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1.
Crit Care ; 24(1): 702, 2020 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-33357240

RESUMO

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.


Assuntos
COVID-19/diagnóstico por imagem , Consenso , Ecocardiografia/normas , Prova Pericial/normas , Internacionalidade , Sistemas Automatizados de Assistência Junto ao Leito/normas , COVID-19/terapia , Ecocardiografia/métodos , Prova Pericial/métodos , Humanos , Pulmão/diagnóstico por imagem , Tromboembolia/diagnóstico por imagem , Tromboembolia/terapia , Triagem/métodos , Triagem/normas , Ultrassonografia/normas
3.
J Am Coll Cardiol ; 76(6): 745-754, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32762909

RESUMO

Focused transthoracic echocardiography (TTE) during cardiac arrest resuscitation can enable the characterization of myocardial activity, identify potentially treatable pathologies, assist with rhythm interpretation, and provide prognostic information. However, an important limitation of TTE is the difficulty obtaining interpretable images due to external and patient-related limiting factors. Over the last decade, focused transesophageal echocardiography (TEE) has been proposed as a tool that is ideally suited to image patients in extremis-those in cardiac arrest and periarrest states. In addition to the same diagnostic and prognostic role provided by TTE images, TEE provides unique advantages including the potential to optimize the quality of chest compressions, shorten cardiopulmonary resuscitation interruptions, guide resuscitative procedures, and provides a continuous image of myocardial activity. This review discusses the rationale, supporting evidence, opportunities, and challenges, and proposes a research agenda for the use of focused TEE in cardiac arrest with the goal to improve resuscitation outcomes.


Assuntos
Reanimação Cardiopulmonar/métodos , Ecocardiografia Transesofagiana , Parada Cardíaca/diagnóstico por imagem , Parada Cardíaca/terapia , Competência Clínica , Ecocardiografia Transesofagiana/métodos , Ecocardiografia Transesofagiana/normas , Humanos , Melhoria de Qualidade
5.
Ann Glob Health ; 85(1): 135, 2019 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-31799128

RESUMO

Insonation, or the use of ultrasound, has been proposed to be included in the medical school curriculum, both for education and bedside physical examination. It is important to consider what impact insonation should have on medical student education. Increasingly students are exposed to ultrasound use on clinical rotations, but to what extent should ultrasound be an integrated part of the preclinical curriculum in the United States? Ultrasound can serve to augment an existing curriculum in anatomy, physiology, physical examination, and disease assessment and treatment. In addition, the actual performance and interpretation of the insonation component of physical examination in real time may be an emerging skill set to be expected of medical students. Here we describe the utility and challenges of incorporating an ultrasound curriculum into undergraduate medical education, including examples from institutions that have pioneered this innovative curricular change.


Assuntos
Currículo , Educação de Graduação em Medicina/métodos , Ultrassonografia , Anatomia/educação , Humanos , Exame Físico , Fisiologia/educação , Sistemas Automatizados de Assistência Junto ao Leito , Estados Unidos
6.
Pediatr Emerg Med Pract ; 16(Suppl 7): 1-50, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31339258

RESUMO

Emergency ultrasound is performed at the point of care to quickly answer focused clinical questions. Over the last 25 years, the use of this technique has expanded rapidly. The use of emergency ultrasound in the pediatric setting is increasing because it does not expose the patient to ionizing radiation, as compared to computed tomography. Utilizing diagnostic point-of-care ultrasound for pediatric trauma patients in the emergency department can facilitate diagnosis at the bedside rather than sending the patient out of the department for another study. This supplement focuses on some of the common indications for diagnostic POCUS that may be useful in the setting of trauma, as found in the pediatric literature, or extrapolated from adult literature where pediatric evidence is scarce.


Assuntos
Serviços Médicos de Emergência/métodos , Avaliação Sonográfica Focada no Trauma/métodos , Ferimentos e Lesões/diagnóstico por imagem , Criança , Avaliação Sonográfica Focada no Trauma/instrumentação , Humanos , Pediatria/métodos
7.
Ultrasound J ; 11(1): 12, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31359172

RESUMO

BACKGROUND: Stump appendicitis (SA) is a rare entity in patients with a history of appendectomy and may result in missed or delayed diagnosis. We report a case of SA diagnosed by emergency department (ED) point-of-care ultrasound (PoCUS) in an elderly woman, thus expediting her care. CASE PRESENTATION: An elderly female patient with a history of appendectomy 27 years ago was referred by her physician to the ED with right lower quadrant pain for 2 days. Using PoCUS the emergency physician identified SA. This was confirmed by computed tomography (CT) scan. The patient was then successfully managed non-operatively using antibiotics. CONCLUSIONS: Despite its rarity, it is feasible to diagnose SA using PoCUS, as patients presenting with right lower quadrant pain and history of appendectomy are at risk for delayed diagnosis, perforation, and poor outcome. PoCUS may reduce time to diagnosis, time to definitive operative or non-operative management, and minimize morbidity.

8.
J Ultrasound Med ; 38(3): 767-773, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30121948

RESUMO

Protocols for the sanitation and maintenance of point-of-care ultrasound (US) equipment are lacking. This study introduces the CLEAR protocol (clean, locate, energize, augment supplies, and remove patient identifiers) as a tool to improve the readiness of US equipment, termed US equipment homeostasis. The state of US equipment homeostasis in the emergency department of a single academic center was investigated before and after implementing this protocol, with an improvement in outcomes. These findings demonstrate that the CLEAR protocol can improve US homeostasis. CLEAR can function as a teaching tool to promote homeostasis as well as a checklist to assess compliance.


Assuntos
Lista de Checagem/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Saneamento/métodos , Ultrassonografia/instrumentação , Serviço Hospitalar de Emergência , Humanos , Manutenção/métodos
10.
Ann Emerg Med ; 71(4): 543-544, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29566899
11.
Ann Emerg Med ; 71(2): 193-198, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28870394

RESUMO

STUDY OBJECTIVE: Cardiac standstill on point-of-care ultrasonography has been widely studied as a marker of prognosis in cardiac arrest. Return of spontaneous circulation has been reported in as few as 0% and as many as 45% of patients with cardiac standstill. When explicitly documented, the definition of cardiac activity in these studies varied from any slight change in echogenicity of the myocardium to any kinetic cardiac activity. We hypothesize that the variability in research definitions of cardiac activity may affect interpretation of video clips of patients in cardiac arrest. The goal of this study is to assess the variability in interpretation of standstill among physician sonographers. METHODS: We surveyed physician sonographers at 6 conferences held at 3 academic medical centers in the Greater New York area. Survey respondents were allotted 20 seconds per slide to determine whether each of 15 video clips of patients in cardiac arrest were standstill or not. Data were collected anonymously with radio frequency remotes. RESULTS: There were 127 total participants, including faculty, fellows, and resident physicians specializing in emergency medicine, critical care, and cardiology. There was only moderate interrater agreement among all participants (α=0.47). This lack of agreement persisted across specialties, self-reported training levels, and self-reported ultrasonographic expertise. CONCLUSION: According to the results of our study, there appears to be considerable variability in interpretation of cardiac standstill among physician sonographers. Consensus definitions of cardiac activity and standstill would improve the quality of cardiac arrest ultrasonographic research and standardize the use of this technology at the bedside.


Assuntos
Ecocardiografia , Parada Cardíaca/diagnóstico por imagem , Variações Dependentes do Observador , Testes Imediatos/normas , Reanimação Cardiopulmonar/métodos , Tomada de Decisão Clínica , Estudos Transversais , Humanos , Inquéritos e Questionários , Ultrassonografia
13.
Teach Learn Med ; 29(1): 85-92, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27191830

RESUMO

PROBLEM: Point-of-care ultrasound has been a novel addition to undergraduate medical education at a few medical schools. The impact is not fully understood, and few rigorous assessments of educational outcomes exist. This study assessed the impact of a point-of-care ultrasound curriculum on image acquisition, interpretation, and student and faculty perceptions of the course. INTERVENTION: All 142 first-year medical students completed a curriculum on ultrasound physics and instrumentation, cardiac, thoracic, and abdominal imaging. A flipped classroom model of preclass tutorials and tests augmenting live, hands-on scanning sessions was incorporated into the physical examination course. Students and faculty completed surveys on impressions of the curriculum, and all students under-went competency assessments with standardized patients. CONTEXT: The curriculum was a mandatory part of the physical examination course and was taught by experienced clinician-sonographers as well as faculty who do not routinely perform sonography in their clinical practice. OUTCOME: Students and faculty agreed that the physical examination course was the right time to introduce ultrasound (87% and 80%). Students demonstrated proper use of the ultrasound machine functions (M score = 91.55), and cardiac, thoracic, and abdominal system assessments (M score = 80.35, 79.58, and 71.57, respectively). Students and faculty valued the curriculum, and students demonstrated basic competency in performance and interpretation of ultrasound. Further study is needed to determine how to best incorporate this emerging technology into a robust learning experience for medical students.


Assuntos
Educação Médica , Sistemas Automatizados de Assistência Junto ao Leito , Estudantes de Medicina , Ultrassonografia , Educação de Graduação em Medicina , Avaliação Educacional , Docentes de Medicina/psicologia , Humanos , Inquéritos e Questionários
14.
J Am Geriatr Soc ; 64(12): 2433-2439, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27787895

RESUMO

OBJECTIVES: To compared outcomes of regional nerve blocks with those of standard analgesics after hip fracture. DESIGN: Multisite randomized controlled trial from April 2009 to March 2013. SETTING: Three New York hospitals. PARTICIPANTS: Individuals with hip fracture (N = 161). INTERVENTION: Participants were randomized to receive an ultrasound-guided, single-injection, femoral nerve block administered by emergency physicians at emergency department (ED) admission followed by placement of a continuous fascia iliaca block by anesthesiologists within 24 hours (n = 79) or conventional analgesics (n = 82). MEASUREMENTS: Pain (0-10 scale), distance walked on Postoperative Day (POD) 3, walking ability 6 weeks after discharge, opioid side effects. RESULTS: Pain scores 2 hours after ED presentation favored the intervention group over controls (3.5 vs 5.3, P = .002). Pain scores on POD 3 were significantly better for the intervention than the control group for pain at rest (2.9 vs 3.8, P = .005), with transfers out of bed (4.7 vs 5.9, P = .005), and with walking (4.1 vs 4.8, P = .002). Intervention participants walked significantly further than controls in 2 minutes on POD 3 (170.6 feet, 95% confidence interval (CI) = 109.3-232 vs 100.0 feet, 95% CI = 65.1-134.9; P = .04). At 6 weeks, intervention participants reported better walking and stair climbing ability (mean Functional Independence Measure locomotion score of 10.3 (95% CI = 9.6-11.0) vs 9.1 (95% CI = 8.2-10.0), P = .04). Intervention participants were significantly less likely to report opioid side effects (3% vs 12.4%, P = .03) and required 33% to 40% fewer parenteral morphine sulfate equivalents. CONCLUSION: Femoral nerve blocks performed by emergency physicians followed by continuous fascia iliaca blocks placed by anesthesiologists are feasible and result in superior outcomes.


Assuntos
Fraturas do Quadril/cirurgia , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Nervo Femoral , Humanos , Masculino , Pessoa de Meia-Idade , New York , Medição da Dor , Recuperação de Função Fisiológica , Resultado do Tratamento , Ultrassonografia de Intervenção
15.
J Emerg Med ; 51(6): 680-683, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27623218

RESUMO

BACKGROUND: Vascular air embolism is a rare but potentially deadly phenomenon. Early diagnosis allows providers to initiate measures aimed at preventing further air entry, preventing the migration of air to the lungs, and mitigating the hemodynamic effects of pulmonary air embolism. CASE REPORT: An emergency physician used point-of-care ultrasound to identify intravascular air before embolization to the pulmonary vasculature. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Bedside ultrasound can be used as a tool for early diagnosis of intravascular air. Emergency physicians should be aware of the typical sonographic manifestations of intravascular air and the initial steps in treating vascular air embolism.


Assuntos
Embolia Aérea/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Embolia Aérea/complicações , Evolução Fatal , Feminino , Infecções por HIV/complicações , Hepatite C/complicações , Humanos , Infusões Intraósseas/efeitos adversos , Pessoa de Meia-Idade , Sepse/complicações , Transtornos Relacionados ao Uso de Substâncias/complicações , Ultrassonografia/instrumentação
16.
Pediatr Emerg Med Pract ; 13(1): 1-27; quiz 27-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27125015

RESUMO

Emergency ultrasound is performed at the point of care to answer focused clinical questions in a rapid manner. Over the last 20 years, the use of this technique has grown rapidly, and it has become a core requirement in many emergency medicine residencies and in some pediatric emergency medicine fellowships. The use of emergency ultrasound in the pediatric setting is increasing due to the lack of ionizing radiation with these studies, as compared to computed tomography. Utilizing diagnostic ultrasound in the emergency department can allow clinicians to arrive at a diagnosis at the bedside rather than sending the patient out of the department for another study. This issue focuses on common indications for diagnostic ultrasound, as found in the pediatric literature or extrapolated from adult literature where pediatric evidence is scarce. Limitations, current trends, controversies, and future directions of diagnostic ultrasound in the emergency department are also discussed.


Assuntos
Apendicite/diagnóstico por imagem , Tamponamento Cardíaco/diagnóstico por imagem , Emergências , Serviço Hospitalar de Emergência , Pediatria , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Tamponamento Cardíaco/cirurgia , Criança , Pré-Escolar , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos , Masculino , Sistemas Automatizados de Assistência Junto ao Leito
17.
Chest ; 150(1): 131-8, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26923626

RESUMO

BACKGROUND: Chest radiography (CXR) is the test of choice for diagnosing pneumonia. Lung ultrasonography (LUS) has been shown to be accurate for diagnosing pneumonia in children and may be an alternative to CXR. Our objective was to determine the feasibility and safety of substituting LUS for CXR when evaluating children suspected of having pneumonia. METHODS: We conducted a randomized control trial comparing LUS with CXR in 191 children from birth to 21 years of age suspected of having pneumonia in an ED. Patients in the investigational arm underwent LUS. If there was clinical uncertainty after ultrasonography, physicians had the option to perform CXR. Patients in the control arm underwent sequential imaging with CXR followed by LUS. The primary outcome was the rate of CXR reduction; secondary outcomes were missed pneumonia, subsequent unscheduled health-care visits, and adverse events between the investigational and control arms. RESULTS: There was a 38.8% reduction (95% CI, 30.0%-48.9%) in CXR among investigational subjects compared with no reduction (95% CI, 0.0%-3.6%) in the control group. Novice and experienced physician-sonologists achieved 30.0% and 60.6% reduction in CXR use, respectively. There were no cases of missed pneumonia among all study participants (investigational arm, 0.0%: 95% CI, 0.0%-2.9%; control arm, 0.0%: 95% CI, 0.0%-3.0%), or differences in adverse events, or subsequent unscheduled health-care visits between arms. CONCLUSIONS: It may be feasible and safe to substitute LUS for CXR when evaluating children suspected of having pneumonia with no missed cases of pneumonia or increase in rates of adverse events. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01654887; URL: www.clinicaltrials.gov.


Assuntos
Pulmão/diagnóstico por imagem , Pneumonia/diagnóstico , Radiografia Torácica/métodos , Ultrassonografia/métodos , Adolescente , Pré-Escolar , Estudos de Viabilidade , Humanos , Recém-Nascido , Segurança do Paciente , Reprodutibilidade dos Testes , Adulto Jovem
18.
Pediatr Emerg Med Pract ; 12(12): 1-28, 2016 01.
Artigo em Inglês | MEDLINE | ID: mdl-26682501

RESUMO

Emergency ultrasound is performed at the point of care to answer focused clinical questions in a rapid manner. Over the last 20 years, the use of this technique has grown rapidly, and it has become a core requirement in many emergency medicine residencies and in some pediatric emergency medicine fellowships. The use of emergency ultrasound in the pediatric setting is increasing due to the lack of ionizing radiation with these studies, as compared to computed tomography. Utilizing diagnostic ultrasound in the emergency department can allow clinicians to arrive at a diagnosis at the bedside rather than sending the patient out of the department for another study. This issue focuses on common indications for diagnostic ultrasound, as found in the pediatric literature or extrapolated from adult literature where pediatric evidence is scarce. Limitations, current trends, controversies, and future directions of diagnostic ultrasound in the emergency department are also discussed.


Assuntos
Medicina de Emergência , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Criança , Emergências , Serviço Hospitalar de Emergência , Humanos
19.
J Ultrasound Med ; 34(9): 1563-8, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26254155

RESUMO

OBJECTIVES: Point-of-care ultrasound is an effective tool for clinical decision making in low- and middle-income countries, but lack of trained providers is a barrier to its utility in these settings. In Liberia, given that midwives provide most prenatal care, it is hypothesized that training them in prenatal ultrasound through an intensive condensed training course is both feasible and practical. METHODS: This quantitative prospective study of preobservational and postobservational assessment evaluated a 1-week ultrasound curriculum consisting of 4 modules, each comprising a didactic component, a practical session, and supervised patient encounters. A knowledge-based pretest and presurvey addressing prior use and comfort were administered. At the intervention conclusion, identical posttests and postsurveys were administered with an objective structured clinical examination (OSCE). The test, survey, and OSCE were repeated after 1 year. All scores and responses were tabulated, and qualitative analysis with paired t tests was performed. RESULTS: Thirty-one midwives underwent intervention and written evaluation, with 14 followed up at 1 year. Seventeen underwent the OSCE, with 8 retained at 1 year. There was a significant increase between pretest and immediate and 1-year posttest scores (36.6% versus 90% and 66%; P < .001) but no difference between immediate and 1-year posttest scores (90% versus 66%; P > .05). Average overall comfort using ultrasound increased from presurvey to immediate postsurvey scores (from 1.8 to 3.8; P< .001) and remained higher at the 1-year postsurvey (1.8 to 3.4; P< .05). Overall OSCE scores remained high from immediately after the OSCE to 1 year after the OSCE (78% to 55%; P > .05). CONCLUSIONS: Midwives in Liberia had very low baseline knowledge and comfort using ultrasound. A 1-week curriculum increased both short- and long-term knowledge and comfort and led to adequate overall OSCE scores that were retained at 1 year.


Assuntos
Currículo , Técnicas de Diagnóstico Obstétrico e Ginecológico , Avaliação Educacional , Tocologia/educação , Obstetrícia/educação , Ultrassonografia Pré-Natal , Libéria
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