality, even when the correct treatment is initiated. The diagnosis of these conditions is hard and the most sensitive methods are time-consuming, expensive and not readily available. Point-of-care ultrasound can complement clinical evaluation to increase the diagnostic accuracy. CASE PRESENTATION: We bring a case of a woman, without comorbidities, who presented to the emergency department with signs of soft tissue infection. Bedside ultrasound showed subcutaneous tissue thickening, with fluid accumulation, and subcutaneous gas in the affected area. Based on the clinical suspicion and the ultrasound findings, the patient underwent prompt medical treatment and surgical debridement. CONCLUSIONS: This case shows the utility of bedside ultrasound for the decision-making process in a disease where an early diagnosis is important. This information should always be used together with the clinical judgement, as it has a relative low sensitivity.
ABSTRACT
BACKGROUND: Extracorporeal shock wave lithotripsy is widely used to treat symptomatic nephrolithiasis. Complications of this procedure can occur and point-of-care ultrasound can help to diagnose and manage some of these cases. CASE PRESENTATION: A 61-year-old man was admitted to the hospital with intense right lumbar pain 24 h after being submitted to a extracorporeal shock wave lithotripsy. Bedside ultrasound showed a hyperechoic subcapsular lesion along the right kidney. This finding, along with the clinical examination, suggested the diagnosis of subcapsular renal hematoma. The patient was managed conservatively with clinical and ultrasound reassessments. CONCLUSIONS: This case shows the use of bedside ultrasound to diagnose a subcapsular renal hematoma as a complication of extracorporeal shock wave lithotripsy. However, the sensitivity is low and other image methods can be necessary to make the diagnosis.