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No POCUS Hate Train

July 7, 2018

Written by Clay Smith

POCUS Hate Train?

One of our awesome POCUS experts jokingly asked, “BTW—what’s with the POCUS hate train on Journal Feed! (Actually, I love that these diagnostic test assessments are getting out there!)”  As I sifted through about 1500 abstracts this month, it just so happened that there were three that were POCUS related, important, and all were unfavorable.  No actual hate train here.  POCUS has an integral role, and these studies help us to use it shrewdly.

JF This Week

To recap, this week we discussed an article suggesting that the diagnostic accuracy of POCUS for retinal detachment was fair but not great.  If you see a big flap waving in the vitreous, it’s probably RD.  But sensitivity was suboptimal for those of us with less experience.
emDOCs has a excellent post on US for RD.

In another article, POCUS had lackluster diagnostic accuracy for kidney stone.  See this insightful comment left by Michael Macias.

“Ultrasound can be very useful for initial evaluation of suspected renal colic especially with recurrent kidney stones. Safe according to Binder study but always need to consider other diagnosis. Be careful with their conclusion ‘any hydro suggests a stone greater than 5mm.’ Probably better to think about no-mild hydro ~15% chance of stone greater than 5 mm with almost no chance of stone greater than 10mm and moderate to severe hydro ~35% chance of stone greater than 5 mm (Goertz 2010). I think saying that any hydro means they probably have a stone > 5 mm may be misleading and would not be accurate to provide this information to the patient. As with any meta analysis, especially POCUS data where studies are quite varied in terms of experience of operator, inclusion/exclusion criteria and methods, I encourage reviewing each study individually to have a better understanding about how the numbers apply to you.”

See this video on LITFL, MedMastery series on US for hydronephrosis.

SHoC-ED showed that POCUS did not change mortality in patients with SBP <100.  There are conditions which cause shock that POCUS can quickly and accurately detect but for all comers, it may not be as useful.
See this podcast on EMCrit – The RUSH Exam.

We covered predictors of outpatient antibiotic failure for cellulitis.  The risk factors were tachypnea, history of MRSA colonization, chronic ulcers, or history of cellulitis in the past year.
Do not miss this post on cellulitis mimics.  It is GOLD.  Required reading for all residents…

This study showed the enduring safety of a low risk HEART Pathway at one year.
This podcast on Skeptics Guide to EM about the HEART Pathway is groovy!

Thanks for reading JournalFeed.

Better patient care through spoon feeding

What are your thoughts?