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.
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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.
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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.
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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.
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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.
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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.
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Using Tegaderm™ during ocular ultrasound was associated with poorer image quality and had no effect on patient comfort. If you’re using ocular ultrasound as a modality, consider if using a Tegaderm™ will get in the way of a good diagnosis.
Source
Covered or uncovered: A randomized control trial of Tegaderm versus no Tegaderm for ocular ultrasound. Am J Emerg Med. 2022 Aug 28;61:87-89. doi: 10.1016/j.ajem.2022.08.044. Online ahead of print.
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This is an EM-focused review of pericardial tamponade, including the bedside echo.
Source
Pericardial tamponade: A comprehensive emergency medicine and echocardiography review. Am J Emerg Med. 2022 Aug;58:159-174. doi: 10.1016/j.ajem.2022.05.001. Epub 2022 May 6.
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Point-of-care ultrasound carotid artery compression was quicker than manual palpation in determining return of spontaneous circulation.
Source
Point-of-care ultrasound compression of the carotid artery for pulse determination in cardiopulmonary resuscitation. Resuscitation. 2022 Jul 2;S0300-9572(22)00590-1. doi: 10.1016/j.resuscitation.2022.06.025. Online ahead of print.
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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.
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Upper airway ultrasound (UA-US) may eventually help us predict if a patient will have a difficult laryngoscopy. However, this is not ready for ED use, and more studies are needed.
Source
Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis. Anesth Analg. 2022 Apr 1;134(4):740-750. doi: 10.1213/ANE.0000000000005839.