Ultrasound

POCUS – We Can…But Should We?

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POCUS in the ED can lead to clinically useful information, although research has not yet demonstrated patient-centered improvements in care. While this modality shouldn’t be used for routine screening in the ED, it performs well with a focused clinical question.

Sources
PoCUS: Just because we can doesn’t mean we should. Acad Emerg Med. 2022 Apr;29(4):515-517. doi: 10.1111/acem.14474. Epub 2022 Mar 22.
Risk-Benefit Analysis of PoCUS for Suspected, Ruptured Abdominal Aortic Aneurysm. Acad Emerg Med. 2022 Apr 14. doi: 10.1111/acem.14506. Online ahead of print.

Importance of RV Assessment in Low-Risk PE

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Among patients with symptomatic PE who are low risk by sPESI, the addition of right ventricular assessment predictors (echo, CT, troponin, and BNP) significantly improved prognostication for clinical deterioration within 5 days. 

Source
Can right ventricular assessments improve triaging of low risk pulmonary embolism? Acad Emerg Med. 2022 Mar 15. doi: 10.1111/acem.14484. Online ahead of print.

Finger (or is that…probe) on the Pulse | Doppler vs Manual Palpation During Arrest

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Use of pulsed-wave Doppler ultrasound by a trained emergency medicine physician to detect any femoral pulse was more accurate than manual palpation but did not necessarily confer an adequate blood pressure (i.e. SBP ≥ 60 mmHg).  Calculation of peak systolic velocity of ≥20 cm/s had a stronger correlation with a SBP ≥ 60 mmHg.

Source
Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest. Resuscitation. 2022 Feb 4;S0300-9572(22)00032-6. doi: 10.1016/j.resuscitation.2022.01.030. Online ahead of print.

Not so FAST! POCUS vs CXR – A Rebuttal Letter

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A recent publication, cheekily titled Not so FAST-Chest ultrasound underdiagnoses traumatic pneumothorax, concluded ultrasound for traumatic pneumothorax should be considered with caution. This response letter breaks down the main reasons why this article is likely a red herring.

Source
Daniel J Kim, Nik Theyyunni, Rachel B Liu Ultrasound is superior to supine chest x-ray for the diagnosis of clinically relevant traumatic pneumothorax. J Trauma Acute Care Surg. 2022 Mar 14. doi: 10.1097/TA.0000000000003575. Online ahead of print.

Focus on the POCUS | Spoon-Feed Version

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Point-of-Care Ultrasonography (POCUS) is an emerging but practice-changing concept that is rapidly becoming a mainstay in clinical practice. Whether POCUS is used for diagnosis, monitoring, or procedural guidance, this bedside clinical adjunct can provide rapid, real-time information to improve patient care.

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