Lung Ultrasound as a Triage Method in Primary Care for Patients with Suspected SARS-CoV-2 Pneumonia.

Background: Currently, there are few studies that have analyzed the benefits of using lung ultrasound in the field of primary care, including in homes and nursing homes, for patients with suspected COVID-19 pneumonia and subsequent follow-ups. The aim of this study was to demonstrate that lung ultrasound is a useful technique for triaging these patients. Methods: An observational and retrospective study of individuals who presented with clinical suspicion of SARS-CoV-2 pneumonia was carried out during the months of March to June 2020 in Health Center number 2 of Ciudad Real and in homes of patients and nursing homes belonging to the Health Service of Castilla-La Mancha (Spain). Results: A total of 209 patients, of whom 86 (41.1%) were male, were included in the study. The most frequent ultrasound findings were bilateral B-lines, with a right predominance, specifically in the posterobasal region. Additionally, there was a statistical significance (p < 0.05) correlation between pathological positivity on lung ultrasound and PCR and chest X-ray positivity. When calculating the sensitivity and specificity of ultrasound and X-ray, ultrasound had a sensitivity of 93%, and X-ray had a sensitivity of 75%. Conclusion: Due to its high sensitivity and negative predictive value, lung ultrasound is very useful as a triage tool for patients with suspected SARS-CoV-2 pneumonia.

Dolor en lóbulo tiroideo: tiroiditis subaguda de De Quervain / Pain in the thyroid lobule: subacute (de De Quervain's) Thyroiditis

Presentamos un caso de tiroiditis subaguda en un hombre de 51 años que comienza con sintomatología inespecífica de febrícula e intensa astenia de días de evolución. De profesión veterinario, la primera sospecha es de picadura de garrapata, y se solicita en primera instancia una analítica completa con serología y una radiografía de tórax. A los 4 días ya disponemos del resultado de las pruebas solicitadas, y llaman nuestra atención unos valores de reactantes de fase aguda elevados, así como una hormona estimulante de la tiroides (TSH) suprimida con valor de T4 libre de 2,56 ng/dl. En ese mismo momento, ante la sospecha de un cuadro de tiroiditis subaguda, realizamos una ecografía tiroidea y obtenemos imágenes compatibles con nuestra sospecha. Comenzamos tratamiento con antinflamatorios no esteroideos, continuando con corticoides y controles ecográficos periódicos en nuestra consulta, hasta resolución del cuadro clínico. La tiroiditis de De Quervain es una patología que, dada la clínica inespecífica con la que puede presentarse y su resolución espontánea, es posible que pase desapercibida en nuestras consultas de Atención Primaria.(AU)

We report a case of subacute thyroiditis in a 51-year-old man who began to present non-specific symptoms of low grade fever and intense asthenia of a few days clinical course. A vet by profession, the initial suspicion was tick bite. Full analysis with serology and chest x-ray was initially requested. After four days we received the results of the tests requested. Some high acute phase reactant values and a depressed TSH with a free T4 value of 2.56 ng/dl were notable. At this same time, given the suspicion of symptoms of subacute thyroiditis, we performed thyroid ultrasound and obtained images compatible with our suspicions. We commenced treatment with NSAIDs and continued corticosteroids and periodic ultrasound controls in our consultation, until the clinical picture resolved. De Quervain thyroiditis is a pathology which - given the non-specific clinical symptoms it can begin with and their spontaneous resolution - may go unnoticed in our primary care consultations.(AU)

Utilidad y fiabilidad de la ecografía clínica en medicina familiar: ecografía del cuello y ecografía en urgencias / Usefulness and reliability of point of care ultrasound in Family Medicine: Focused ultrasound in neck and emergency

La ecografía es una herramienta de gran valor para el diagnóstico y el manejo de una gran variedad de situaciones clínicas cotidianas. El médico de familia como especialista generalista debe ser competente para el abordaje de prácticamente cualquier problema de salud que afecte a su población, por lo que, en sus manos, esta herramienta puede proporcionar un elevado impacto sobre la calidad y la eficacia del proceso asistencial. Este es el último artículo de una serie dedicada a mostrar la aplicabilidad de la ecografía clínica en nuestras manos, en la que hemos revisado la mayoría de sus aplicaciones, como la ecografía clínica abdominal, la nefrourológica, la musculoesquelética, la cardiaca o la pulmonar. Queremos terminar con escenarios como la afección del cuello o su uso en situaciones de urgencia, en las que proporciona datos definitivos para la orientación diagnóstica, el manejo clínico e incluso la supervivencia del paciente, tales como el paciente con sospecha de trombosis venosa profunda en miembros inferiores, traumatismo toracoabdominal, compromiso hemodinámico o parada cardiaca

Ultrasound is a very useful tool for diagnosis and to handle a great sort of daily affaires. The family Doctor, as general specialist, must be competent to carry out almost all kind of wealthy situations that can potentially affect to his population. Because of that, with this tool in his hand, the Doctor can get a higher level of quality in the efficiency of the assistant procedure. This is the last paper of a serial dedicated to show the different applications of clinical ultrasound, in which most of them have been reviewed, such as abdominal, nephrourological, musculoskeletal, cardiac or pulmonary focused ultrasound. We want to finalize with scenarios like neck pathology or applications in urgencies in which we can provide the definitive data to get the right diagnosis orientation, the clinic use, or even patient live, such as the patient under deep vein thrombosis in lower members, thoracoabdominal trauma, hemodynamic compromise situation or cardiac arrest

[Usefulness and reliability of point of care ultrasound in Family Medicine: Focused ultrasound in neck and emergency]. / Utilidad y fiabilidad de la ecografía clínica en medicina familiar: ecografía del cuello y ecografía en urgencias.

Ultrasound is a very useful tool for diagnosis and to handle a great sort of daily affaires. The family Doctor, as general specialist, must be competent to carry out almost all kind of wealthy situations that can potentially affect to his population. Because of that, with this tool in his hand, the Doctor can get a higher level of quality in the efficiency of the assistant procedure. This is the last paper of a serial dedicated to show the different applications of clinical ultrasound, in which most of them have been reviewed, such as abdominal, nephrourological, musculoskeletal, cardiac or pulmonary focused ultrasound. We want to finalize with scenarios like neck pathology or applications in urgencies in which we can provide the definitive data to get the right diagnosis orientation, the clinic use, or even patient live, such as the patient under deep vein thrombosis in lower members, thoracoabdominal trauma, hemodynamic compromise situation or cardiac arrest.

Utilidad y fiabilidad de la ecografía clínica en Medicina Familiar: ecocardioscopia y ecografía pulmonar / Usefulness and reliability of point of care ultrasound in Family Medicine: Focused cardiac and lung ultrasound

El médico de familia está incorporando la ecografía clínica como técnica de exploración y diagnóstico en su actividad asistencial, del mismo modo que el resto de los especialistas. Su papel generalista lo convierte en un potencial utilizador de todas las posibles aplicaciones de esta técnica, lo cual puede causar un elevado impacto en su capacidad de manejar, enfocar y resolver un gran número de situaciones clínicas. En este artículo nos dedicamos a valorar la utilidad y la efectividad de la ecografía clínica por parte del médico de familia en sus aspectos más novedosos, como son la ecocardiografía clínica y la ecografía pulmonar

The family doctor incorporates clinical ultrasound as an exploration and diagnosis technique in his care activity, the same way as the rest of the specialists. His generalist role makes him a potential user of all possible applications of this technique, which can provide a high impact on his ability to manage, focus and solve a large number of clinical situations. In this article we focus on assessing the usefulness and reliability of clinical ultrasound performed by the family doctor in their most novel aspects such as focused cardiac ultrasound and lung ultrasound

[Usefulness and reliability of point of care ultrasound in Family Medicine: Focused cardiac and lung ultrasound]. / Utilidad y fiabilidad de la ecografía clínica en Medicina Familiar: ecocardioscopia y ecografía pulmonar.

The family doctor incorporates clinical ultrasound as an exploration and diagnosis technique in his care activity, the same way as the rest of the specialists. His generalist role makes him a potential user of all possible applications of this technique, which can provide a high impact on his ability to manage, focus and solve a large number of clinical situations. In this article we focus on assessing the usefulness and reliability of clinical ultrasound performed by the family doctor in their most novel aspects such as focused cardiac ultrasound and lung ultrasound.

Cólico Renal / Renal colic

La disponibilidad de la ecografía en el centro de salud permite un seguimiento de alta calidad enlos cólicos nefríticos no complicados. Permite documentarlos correctamente, adelantarse a lasposibles complicaciones y mejora considerablemente la confi anza de los enfermos, a la vez que la propia satisfacción profesional. Presentamos el caso de una mujer de 30 años que acudió a la consulta por dolor agudo en fosa renal derecha

The availability of ecography in health centre makes possible the high quality follow up in notcomplicate renal colic. It offers a improvement of warranty, the management of information previouslyto complication and the satisfaction of professionals. The article show the case of a 30 years old woman who consulted by acute renal pain (AU)