Best POCUS Papers Made Easy? Count Me In!
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This expert panel from Canada has compiled a list of what they deem to be the most influential POCUS papers with regard to cardiac arrest as well as evaluation of shock. Whether you want to further educate yourself or guide your residents to learn more on the subject, this primer is a great place to start.
Source
POCUS literature primer: key papers on POCUS in cardiac arrest and shock. CJEM. 2023 Nov 23. doi: 10.1007/s43678-023-00611-1. Epub ahead of print.
1-Plane, 2-Plane, X-plane? Ultrasound-Guided Central Lines
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In a small, randomized trial, placing an ultrasound-guided central venous catheter (CVC) using 2 planes simultaneously was more likely to be successful on the first attempt and performed more quickly. Both groups had a 100% procedural success rate.
POCUS for the PTA
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While it doesn’t have great specificity, the sensitivity of ultrasound makes it a viable first step in making the diagnosis of peritonsillar abscess.
Source
Test characteristics of ultrasound for the diagnosis of peritonsillar abscess: A systematic review and meta-analysis. Acad Emerg Med. 2023 Aug;30(8):859-869. doi: 10.1111/acem.14660. Epub 2023 Jan 30.
LUS (Let’s Use Sonography) to Diagnose ARDS!
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The LUS-ARDS score can make a diagnosis of acute respiratory distress syndrome (ARDS) easier, particularly in patients who can’t have CT scan. The LUS-ARDS score performs similarly to the standard of care (Berlin criteria plus CXR evaluation) in diagnosis of ARDS in ventilated patients.
Traction Technique for Manual Detorsion
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Pulling traction on a testicle with torsion is proposed by these authors to help relieve pressure, identify direction of torsion, and to make manual detorsion easier to perform. See figure below for technique.
POCUS for the Physiologically Difficult Airway
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Through the use of point-of-care ultrasound (POCUS) Emergency Medicine providers can optimize and tailor pre-intubation resuscitation in critically ill patients. See algorithm below.
Does E-FAST Add Value Before CT Traumagram?
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An initial diagnostic workup that includes an E-FAST exam and targeted chest and pelvis x-rays allows clinicians an opportunity to assess and intervene appropriately on the majority of patients prior to WBCT in the setting of blunt trauma.
Source
Appropriateness of Initial Course of Action in the Management of Blunt Trauma Based on a Diagnostic Workup Including an Extended Ultrasonography Scan. JAMA Netw Open. 2022 Dec 1;5(12):e2245432. doi: 10.1001/jamanetworkopen.2022.45432.
Ultrasound First for Appendicitis in Adults?
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When performed by an experienced EM physician or radiologist, a conclusive appendix ultrasound is both sensitive and specific when evaluating for acute appendicitis and can be used in place of CT.
Don’t Miss Torsion – How to Get the Diagnosis
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Diagnostic characteristics that help differentiate testicular torsion from other causes of acute scrotal pain include vomiting, age > 13, scrotal edema, and palpation of a hard testis. Use caution with normal ultrasound results in those with high pretest probability.
Source
Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Emerg Med J. 2022 Dec 16;emermed-2021-211946. doi: 10.1136/emermed-2021-211946. Online ahead of print.
Cutting the Neck? How About POCUS-Guided Cricothyrotomy?
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Ultrasonography can assist in identification of cricothyroid membrane for scalpel cricothyroidotomy pre-planning but should not be used in completion of the procedure itself.
Source
Role of ultrasonography in an impalpable tissue larynx model during a simulated front-of-neck access scenario: a randomized simulation study. CJEM. 2022 Nov 8. doi: 10.1007/s43678-022-00399-6. Epub ahead of print.