A rare ultrasound case report: intramuscular tear of the sartorius muscle
We report a case of a 65-year-old male patient who presented with localized swelling and lump in the proximal third of the upper thigh. Most common upper thigh injuries involve the quadriceps muscle group associated with football injuries; however, in rare incidents certain forceful intrinsic injuries can cause intramuscular tear of the sartorius muscle. This is a rare case of spontaneous muscle rupture in an elderly patient with no history of recent sporting activity. Ultrasound provides a cost-effective, dynamic evaluation of the anterior upper thigh muscles to differentiate between chronic and acute phases of injury. (S...
Source: Critical Ultrasound Journal - July 26, 2019 Category: Radiology Source Type: research

Sonographic presentation of rice bodies in subacromial-subdeltoid chronic bursitis
ConclusionThe unique sonographic presentation of rice bodies in the chronic subacromial-subdeltoid bursitis makes it easy to be diagnosed confidently, but it is difficult to be recognized, due to its rare occurrence. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - July 22, 2019 Category: Radiology Source Type: research

Interscalene brachial plexus nerve block in the emergency department: an effective and practice-changing workshop
ConclusionsOur study suggests that EM residents can learn the ISNB, perform it safely in the emergency department, and that the ISNB may be an alternative to procedural sedation and opiate use for shoulder dislocation. Residents are adept at ISNB technical skills but demonstrate some deficits in knowledge retention. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - July 15, 2019 Category: Radiology Source Type: research

Giant rectus sheath hematoma
ConclusionsPOCUS has a good sensitivity for the diagnosis of RSH and it is also an excellent tool for patient follow-up. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - June 18, 2019 Category: Radiology Source Type: research

“Sigmoid diverticulitis mimicking cholecystitis” a clinical challenge
We reported a case of a 70-year-old female who presented to our Emergency Department (ED) with right upper quadrant pain and an initial clinical suspicion of cholecystitis. Ultrasound (US) and Computed Tomography (CT) demonstrated an anatomical variation of the sigmoid colon diverticulitis. This clinical report demonstrates that ultrasound plays a relevant part as first-step approach to the acute abdominal conditions and its accuracy increases together with other diagnostic tools such as Computer Tomography. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - June 11, 2019 Category: Radiology Source Type: research

Point-of-care ultrasound diagnosis of stump appendicitis in the emergency department
ConclusionsDespite its rarity, it is feasible to diagnose SA using PoCUS, as patients presenting with right lower quadrant pain and history of appendectomy are at risk for delayed diagnosis, perforation, and poor outcome. PoCUS may reduce time to diagnosis, time to definitive operative or non-operative management, and minimize morbidity. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - June 11, 2019 Category: Radiology Source Type: research

Diagnostic value of whole-body-focused ultrasonography in high-acuity patients in the emergency department: a prospective single-center cross-sectional study
AbstractBackgroundA fast and diagnostic accurate tool to assess the unselected category of high-acuity patients, in whom the underlying pathology is not always obvious, is needed in the emergency departments (ED). We aim to describe the feasibility, validity and diagnostic yield of a routine whole-body-focused ultrasonography (wbf-us) in an unselected group of high-acuity ED patients.MethodsIn a prospective observational study, a convenience sample of ED patients ( ≥ 18 years) with a high-acuity score or systolic blood pressure 
Source: Critical Ultrasound Journal - May 27, 2019 Category: Radiology Source Type: research

A road map for point-of-care ultrasound training in internal medicine residency
ConclusionsPOCUS can be successfully taught to internal medicine residents as a part of internal medicine training. Many common elements and principles are evident on review of these four described successful programs. Future support, in the form of endorsed medical society guidelines, will be needed before POCUS is universally incorporated across internal medicine residency training programs. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - May 9, 2019 Category: Radiology Source Type: research

Changes in speckle-tracking-derived mechanical dispersion index are associated with 30-day readmissions in acute heart failure
ConclusionsMDI has promise as a treatment response variable in admitted patients with AHF; however, further study is needed. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - May 2, 2019 Category: Radiology Source Type: research

Cardiac A-lines in fast scan as a sign of pneumopericardium
ConclusionsAlthough FAST scan was originally used to look for presence of free fluid, with the knowledge of lung ultrasound for pneumothorax, our findings suggest that FAST scan can also be used to detect pneumopericardium. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - April 25, 2019 Category: Radiology Source Type: research

Basic critical care echocardiography training of intensivists allows reproducible and reliable measurements of cardiac output
AbstractBackgroundAlthough pulmonary artery catheters (PACs) have been the reference standard for calculating cardiac output, echocardiographic estimation of cardiac output (CO) by cardiologists has shown high accuracy compared to PAC measurements. A few studies have assessed the accuracy of echocardiographic estimation of CO in critically ill patients by intensivists with basic training. The aim of this study was to evaluate the accuracy of CO measurements by intensivists with basic training using pulsed-wave Doppler ultrasound vs. PACs in critically ill patients.MethodsCritically ill patients who required hemodynamic mon...
Source: Critical Ultrasound Journal - April 16, 2019 Category: Radiology Source Type: research

Temporary transvenous pacing guided by the combined use of ultrasound and intracavitary electrocardiography: a feasible and safe technique
AbstractTemporary transvenous pacing is a crucial procedure in emergency and critical care medicine. While fluoroscopy guidance is considered the gold-standard to place the temporary pacing electrode catheter (EC), its use is usually limited by equipment availability and time. By contrast, ultrasound (US) guidance is a useful alternative, since it is widely available at the bedside, does not emit ionizing radiation and provides optimal times to active pacing with fewer complications. However, many times, in spite of visualizing the EC in the right ventricle using US, the pacing capture and sensing are not optimal, and thus...
Source: Critical Ultrasound Journal - April 4, 2019 Category: Radiology Source Type: research

Persistent hypoxemia after an asthma attack
We report the case of a patient who presented persistent hypoxemia after an adequate treatment for a severe asthma attack requiring intensive care unit admission. The patient underwent a transthoracic microbubbles contrast echocardiography that showed a massive patent foramen ovale. The favorable clinical course and the absence of major signs and symptoms related to patent foramen ovale allowed a conservative approach with a follow-up program. Patent foramen ovale should be suspected in case of persistent hypoxemia after a severe asthma attack had resolved. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - March 21, 2019 Category: Radiology Source Type: research

Correlation of OSCE performance and point-of-care ultrasound scan numbers among a cohort of emergency medicine residents
ConclusionThe results of this small single residency program study suggest a pattern of improvement in OSCE performance as scan numbers increased, with the appearance of a plateau effect around 300 scans. Further investigation of this correlation in diverse practice environments and within individual ultrasound modalities will be necessary to create generalizable recommendations for scan requirements as part of overall POCUS proficiency assessment. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - March 5, 2019 Category: Radiology Source Type: research

A narrative review of diaphragm ultrasound to predict weaning from mechanical ventilation: where are we and where are we heading?
ConclusionsThe aim of this narrative review is to briefly describe the common methods of diaphragmatic function assessment using ultrasound techniques, before summarizing the major points raised by the recent reviews. A narrative summary of the most recent data will be presented, before concluding with a brief discussion of future research directions in this field. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - February 28, 2019 Category: Radiology Source Type: research

Fat embolism in right internal jugular vein: incidental ultrasound finding during internal jugular vein cannulation
ConclusionsPoint-of-care ultrasound findings of fat embolism in central vein can facilitate and increase the suspicion of fat embolism syndrome. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - February 25, 2019 Category: Radiology Source Type: research

Clinical measurements obtained from point-of-care ultrasound images to assess acquisition skills
ConclusionsClinical measurements obtained from point-of-care ultrasound images acquired contemporaneously by trainees and an instructor can be used to quantitatively assess the image acquisition competence of specific trainees. This method may obviate resource-intensive qualitative rating systems that are based on ultrasound image quality and direct observation, while also helping instructors guide remediation. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - February 22, 2019 Category: Radiology Source Type: research

Point-of-care ultrasound evaluation and puncture simulation of the internal jugular vein by medical students
ConclusionThe 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. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - December 19, 2018 Category: Radiology Source Type: research

Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists
ConclusionNovice 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. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - December 9, 2018 Category: Radiology Source Type: research

Mitral valve velocity time integral and passive leg raise as a measure of volume responsiveness
ConclusionMitral valve velocity time integral in conjunction with passive leg raise seem to correlate with volume responsiveness in hemodialysis patients. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - December 2, 2018 Category: Radiology Source Type: research

Diagnostic performance of abdominal point of care ultrasound performed by an emergency physician in acute right iliac fossa pain
AbstractBackgroundRight 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.Me...
Source: Critical Ultrasound Journal - November 23, 2018 Category: Radiology Source Type: research

Strain analysis for the identification of hypertensive cardiac end-organ damage in the emergency department
We present a case demonstrating the use of emergency physician performed point-of-care strain echocardiography to identify and quantify LV mechanical dysfunction during a hypertensive crisis and to monitor improvement over 6  h. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - November 19, 2018 Category: Radiology Source Type: research

Transient systolic anterior motion with junctional rhythm after mitral valve repair in the intensive care unit
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. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - November 12, 2018 Category: Radiology Source Type: research

Which ultrasound transducer type is best for diagnosing pneumothorax?
The objective is to assess the difference between a linear-array, curved-array, and phased-array ultrasound transducer in the assessment for pneumothorax and to determine which is best.MethodsIn this double-blinded, cross-sectional, observational study, 15 observers, experienced in lung ultrasonography, each assessed 66 blinded ultrasound video clips of either normal ventilation or pneumothorax that were recorded with three types of ultrasound transducers. The clips were recorded in 11 adult patients that underwent thoracoscopic lung surgery immediately before and after the surgeon opened the thorax. The diagnostic accurac...
Source: Critical Ultrasound Journal - October 22, 2018 Category: Radiology Source Type: research

Ultrasound-guided thoracostomy site identification in healthy volunteers
ConclusionsThe ability to accurately locate the correct intercostal space for thoracostomy incision was improved under ultrasound guidance. Further studies are warranted to determine if this ultrasound-guided technique will decrease complications with chest tube insertion and improve patient outcomes. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - October 15, 2018 Category: Radiology Source Type: research

Diagnosis of diastolic dysfunction in the emergency department: really at reach for minimally trained sonologists? A call for a wise approach to heart failure with preserved ejection fraction diagnosis in the ER
(Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - October 8, 2018 Category: Radiology Source Type: research

Is point-of-care ultrasound disruptive innovation? Formulating why POCUS is different from conventional comprehensive ultrasound
AbstractBackgroundPoint-of-care ultrasound (PoCUS) is spreading throughout Emergency Medicine, Critical Care and Pre-hospital Care. However, there is an underlying inherited conflict with the established specialties performing comprehensive examinations. It has been stated that PoCUS is disruptive innovation. If this is true the definition might open up for a new perspective on differentiating comprehensive ultrasound from PoCUS. PoCUS in the light of disruptive innovation is a different perspective on ultrasound that has not before been academically scrutinized.MethodsIn this paper we investigate if PoCUS is in fact disru...
Source: Critical Ultrasound Journal - October 1, 2018 Category: Radiology Source Type: research

Combined lung and brain ultrasonography for an individualized “brain-protective ventilation strategy” in neurocritical care patients with challenging ventilation needs
AbstractWhen intracranial hypertension and severe lung damage coexist in the same clinical scenario, their management poses a difficult challenge, especially as concerns mechanical ventilation management. The needs of combined lung and brain protection from secondary damage may conflict, as ventilation strategies commonly used in patients with ARDS are potentially associated with an increased risk of intracranial hypertension. In particular, the use of positive end-expiratory pressure, recruitment maneuvers, prone positioning, and protective lung ventilation can have undesirable effects on cerebral physiology: they may pos...
Source: Critical Ultrasound Journal - September 17, 2018 Category: Radiology Source Type: research

Pre-hospital lung ultrasound for cardiac heart failure and COPD: is it worthwhile?
ConclusionsPre-hospital lung ultrasound is easy and feasible, and learning curve is rapid. Our study suggests that cardiac heart failure and acute exacerbation of chronic obstructive pulmonary disease can be considered two indications for pre-hospital ultrasound, and can improve the management of patient with acute respiratory insufficiency. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - September 10, 2018 Category: Radiology Source Type: research

Lung ultrasound training: a systematic review of published literature in clinical lung ultrasound training
ConclusionAll educational methods proved increased theoretical and practical knowledge obtained at the ultrasound courses, but the included studies were substantial heterogeneous in setup, learning-, and assessment methods, and outcome measures. On behalf of current published studies, it was not possible to construct clear guidelines for the future education and certification in clinical lung ultrasound, but the use of different hands-on training facilities tends to contribute to different aspects of the learning process. This systematic review proves a lack of learning studies within this content, and research with valida...
Source: Critical Ultrasound Journal - September 3, 2018 Category: Radiology Source Type: research

Today ’s advanced is tomorrow’s basic
(Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - August 15, 2018 Category: Radiology Source Type: research

Is it best to reFOCUS on basic echocardiography in the emergency department?
(Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - August 15, 2018 Category: Radiology Source Type: research

The implementation of a longitudinal POCUS curriculum for physicians working at rural outpatient clinics in Chiapas, Mexico
ConclusionA longitudinal POCUS educational curriculum is an effective way to equip local physicians in resource limited countries with a tool to improve their clinical management of patients. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - August 15, 2018 Category: Radiology Source Type: research

Today ’s advanced is tomorrow’s basic
(Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - August 15, 2018 Category: Radiology Source Type: research

Is it best to reFOCUS on basic echocardiography in the emergency department?
(Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - August 15, 2018 Category: Radiology Source Type: research

The implementation of a longitudinal POCUS curriculum for physicians working at rural outpatient clinics in Chiapas, Mexico
ConclusionA longitudinal POCUS educational curriculum is an effective way to equip local physicians in resource limited countries with a tool to improve their clinical management of patients. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - August 15, 2018 Category: Radiology Source Type: research

ABCDE of prehospital ultrasonography: a narrative review
AbstractPrehospital point-of-care ultrasound used by nonradiologists in emergency medicine is gaining ground. It is feasible on-scene and during aeromedical transport and allows health-care professionals to detect or rule out potential harmful conditions. Consequently, it impacts decision-making in prioritizing care, selecting the best treatment, and the most suitable transport mode and destination. This increasing relevance of prehospital ultrasonography is due to advancements in ultrasound devices and related technology, and to a growing number of applications. This narrative review aims to present an overview of prehosp...
Source: Critical Ultrasound Journal - August 8, 2018 Category: Radiology Source Type: research

An easier and safe affair, pleural drainage with ultrasound in critical patient: a technical note
AbstractThoracic ultrasound is a powerful diagnostic imaging technique for pleural space disorders. In addition to visualising pleural effusion, thoracic ultrasound also helps clinicians to identify the best puncture site and to guide the drainage insertion procedure. Thoracic ultrasound is essential during these invasive manoeuvres to increase safety and decrease potential life-threatening complications. This paper provides a technical description of pigtail-type drainage insertion using thoracic ultrasound, paying particular attention to indications, contraindications, ultrasound guidance, preparation/equipment, procedur...
Source: Critical Ultrasound Journal - August 1, 2018 Category: Radiology Source Type: research

Application of robotic transcranial Doppler for extended duration recording in moderate/severe traumatic brain injury: first experiences
(Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - July 23, 2018 Category: Radiology Source Type: research

Icterus and abdominal pain: an unexpected, rare sonographic finding in a Peruvian Emergency Department
ConclusionsThis case initially appears as a “classic” finding ofEchinococcus disease. It is important for the clinician sonographer to appreciate the features consistent withEchinococcus cysts and distinguish from those features that are more consistent with other pathology. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - July 12, 2018 Category: Radiology Source Type: research

The impact of heart, lung and diaphragmatic ultrasound on prediction of failed extubation from mechanical ventilation in critically ill patients: a prospective observational pilot study
ConclusionsFailed extubation in mechanically ventilated patients is more prevalent if markers of left ventricular diastolic dysfunction and loss of lung aeration are present. (Source: Critical Ultrasound Journal)
Source: Critical Ultrasound Journal - July 4, 2018 Category: Radiology Source Type: research