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Home Echocardiography, Ultrasound, and POCUS Application: Abstracts, Summaries & Reviews

CORRESPONDENCE 
• Transthoracic Utilization of the Transesophageal Echocardiography Probe—A Novel Window to Non-Invasive Hemodynamic Monitoring for the Pediatric Anesthesiologist

The precordial stethoscope has been the universal standard for continuous cardiorespiratory monitoring during pediatric anesthesia. This long-standing standard has been replaced with transesophageal echocardiography (TEE)…

Clinical Investigations • Simple Two-Dimensional Echocardiographic Scoring System for the Estimation of Left Ventricular Filling Pressure

A noninvasive method of LVFP estimation is necessary in the clinical management of patients with HF. Echocardiography is the first-line tool both for the diagnosis and follow-up of patients with HF…

REPORTS OF ORIGINAL INVESTIGATION • Ultrasound Evaluation of Inferior Vena Cava Compression in Tilted and Supine term Parturients

The authors of this study demonstrated that ultrasound imaging of the IVC is easy to acquire and can detect IVCCI changes in the supine versus tilted position in term parturients…

ORIGINAL ARTICLE • A Retrospective Evaluation of Point of Care Ultrasound for Acute Cholecystitis in a Tertiary Academic Hospital Setting

To diagnose acute cholecystitis, clinicians in the emergency department (ED) routinely order radiology-performed ultrasound (RADUS) of the gallbladder to “rule out” acute cholecystitis…

Assessment of Diaphragmatic Function by Ultrasonography: Current Approach and Perspectives

Ultrasonography (US) for the assessment of diaphragmatic function has been reported for 25 years. Several methods have been proposed to evaluate diaphragmatic function…

CLINICAL INVESTIGATION • A Doppler Echocardiographic Pulmonary Flow Marker of Massive or Submassive Acute Pulmonary Embolus

The role of echocardiography in the workup of suspected PE has historically been supportive and primarily reserved for the detection of RV strain or dysfunction in unstable patients….

GENERAL MEDICINE/SYSTEMATIC REVIEW SNAPSHOT • Is Chest Ultrasonography Superior to Supine Chest Radiography in Identifying Pneumothorax in Emergency Department Trauma Patients?

In this clinical synopsis, the authors included 9 studies comprising 1,271 patients with 410 pneumothoraces from an initial 2,293 references. The median prevalence of traumatic pneumothorax was 30% (range 21% to 52%). The overall sensitivity of chest ultrasonography was 0.91…

ECHOCARDIOGRAPHY IN COVID-19 • The Predictive Role of Combined Cardiac and Lung Ultrasound in Coronavirus Disease 2019

Despite the recognition of the prognostic significance and clinical implications of the cardiac complications of coronavirus disease 2019 (COVID-19), both the European Association of Cardiovascular Imaging and the American Society of Echocardiography recommend limiting the echocardiographic assessment of patients with COVID-19…

ORIGINAL RESEARCH • Pneumothorax Diagnosis with Lung Sliding Quantification by Speckle Tracking: A Prospective Multicentric Observational Study

Lung ultrasound is commonly used for the diagnosis of pneumothorax, when the absence of pleural sliding, B-lines and lung pulse, or by the presence of a lung point, has been recommended to make the ultrasound diagnosis of pneumothorax…

PERIOPERATIVE MEDICINE • Ultrasound Evaluation of Gastric Emptying Time in Healthy Term Neonates after Formula Feeding

The current American Society of Anesthesiologists (ASA) fasting guideline for formula-fed infants in the periprocedural setting is 6 h before elective procedures requiring general anesthesia, regional anesthesia, or sedation/analgesia….

QUALITY IMPROVEMENT REPORT • Improving the Documentation Quality of Point-of-Care Ultrasound Scans in the Emergency Department

Point-of-care ultrasound scan (POCUS) has been incorporated a as a mandatory element of the Royal College of Emergency Medicine (RCEM)since 2010. All trainees must be signed off as competent in the four CORE clinical applications…

HEAD-TO-HEAD • Should Point-of-Care Ultrasonography Replace Stethoscopes in Acute Respiratory Failure?

When it comes to diagnosing the cause of acute respiratory failure, the current standard is to use the stethoscope and chest radiography—two technologies with a combined age of over 300 years….

ORIGINAL ARTICLE | Scoping Review of Implementing a Longitudinal Curriculum in Undergraduate Medical Education: The Wake Forest Experience.

The integration of hands-on ultrasound experience has become a highly desirable component for undergraduate medical education (UGME) curricula throughout the United States. Several schools have implemented a student-performed ultrasound experience…

ORIGINAL ARTICLE | Case series: Point-of-Care Ultrasound Conducted by Medical Students During their First Clinical Rotation Changes Patients’ Primary Diagnosis and Management

The authors point out that we practice medicine in a transitional time where POCUS has entered the curriculum of some medical schools, but many senior and experienced physicians do not hold this new bedside capability…

ORIGINAL RESEARCH | Emergency Medicine Advanced Ultrasound Service: A New Paradigm

The use of point-of-care US (POCUS) has become well established in emergency medicine (EM), largely due to social and economic pressures to provide rapid assessment and transit through the emergency department (ED) and the desire for improved diagnostic and procedural ability in acute care settings…

REVIEW | Effect of Intermittent High–Mechanical Index Impulses on Left Ventricular Strain

Endocardial border resolution can be improved by using Intermittent high–mechanical index (MI) impulses during ultrasound enhancing agent (UEA) infusion. In animal models, these high-MI impulses have been shown to also release adenosine triphosphate (ATP) for sustained periods of time…

MITRALVALVE DISEASE | Mitral Valve Prolapse Patients with Less than Moderate Mitral Regurgitation Exhibit Early Cardiac Chamber Remodeling

Mitral valve prolapse (MVP), which has a prevalence of 2.4% in the general population, is the most common etiology of mitral regurgitation (MR). The natural history of MVP is diverse, ranging from slow progression of mild MR degrees, to rapid progression to severe MR requiring cardiac surgery….

REVIEW | A Systematic Review of the Cost-Effectiveness of Ultrasound in Emergency Care Settings

Ultrasound (US) is safe and effective imaging modality for the rapid diagnosis and management of emergency conditions. Technological advances and the increasing availability of imaging modalities led to expansion of the use of clinical US. It is assumed that US is cost-effective in emergency care settings….

ORIGINAL INVESTIGATION | Utility of a Deep-Learning Algorithm to Guide Novices to Acquire Echocardiograms for Limited Diagnostic Use

The believe that this AI guidance algorithm represents a step forward in the interaction of AI with medical imaging and may allow for extension of ultrasonography to settings that ordinarily do not have access…

ORIGINAL ARTICLE | The Reproducibility of Measuring Maximum Abdominal Aortic Aneurysm Diameter from Ultrasound Images

Findings suggest that abdominal ultrasound measurements of AAA size should be performed in the anterior–posterior plane and ideally compared between different time periods by the same observer……

CLINICAL STUDY | Carotid Ultrasound in Assessing Fluid Responsiveness in Patients with Hypotension and Suspected Sepsis

Since over-and under-resuscitation are associated with adverse outcome, it is important to identify patients who would benefit from additional fluid administration after initial intravenous fluid (IVF) bolus…..

A DIAGNOSTIC ACCURACY STUDY | Auscultation Versus Point-of-care Ultrasound to Determine Endotracheal Versus Bronchial Intubation

While it is relatively straightforward to discriminate tracheal intubation from esophageal intubation, identifying correct location of the endotracheal tube (ETT) within the trachea remains challenging….

STATE OF THE ART REVIEW | Usefulness of Stress Echocardiography in the Management of Patients Treated with Anticancer Drugs

Stress echocardiography has a pivotal role in a timely diagnosis of CAD. The atherosclerotic process can be accelerated by both chemotherapy and chest irradiation in patients with cancer, even several years after treatment completion….

ORIGINAL CLINICAL RESEARCH REPORT | Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study

Gastric ultrasound provides quantitative and qualitative information about nature of gastric contents before anesthesia. It is a useful tool for assessing risk of pulmonary aspiration, which has altered clinical management during anesthesia…

BRIEF RESEARCH COMMUNICATIONS | Efficacy of Saline Contrast Transthoracic Echocardiography for Identifying High-Risk Patent Foramen Ovale

The authors concluded that grade 4 on saline contrast TTE can be valuable for identifying high-risk PFO associated with CS. Saline contrast TTE may be effective to stratify patients for performing. …

ORIGINAL ARTICLE | Teaching Limited Compression Ultrasound to General Practitioners Reduces Referrals of Suspected DVT to a Hospital: a Retrospective Cross-Sectional Study

The authors concluded that teaching LCUS protocol to GPs substantially reduced referrals to the hospital due to a suspected DVT. Importantly, it did not seem to result in an increasing number of pulmonary embolisms…

Systematic Review Article: Intraoperative Focused Cardiac Ultrasound for Assessment of Hypotension: A Systematic Review

The use of focused cardiac ultrasound (FoCUS), which can be performed by non-cardiologists with proper training for cardiovascular evaluation, has gained acceptance in emergency department (ED) & intensive care units…

Research Letter: Lung Ultrasound Can Predict Response to the Prone Position in Awake Non-Intubated Patients with COVID-19 Associated Acute Respiratory Distress Syndrome.

Prone positioning (PP) is often used in acute respiratory distress syndrome (ARDS). While studies have demonstrated positive effects on oxygenation in awake and non-intubated patients, it isn’t effective in every case…

CASE REPORT | Native Mitral Valve Infective Endocarditis From Flossing: A Case Report and Emergency Department Management

Infective endocarditis (IE) is often classified into left (mitral and aortic), right (tricuspid and pulmonic), as well as by the nature of the affected valve (native or prosthetic). 40% of these cases affect the mitral valve. …

STATE OF THE ART REVIEW | Agitated Saline Contrast Echocardiography in the Identification of Intra- and Extracardiac Shunts: Connecting the Dots

Cardiologists throughout the world often perform and interpret echocardiographic studies using agitated saline as a contrast agent. Also known as ‘‘bubble studies’’, these studies can provide valuable information…

ECHOCARDIOGRAPHY IN CHILDREN | Longitudinal Variation in Presence and Severity of Cardiac Valve Regurgitation in Healthy Children

In both normal adults and pediatric populations, trivial or mild valvular regurgitation (VR) is a common finding. However, in a specific individual, such finding may raise the concern whether this is a physiologic or pathologic finding…

BRIEF RESEARCH COMMUNICATION – COVID 19 | Mitral Annular Plane Systolic Excursion: An Early Marker of Mortality in Severe COVID-19

Respiratory failure is one of the major causes of death in hospitalized patients with COVID-19. Right ventricular (RV) dilation and reduced RV longitudinal strain have been shown to be markers of poor outcome in this disease…

Original Article: Point-of-Care Ultrasound for the Detection of Hydronephrosis in Emergency Department Patients with Suspected Renal Colic.

Renal colic is a common presentation in the emergency department (ED), leading to significant utilization of resources, including advanced imaging as well as direct and indirect costs related to patient care and lost work time…

Aortic Awareness Case Review: Esophageal Perforation with Transesophageal Echocardiography in an Elderly Patient

While uncommon, transesophageal echocardiography (TEE) can lead to esophageal perforation which, in rare occasion, can even lead to death. The authors present a case of iatrogenic esophageal perforation from TEE…

Review: Role of Point-of-Care Ultrasound During the COVID-19 Pandemic: Our Recommendations in the Management of Dialytic Patients

LUS is well validated in evaluation of several respiratory conditions. LUS is an image method that classically allows the evaluation of the pulmonary periphery, which is helpful in assessing COVID-19….

Ultrasound-Guided Peripheral Vascular Catheterization in Pediatric Patients: A Narrative Review

In children, the utility of ultrasound-guided PVC placement has been demonstrated in numerous studies, showing improved success rate, procedure time, number of attempts, and number of complications…

Original Article: Unanticipated Critical Findings on Echocardiography in Septic Patients

Use of echocardiography to manage patients with sepsis has become routine. Transthoracic echocardiogram (TTE) now considered appropriate in management of patients in shock or where TTE is likely to change management…

Opinion Paper: Lung Ultrasound in a COVID Pandemic – Choosing Wisely

This paper reviews four important questions that should be answered by each provider, which will help the provider customize lung ultrasound provision: Why, what, who, and when?

Letter: Optic Nerve Sheath Diameter Guided Detection of Sepsis-Associated Encephalopathy

This letter was written in response to the research letter discussing the measurement of ultrasonography guided optic nerve sheath diameter (ONSD) in sepsis associated encephalopathy (SAE) and its correlation with outcome…

Research Letter: Bedside Ultrasound Measurement of Optic Nerve Sheath Diameter in Patients with Sepsis: A Prospective Observational Study

Sepsis-associated encephalopathy (SAE) is a serious condition that can lead to cognitive impairment, sleep disturbances, delirium and even coma. One of the complications of SAE is brain edema leading to high intracranial pressure…

Clinical Investigation: Hypertrophic Cardiomyopathy and Contrast Echocardiography

Hypertrophic cardiomyopathy (HCM) is marked by left ventricular hypertrophy. Left ventricular wall thickness (LVWT) is a key element in the diagnostic workup and prognostic assessment of HCM…

Systematic Review & Meta‐Analysis: Is Contrast-Enhanced Ultrasound (CEUS) Superior to Computed Tomography Angiography (CTA) in Detection of Endoleaks in Post-EVAR Patients?

The author concluded contrast-enhanced ultrasound scan has a higher sensitivity and comparable specificity to computed tomography angiography for detection of endoleaks post-EVAR…

Original Investigation: Right Ventricular Global Longitudinal Strain and Outcomes in Heart Failure with Preserved Ejection Fraction

Studies evaluated prognostic impact of right ventricular dysfunction (RVD) in patients with HF with preserved ejection fraction (HFpEF) found patients with RVD had a worse prognosis…

Clinical Research: Echocardiographic Evaluation of Cardiac Recovery After Refractory Out-of-Hospital Cardiac Arrest

While several techniques have been employed, there is no consensus as to whether unloading strategies should be routinely employed to reduce LV wall stress…

Original Investigation: Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic

Recent reports suggest that the incidence of stress cardiomyopathy (also known as Takotsubo cardiomyopathy) may have gone up during the COVID-19 crisis.

Research Analysis: A Prospective Evaluation of Point-of-Care Ultrasonographic Diagnosis of Diverticulitis in the Emergency Department

Diverticulitis often presents with a constellation of non-specific symptoms, including diarrhea, fever, and abdominal pain, making it challenging to diagnose…

Review: A Systematic Review and Pooled Analysis of CPR-Associated Cardiovascular and Thoracic Injuries

CPR-associated thoracic injuries in setting of manual chest compressions or circulatory adjuncts using active compression–decompression technology is not well characterized…

Review: Recommendations for Core Critical Care Ultrasound Competencies as a Part of Specialist Training

Critical care ultrasound (CCUS) has become an integral part of intensive care practice but only few countries have managed to operationalize this guidance…

Clinical Research: Tissue Doppler Imaging of the Diaphragm in Healthy Subjects and Critically Ill Patients

Ultrasonography has been used to evaluate diaphragmatic motion characteristics, with derived measurements relating to outcome of weaning from ventilation…

Case Report: Stab Wound of the Superficial Femoral Artery Early Diagnosed by Point-of-Care Doppler Ultrasound

Point-of-care Doppler ultrasound was performed and demonstrated a large hypoechoic, slightly pulsating hematoma in the subfascial compartment…

Prospective International Survey: Global Evaluation of Echocardiography in Patients with COVID-19

Accumulating data suggest that COVID-19 can cause a wide range of cardiac conditions that include acute myocardial infarction, myocarditis, and stress cardiomyopathy.

Study of Ethics & Law: Analysis of Lawsuits Related to Diagnostic Errors from Point-of-Care Ultrasound in Internal Medicine, Pediatrics, Family Medicine and Critical Care in the USA.

As adoption of this Point-of-Care ultrasound continues to increase in internal medicine, cardiac care, pediatrics and more, there are some concerns about potential for lawsuits related to its use in clinical practice.

Clinical Investigations: Systematic Assessment of the Impact of Ultrasound-Enhancing Agents upon Measurements of Cardiac Size and Function by Echocardiography

Ultrasound-enhancing contrast agent (CON) is now used routinely to improve both endocardial definition and accurate measurements in patients with suboptimal image quality.

Case Report: Pediatric Case of Successful Point-of-Care Ultrasound-Guided Nasogastric Tube Placement

Nasogastric tube (NGT) placement is commonly performed in pediatric emergency care for gastric decompression, enteral feeding, and drug administration, and has the potential to cause serious complications.

Case Report: Point-of-Care Ultrasound in the Diagnosis of Neonatal Cerebral Sinovenous Thrombosis

This is a case of a 27-day-old male neonate who was admitted to the pediatric ward with acute respiratory syncytial virus-bronchiolitis.

Research Letter: A longitudinal cohort of stress cardiomyopathy assessed with speckletracking echocardiography after moderate to severe traumatic brain injury.

When assessed with speckle-tracking echography, stress cardiomyopathy is seen in about a third of patients with subarachnoid hemorrhage (SAH).

Correspondence: Contrast-enhanced ultrasound (CEUS) of the lung reveals multiple areas of microthrombi in a COVID-19 patient

The correspondence letter describes contrast-enhanced ultrasound (CEUS) of the lung, and follows a different letter in Intensive Care Medicine (April 23, 2020) questioning whether areas of subpleural consolidation are indicative of segmental pulmonary embolus.

Research: Regional right ventricular longitudinal systolic strain for detection of severely impaired right ventricular performance in pulmonary hypertension

Right ventricular (RV) function is a key determinant of outcome in patients with pulmonary hypertension (PH), which is a life- threatening disease leading to RV dilatation and failure. Hemodynamics assessed using Invasive approach of right heart catheterization (RHC) provides important information of RV function and prognosis.

Review: Point-of-care ultrasound in pregnancy: gastric, airway, neuraxial, cardiorespiratory.

This is a review article that looks into the use of PoCUS in the anesthetic management of the obstetric patient. The article reviews the use of ultrasound for assessment of aspiration risk, airway management, placement of neuraxial blocks and the diagnosis and follow-up of cardiorespiratory dysfunction.

Review: Rolling a trauma patient onto the right side increases sensitivity of FAST examination.

Shortening time for hemoperitoneum diagnosis may improve morbidity and mortality if time from diagnosis to operating room is shortened. Therefore, techniques that increases the sensitivity of FAST exam may lead to reduced morbidity & mortality.

Analysis: Self-learning of point-of-care cardiac ultrasound — Can medical students teach themselves?

Training of PoCUS is challenging, time-consuming and resource-intensive. This study evaluated whether training process can be simplified by allowing medical students to self-train with web-based cardiac ultrasound software.

Abstract: Echocardiography – POCUS Training Recommendations

Recommendations for Echocardiography Laboratories Participating in Cardiac Point of Care Cardiac Ultrasound (POCUS) and Critical Care Echocardiography Training: Report from the American Society of Echocardiography.

Abstract: Echocardiography – Diagnosis of PFO

Importance of Abdominal Compression Valsalva Maneuver and Microbubble Grading In Contrast Transthoracic Echocardiography for Detecting Patent Foramen Ovale.

Abstract: Pediatric POCUS: Skull Fractures Detection

The utility of Ultrasound in detecting skull fractures after pediatric blunt head trauma. Systematic review and meta-analysis.

Abstract: Pediatric POCUS: G-Tube Confirmation

Point-of-care ultrasound for confirmation of gastrostomy tube replacement in the pediatric emergency department

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