Ultrasound Gel

Suspected acute heart failure is a great reason to use point-of-care ultrasound. It can tell you in seconds if this patient is up to their neck in pulmonary edema. Knowing that interstitial edema is more common in dependent areas of the lung, one would think that the lateral areas of the lung fields would be most sensitive for the diagnosis. Likewise, if there is enough pulmonary edema to fill up the anterior lung fields, this theoretically should be pretty specific. But is this actually true?! These authors investigate the issue. https://www.ncbi.nlm.nih.gov/pubmed/30665807

POCUS can be used to visualize small bowel obstruction (SBO) fairly easily. It has proven itself superior to xrays and has some advantages over CT, which for most people is the standard for diagnosis. Although initial work was quite promising, there were no large studies done confirming the accuracy of ultrasound for this purpose. In this podcast we examine the latest study (plus discuss a bonus similar one) that reveals maybe this is not as good as we thought! https://www.ncbi.nlm.nih.gov/pubmed/30762916

There are many ways that TEE can help you in cardiac arrest. One of these is to monitor your chest compressions to make sure they are actually doing what you want. Although this makes sense intuitively and is supported by animal models, there has not been a lot of evidence to date. This article takes a step in that direction by showing some data on outcomes in humans. https://www.ncbi.nlm.nih.gov/pubmed/30825552

We know that the carotid arteries are easily seen on ultrasound, but usually we think of this scan in the context of comprehensive sonography. Certainly, it is not hard to believe that having increased atherosclerotic build up would put someone at increased risk for coronary artery disease, but what can we do with that in the acute setting? These authors had an idea - maybe measuring the Carotid Intima-Media Thickness (CIMT), could be a predictor of the outcomes of a cardiac stress test. Is this brilliance or craziness? Decide for yourself! https://www.ncbi.nlm.nih.gov/pubmed/30612781/

Necrotizing fasciitis (NF) is a real bad deal. We usually rely on clinical exam (which can be misleading) or other imaging studies (which can take forever) to make the diagnosis. POCUS would be an awesome solution in helping to make this time-sensitive determination. We know it can pick up fascial fluid, air, subcutaneous changes...but really how good is it when it comes down to diagnosing this deadly disease? https://www.ncbi.nlm.nih.gov/pubmed/31031033

Theoretically, regional wall motion abnormalities (RWMA) would be really useful in the acute care setting. In the patient with concern for cardiac ischemia, this finding might help push to definitive management. The problem is that this is a nuanced exam - it takes some experience and practice. It hasn't been studied much in the point-of-care world. So can emergency physicians with relatively little training do this accurately? Find out in this next adventure into the world of point-of-care echocardiography! https://www.ncbi.nlm.nih.gov/pubmed/30987914

In part 2 (and the finale) of the series from the IAEM conference, the discussion heats up even more! The same star-studded international band of wisdom and wizardry tackles POCUS in cardiac arrest. They discuss the CASA exam and other pointers for using POCUS in the pulseless patient. A must listen!

In October 2018, an all-star group met during the Irish Association for Emergency Medicine annual conference to talk about point-of-care ultrasound. The result was a convivial discussion of a few key papers and topics, packed with pearls and perspectives. In part 1 of 2, the group talks about the landmark original SHoC-ED trial and performing the erector spinae plane block for rib fractures.

It is great to see more and more research on ultrasound in cardiac arrest. Although many people are already using this, there is still much work to be done to tease out the details of how exactly POCUS should affect our decision making. Here is a nice study that looks to see if ultrasound is associated with increased resuscitation efforts or better survival outcomes. https://www.ncbi.nlm.nih.gov/pubmed/31205842

They say seeing is believing...what about seeing a study about a machine that listens in order to see an organ that itself is used to see? Most scholars agree this too is believing. Of course, we are (in a convoluted way) referring to ocular ultrasound. Historically a great party trick, can this modality accurately diagnose visual problems in the emergency department? It's been done before, but it hasn't been done to this degree. Sit back, relax, and visualize the latest in ocular POCUS research. https://www.ncbi.nlm.nih.gov/pubmed/30977855

The annual conference of the Society of Clinical Ultrasound Fellowships (SCUF) is an incredible opportunity to converse and interact with many leaders in point-of-care ultrasound education and research. We took advantage of having so many brilliant people in one place to ask them all a few question about what they think are the next steps in POCUS research.

Resa and Mike team up to discuss important happening at SCUF 2019 Annual conference. Guest stars Nova Panebianco and Sara Damewood!

We use ultrasound a lot. Sometimes we find things that are not clearly related to the reason the patient came in. The prevalence of these incidental findings relates to the usefulness of the diagnostic test. These authors take the bull by the horns, randomly whole-body-POCUS scanning emergency department patients to see what sort of findings might pop up. But should disease prevalence change our use of the tool? https://www.ncbi.nlm.nih.gov/pubmed/30587153

Fractures of the distal radius are pretty common among people who choose not to break their fall with their face. Sure - it's not hard to see these on xray, but is there a better way? Ultrasound is great for finding fractures, but what about being able to guide the reduction? This has been shown to be useful in a pediatric population, but this study looks at a population of adult patients in the emergency department to see just how accurate ultrasound is for determining if the pieces have been put back together. https://www.ncbi.nlm.nih.gov/pubmed/30191190

TEE has been heralded as the latest and greatest way to monitor a cardiac arrest resuscitation. The advantages include continuous monitoring of cardiac activity, ability to evaluate efficacy of chest compressions, and better evaluation of etiologies of the arrest. Although many places are using it currently, there is not much evidence to support these theoretical benefits. What we do know is that a few studies have shown that transthoracic ultrasound leads to prolonged pauses in cardiac arrest. This study aims to see if TEE is the solution. https://www.ncbi.nlm.nih.gov/pubmed/30773413

Many ultrasound enthusiasts have been using point of care ultrasound to assist in the diagnosis of acute decompensated heart failure, but it has not been widely adopted. It has been shown by many studies that ultrasound can visualize pulmonary edema easily so that treatment can be started quickly. However, some still cling to their chest xrays and their natriuretic peptides, just hoping it won't lead them astray. Well this trial aims to prove the superior accuracy of lung ultrasound combined with clinical assessment over chest xray and pro-BNP (also combined with clinical assessment). Hold onto your hats, because there is a lot we can learn from this well done randomized controlled trial of over 500 patients! https://www.ncbi.nlm.nih.gov/pubmed/30690825

Point of care ultrasound can be used for a great many things, but I don't think many people grab for the probe when a patient comes in with suspected pre-eclampsia. However, we know that pre-eclampsia can lead to pathophysiology that is readily identified on ultrasound - things like interstitial edema, cardiac dysfunction, and increased intracranial pressure. This study takes the first step by examining patients in pre-eclampsia and determining how often you might find something if you go a lookin. https://www.ncbi.nlm.nih.gov/pubmed/30211771

The gallbladder loves to be scanned - a fluid filled sac nestled against a wonderful acoustic window? Are you kidding me? In any case, here is what we know: ultrasound is good for diagnosing cholecystitis, point of care ultrasound in the emergency department is good for diagnosing cholecystitis, BUT many surgeons still prefer a comprehensive RUQ ultrasound prior to cuttin' anyone. This article takes a look to see if these positive findings in the ED lead to people requiring cholecystectomy. Also - does it actually save time? https://www.ncbi.nlm.nih.gov/pubmed/30109274

Chest pain is fun, right? Maybe add in some shortness of breath? It can be hard to sort through the potentially sick from the okay to go home. We know that point of care ultrasound (POCUS) can be helpful in making or excluding many cardiothoracic pathologies, but we don't even know if it really makes a difference! This article takes the first step by asking, "when you use POCUS, does it help lower the diagnostic uncertainty about that patient?" Secondly, it takes on an old rivalry by comparing POCUS to chest xray in these patients. https://www.ncbi.nlm.nih.gov/pubmed/30413369

Fluid responsiveness has been all the rage in emergency and critical care medicine. Trying to determine which patients will benefit from fluids or how much fluids is a daily struggle for providers. However, every new measurement or technique to quantify a patients possible responsiveness to fluids has been riddled with problems. Is carotid flow time, the holy grail that we have been waiting for? This study dives into the use of carotid flow time in an ICU patient population and attempts to answer if flow time can predict fluid responsiveness.