Critical Ultrasound Journal

In children, non-fractured wrists generally need no treatment and those that are fractured may only require a 3-week cast without any clinical follow-up. The ability to perform a point-of-care triage decision if radiographs are needed could improve patient flow and decrease unnecessary radiographs. The aim of this study was to evaluate the role of ultrasound (US) as a point-of-care triage tool for pediatric wrist injuries with limited training.Physicians with no previous US experience attended a 1.5 h course in the use of US to diagnose distal radius fractures at the Emergency Department (ED). The physicians firstly used US to diagnose a potential fracture and, if the patient had a fracture, grouped the patient according to how they wanted him/her to be treated based on US. The physician then interpreted the subsequent radiographs and decided on a treatment based on this information. Consultant traumatologists and a senior radiologist established a gold standard for correct treatment and radiological diagnosis, respectively.One hundred and sixteen injuries in 115 patients were included. The ED physician identified 75 fractures on radiographs. With the exception of a minimal buckle fracture, all were identified on US. US had a tendency to interpret complete fractures on radiographs as incomplete (n = 7) leading to incorrect treatment decisions.In the hands of an US novice, US examination is comparable with radiographs as a point-of-care tool to distinguish a fractured wrist from a non-fractured one. US is not, however, as good as radiographs for placing fractured wrists into the correct treatment group.Level III. Diagnostic study of non-consecutive patients.

Henrik Hedelin

Christian Tingström

Hanna Hebelka

Jon Karlsson

Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound

超声诊断儿童腕部骨折所需的最少培训

Percutaneous cardiac intervention is an invasive diagnostic and therapeutic technique which carries a significant complication rate. Although the usefulness of EFAST protocol is widely recognised, this paper will attempt to explore a modified approach involving a focused examination on the retroperitoneal (r-EFAST). We have provided examples of 3 cases where r-EFAST was used to detect retroperitoneal bleeding in critical situations.

José Luis Vázquez Martínez

Kary Leonisa Quiñones Coneo

Tomas Villen Villegas

María Sánchez Porras

Cesar Pérez-Caballero Macarrón

Ana Coca Pérez

Luis Fernandez Pineda

Applicability of a modified EFAST protocol (r-EFAST) to evaluate hemodynamically unstable patients after percutaneous cardiac intervention

改良EFAST协议（r-EFAST）在评估经皮心脏介入术后血流动力学不稳定患者中的适用性

The quantification of B-lines at lung ultrasonography is a valid tool to estimate the extravascular lung water (EVLW) in patients after major cardiac surgery. However, there is still uncertainty about the correlation between B-lines and EVLW in a general population of critically ill.To evaluate a simplified lung ultrasonographic assessment as a tool to estimate the EVLW in critically ill patients admitted to a polyvalent intensive care unit (ICU).Nineteen consecutive critically ill patients requiring mechanical ventilation and hemodynamic monitoring were enrolled. Lung ultrasonography and the thermodilution methodology (PiCCO system) were performed by two independent operators. The positive scan at lung ultrasound was defined by visualization of at least 3 B-lines. We then compared the number of chest areas positive for B-lines with the EVLW index obtained by the invasive procedure.A significant correlation was found between the number of lung quadrants positive for B-lines and EVLW indexed using both actual body weight (rho = 0.612 p = 0.0053) and predicted body weight (rho = 0.493 p = 0.032). Presence of more than 3 positive lung quadrants showed a good performance in identifying an EVLW index value >10 ml/kg of actual body weight(area under the ROC 0.894; 95% CI 0.668-0.987 p < 0.0001). Presence of of more than 4 positive lung quadrants indentified an EVLW index value >10 ml/kg of predicted body weight (area under the ROC 0.8; 95% CI 0.556-0.945 p = 0.0048).A simplified lung ultrasound approach can by used as a reliable noninvasive bedside tool to predict EVLW in emergency and critically ill patients.

Antonio Anile

Jole Russo

Giacomo Castiglione

Giovanni Volpicelli

A simplified lung ultrasound approach to detect increased extravascular lung water in critically ill patients

一种简化的肺部超声方法用于检测危重患者肺外水分增加

Right heart thrombus in transit is an increasingly recognized medical emergency with very high mortality rate. Echocardiography helps to establish the diagnosis and can differentiate between right heart thrombi that result from atrial fibrillation and those originating from deep venous thrombosis. We present two cases of right heart thrombus in transit diagnosed with echocardiography that were managed with different approaches.

Eva Otoupalova

Bhavinkumar Dalal

Brian Renard

Right heart thrombus in transit: a series of two cases

右心血栓转运：两例系列报告

Intraoperative transesophageal echocardiography is a minimally invasive monitoring tool that can provide real-time visual information on ventricular function and hemodynamic volume status in patients undergoing liver transplantation. The American Association for the Study of Liver Diseases states that transesophageal echocardiography should be used in all liver transplant candidates in order to assess chamber sizes, hypertrophy, systolic and diastolic function, valvular function, and left ventricle outflow tract obstruction. However, intraoperative transesophageal echocardiography can be used to "visualize" other organs too; thanks to its proximity and access to multiple acoustic windows: liver, lung, spleen, and kidney. Although only limited scientific evidence exists promoting this comprehensive use, we describe the feasibility of TEE in the setting of liver transplantation: it is a highly valuable tool, not only as a cardiovascular monitoring, but also as a tool to evaluate lungs and pleural spaces, to assess hepatic vein blood flow and inferior vena cava anastomosis and patency, i.e., in cases of modified surgical techniques. The aim of this case series is to add our own experience of TEE as a comprehensive intraoperative monitoring tool in the field of orthotopic liver transplantation (and major liver resection) to the literature.

Luigi Vetrugno

Federico Barbariol

Umberto Baccarani

Francesco Forfori

Giorgio Della Rocca

Transesophageal echocardiography in orthotopic liver transplantation: a comprehensive intraoperative monitoring tool

经食管超声心动图在原位肝移植中的应用：一种全面的术中监测工具

To show that medical students can evaluate the internal jugular vein (IJV) and its anatomical variations after rapid and focused training. We also aimed to evaluate the success rate of IJV puncture in simulation following traditional techniques (TTs) and monitored via ultrasound (US).Six medical students without experience with US were given 4 h of theoretical-practical training in US, and then evaluated the IJV and common carotid artery (CCA) of 105 patients. They also simulated a puncture of the IJV at a demarcated point, where a TT was theoretically performed.Adequate images were obtained from 95% of the patients; the IJV, on the right side, was more commonly found in the anterolateral position in relation to the CCA (38%). On the left side, the most commonly position observed was the anterior (36%). The caliber of the IJV relative to the CCA greatly varied. The success rate in the IJV puncture simulation, observed with US, by the TTs was 55%.The training of medical students to recognize large neck vessels is a simple, quick, and feasible task and that can be integrated into the undergraduate medical curriculum.

José Muniz Pazeli

Ana Luisa Silveira Vieira

Rosimary Souza Vicentino

Luisa Jabour Pazeli

Bernardo Costa Lemos

Marinna Marques Rodrigues Saliba

Pedro Andrade Mello

Maurício Dutra Costa

Point-of-care ultrasound evaluation and puncture simulation of the internal jugular vein by medical students

医学生对颈内静脉的即时超声评估及穿刺模拟

Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition.PEM fellows performed and interpreted FOCUS on patients who also received cardiology service echocardiograms, the reference standard. Subsequently, eight different PEM fellows remotely interpreted a subset of the PEM-acquired and cardiology-acquired echocardiograms.Eight PEM fellows performed 54 FOCUS exams, of which two had pericardial effusion and four had diminished function. PEM fellow FOCUS had a sensitivity of 50.0% (95% CI 9.19-90.8) and specificity of 100.0% (95% CI 91.1-100.0) for detecting diminished function, and sensitivity of 50.0% (95% CI 2.67-97.33) and specificity of 98.1% (95% CI 88.42-99.9) for detecting pericardial effusions. When PEM fellows remotely interpreted 15 echocardiograms, the sensitivity was 81.3% (95% CI 70.7-88.8) and specificity 75% (95% CI 67.0-81.0) for detecting diminished function, and sensitivity of 76.3% (95% CI 65.0-85.0) and specificity 94.4% (95% CI 89.0-97.0) for detecting pericardial effusion. There were no differences in sensitivity and specificity of PEM fellows' interpretation of FOCUS studies compared to their interpretation of cardiology echocardiograms. Interrater reliability for interpretation of remote images (kappa) was 0.66 (95% CI 0.59-0.73) for effusion and 0.31 (95% CI 0.24-0.38) for function among the fellows.Novice PEM fellow sonologists (a physician who performs and interprets ultrasound) in the majority of instances were able to acquire and remotely interpret FOCUS images with limited training. However, they made real-time interpretation errors and likely need further training to incorporate real-time image acquisition and interpretation into their practice.

Rosemary Thomas-Mohtat

Craig Sable

Kristen Breslin

Jacqueline G. Weinberg

Aparna Prasad

Lauren Zinns

Joanna S. Cohen

Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists

儿科急诊医学新手超声医师在心脏超声检查中的解读错误

Fluid responsiveness is an important topic for clinicians. Aggressive hydration has been shown to lead to worse outcomes. The aim of this study was to investigate the sensitivity and specificity of mitral valve (MV) velocity time integral (VTI) as a non-invasive marker of volume responsiveness.This was a prospective observational study conducted in a tertiary emergency department. End-stage renal disease patients presenting to the emergency department requiring emergent hemodialysis were enrolled. A focused echocardiogram was done on enrolled patients. Two sets of measurements were obtained before and after hemodialysis. During each scanning session, the left ventricular outflow tract and the mitral valve VTI were obtained before and after a passive leg raise maneuver.54 patients were enrolled, of which, 30 (55%) were male. The mean age was 47.4 years. The mean volume of fluid removed was 3.89 ± 0.91 L. All patients had a diagnosis of hypertension, 22 (41%) patients were diabetic, 14 (26%) patients had coronary artery disease, and 19 (35%) patients had congestive heart failure. The mean change in LVOT VTI was 1.83% (95% CI 0.12-3.55) in the pre-dialysis group and 15.05% (95% CI 12.76-17.34) in the post-hemodialysis cohort. The mean change in MV VTI was 3.74% (95% CI 2.84-4.65) in the pre-dialysis cohort and 12.95% (95% CI 11.50-14.39) in the post-dialysis cohort. For patients who had < 4 L removed, the mean delta LVOT VTI post-hemodialysis was 12.64% (95% CI 9.79-15.49) and the mean delta MV VTI was 10.48% (95% CI 8.28-12.69). For patients who had > 4 L removed, the mean delta LVOT VTI was 16.84% (95% CI 13.47-20.22) and the mean MV VTI was 14.77% (95% CI 13.03-16.51). Mitral valve VTI with PLR was found to have a sensitivity of 89.18% and a specificity of 94.11% in detecting volume responsiveness.Mitral valve velocity time integral in conjunction with passive leg raise seem to correlate with volume responsiveness in hemodialysis patients.

Ralphe Bou Chebl

Gilbert Abou Dagher

Jeffrey Wuhantu

Rana Bachir

Jennifer Carnell

Mitral valve velocity time integral and passive leg raise as a measure of volume responsiveness

二尖瓣速度时间积分与被动抬腿作为容量反应性的测量指标

Systolic anterior motion (SAM) after mitral valve repair (MVR) can adversely affect hemodynamics due to exacerbation of left ventricular outflow tract obstruction and mitral regurgitation. Intraoperative transient SAM after MVR can usually be managed with hemodynamic maneuvers under continuous monitoring by transesophageal echocardiography (TEE). However, during postoperative intensive care management, transient SAM is seldom diagnosed and the start of treatment may be delayed. We present a case of transient SAM after MVR with abrupt deterioration due to junctional rhythm in the intensive care unit (ICU). TEE revealed that conversion from normal sinus rhythm into junctional rhythm induced the exacerbation of SAM. TEE was useful for identifying the etiology of unstable hemodynamics after cardiac surgery in the ICU, similar to its use in the operating room.

Yusuke Seino

Nobuo Sato

Kimiya Fukui

Junya Ishikawa

Masahi Nakagawa

Takeshi Nomura

Transient systolic anterior motion with junctional rhythm after mitral valve repair in the intensive care unit

二尖瓣修复术后重症监护病房中出现交接区心律的短暂性室间隔前向运动

Right iliac fossa abdominal pain is a common reason for emergency ward admissions, its etiology is difficult to diagnose. It can be facilitated by an imaging examination, such as a Computerized Tomography scan which exposes the patient to ionizing radiation and implies delays. A bedside ultrasound performed by emergency physicians could avoid these issues. The aim of our study was to assess the performance of ultrasound carried out at the patient's bedside by an emergency physician compared with a clinical-laboratory examination for the diagnosis of a surgical pathology in right iliac fossa pain. This is a single-center prospective cohort study conducted in an Emergency Department receiving 19,000 patients per year. All patients presenting pain in the right iliac fossa were included by four (out of ten) emergency physicians certified in an ultrasound examination. A full grid pattern scan ultrasound of the abdominal cavity with analysis of the right iliac fossa was performed. The primary outcome was to compare the diagnosis performance of bedside ultrasound and clinical-laboratory examination to detect a surgical pathology. Two emergency physicians who did not participate in the study made the final diagnosis (i.e., surgical or non-surgical pathology) by reviewing the entire medical chart of each patient. From January 2011 to July 2013, 158 patients with a median age of 17 [13–32] years were analyzed. The diagnosed cases were: appendicitis (53), non-specific abdominal pain (48), lymphadenitis (22), ileitis (11), complicated ovarian cysts (7), neoplasias (5), inflammatory or infectious colitis (5), inguinal herniations (3), bowel obstructions (2), and salpingitis (2). The accuracy of ultrasound diagnoses was 0.89 (95% CI 0.84–0.94) versus 0.70 (95% CI 0.57–0.82) for diagnoses based on clinical-laboratory examination only (p < 0.001). Bedsides, ultrasound allows an accurate diagnosis of a surgical pathology in 89% of cases, which is more efficient than the clinical-laboratory examination.

Jean-Eudes Bourcier

Emeric Gallard

Jean-Philippe Redonnet

Magali Majourau

Dominique Deshaie

Jean-Marie Bourgeois

Didier Garnier

Thomas Geeraerts

Diagnostic performance of abdominal point of care ultrasound performed by an emergency physician in acute right iliac fossa pain

急诊医师在急性右髂窝疼痛中进行腹部床旁超声的诊断性能

短名	Crit. Ultrasound J.
Journal Impact	3.69
国际分区	RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING(Q1)

涉及主题	医学放射科外科物理声学内科学超声波介入放射学心理学生物精神科护理部病理急诊科心脏病学超声科麻醉解剖医学物理学
出版信息	出版商: Springer-Verlag Italia s.r.l.，出版周期: ，期刊类型: journal，开源期刊: 是
基本数据	创刊年份: 2010，原创研究文献占比: 0.00%，自引率:N.A.， Gold OA占比: 100.00%
期刊费用	$详情
平均审稿周期	网友分享经验：13 Weeks

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