2,695 research outputs found

    Pediatric emergency medicine point-of-care ultrasound: summary of the evidence.

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    The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed how to and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines

    Thoracic Vascular Trauma

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    Urban thoracic trauma: diagnosis and initial treatment of non-cardiac injuries in adults.

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    This comprehensive review aims to delineate the prevailing non-cardiac thoracic injuries occurring in urban environments following initial on-site treatment and subsequent admission to hospital emergency departments. Our study involved a rigorous search within the PubMed database, employing key phrases and their combinations, including "thoracic injury," "thoracic trauma," "haemothorax," "lung contusion," "traumatic pneumothorax," "rib fractures," and "flail chest." We focused on original research articles and reviews. Non-cardiac thoracic injuries exhibit a high prevalence, often affecting poly-trauma patients, and contributing to up to 35% of polytrauma-related fatalities. Furthermore, severe thoracic injuries can result in a substantial 5% mortality rate. This review provides insights into clinical entities such as lung contusion, traumatic haemothorax, pneumothorax, rib fractures, and sternal fractures. Thoracic injuries represent a frequent and significant clinical concern for emergency department physicians and thoracic surgeons, warranting thorough understanding and timely intervention

    Ultrasound for the Anesthesiologists: Present and Future

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    Ultrasound is a safe, portable, relatively inexpensive, and easily accessible imaging modality, making it a useful diagnostic and monitoring tool in medicine. Anesthesiologists encounter a variety of emergent situations and may benefit from the application of such a rapid and accurate diagnostic tool in their routine practice. This paper reviews current and potential applications of ultrasound in anesthesiology in order to encourage anesthesiologists to learn and use this useful tool as an adjunct to physical examination. Ultrasound-guided peripheral nerve blockade and vascular access represent the most popular ultrasound applications in anesthesiology. Ultrasound has recently started to substitute for CT scans and fluoroscopy in many pain treatment procedures. Although the application of airway ultrasound is still limited, it has a promising future. Lung ultrasound is a well-established field in point-of-care medicine, and it could have a great impact if utilized in our ORs, as it may help in rapid and accurate diagnosis in many emergent situations. Optic nerve sheath diameter (ONSD) measurement and transcranial color coded duplex (TCCD) are relatively new neuroimaging modalities, which assess intracranial pressure and cerebral blood flow. Gastric ultrasound can be used for assessment of gastric content and diagnosis of full stomach. Focused transthoracic (TTE) and transesophageal (TEE) echocardiography facilitate the assessment of left and right ventricular function, cardiac valve abnormalities, and volume status as well as guiding cardiac resuscitation. Thus, there are multiple potential areas where ultrasound can play a significant role in guiding otherwise blind and invasive interventions, diagnosing critical conditions, and assessing for possible anatomic variations that may lead to plan modification. We suggest that ultrasound training should be part of any anesthesiology training program curriculum

    Current Neonatal Applications of Point-of-Care Ultrasound

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    Point-of-care ultrasound (POCUS) is an imaging modality that continues to gain acceptance in pediatric and neonatal medicine. In neonatology throughout many areas of the world, functional echocardiography performed by neonatologists has been at the forefront in the growth of POCUS compared to non-cardiac POCUS, the latter which potentially carries more opportunities for use. Despite the early adoption in obstetrics and maternal-fetal medicine, the actual bedside implementation in neonatology has unfortunately been much slower. Examples in neonatology where POCUS may continue to expand include central line placement, endotracheal tube localization, diagnosis of pneumothoraces, cardiac function assessment, and bowel viability assessment just to name a few. This chapter will be a practical synopsis of the most active uses and opportunities for POCUS in neonatology. Expanded training for neonatologists and trainees is required before widespread adoption occurs

    Diagnosis of hemidiaphragm paralysis: refine ultrasound criteria

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    BackgroundUltrasound has demonstrated its interest in the analysis of diaphragm function in patients with respiratory failure. The criteria used to diagnose hemidiaphragm paralysis are not well defined.MethodsThe aim of this observational retrospective study was to describe the ultrasound findings in 103 patients with diaphragm paralysis, previously diagnosed by conventional methods after various circumstances such as trauma or surgery. The ultrasound study included the recording of excursions of both diaphragmatic domes and the measurement of inspiratory thickening.ResultsOn paralyzed hemidiaphragm, thickening was less than 20% in all patients during deep inspiration. Thinning was recorded in 53% of cases. In some cases, the recording of the thickening could be difficult. The study of motion during voluntary sniffing reported a paradoxical excursion in all but one patient. During quiet breathing, an absence of movement or a paradoxical displacement was observed. During deep inspiration, a paradoxical motion at the beginning of inspiration followed by a reestablishment of movement in the cranio-caudal direction was seen in 82% of cases. In some patients, there was a lack of movement followed, after an average delay of 0.4 s, by a cranio-caudal excursion. Finally, in 4 patients no displacement was recorded. Evidence of hyperactivity (increased inspiratory thickening and excursion) of contralateral non-paralyzed hemidiaphragm was observed.ConclusionTo accurately detect hemidiaphragm paralysis, it would be interesting to combine the ultrasound study of diaphragm excursion and thickening. The different profiles reported by our study must be known to avoid misinterpretation

    Ultrasound-Guided Resuscitation in Open Aortic Surgery - The AORTUS Trial

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    Introduction: Major abdominal aortic surgery requires significant fluid resuscitation in the post-operative phase. Patients are at significant risk of perioperative morbidity and mortality which can be affected by the approach to post-operative fluid resuscitation. Point of care ultrasonography (POCUS) has evolved as a tool to perform whole-body assessments at the bedside to augment the physical exam and guide the resuscitation of the critically ill. This study will aim to explore the value of rigorous goal-directed resuscitation in aortic surgery using point of care ultrasonography (POCUS). Methods: In an open-label, randomized, feasibility trial we enrolled 17 patients to receive resuscitation guided by either POCUS or usual care Results: We observed that the trial protocol as designed met all of our pre-specified feasibility metrics Conclusion: The use of POCUS in guiding post-operative fluid resuscitation is feasible and utilizing this protocol to design a study powered to detect statistically significant differences in clinical outcomes is warranted

    Computed tomography in diagnostics and treatment decisions concerning multiple trauma and critically ill patients

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    AbstractTechnical improvements in computed tomography (CT) scanners have provided new possibilities to exploit the resources of this imaging modality in the evaluation of patients with multiple injuries or patients being treated in an intensive care unit (ICU). The purpose of this study was to assess the significance of multi-detector computed tomography (MDCT) in diagnostics and treatment decisions concerning multiple trauma and critically ill patients. Findings of MDCT using a dedicated trauma protocol in 133 patients exposed to high-energy blunt trauma were retrospectively evaluated. Diagnostic information about the injuries that would enable planning of treatment was sought. The imaging protocol consisted of axial scanning of the head and helical scanning of the facial bones, cervical spine, thorax, abdomen, and pelvis. Ninety-nine of the patients (74%) had at least one finding consistent with trauma. Nineteen false negative findings and two false positive findings were made. The overall sensitivity of MDCT was 94%, specificity 100%, and accuracy 97%.The reliability of a structured 5-min evaluation of MDCT images from the scanner’s console was prospectively evaluated in 40 high-energy trauma patients. The dedicated trauma protocol covering the thorax, abdomen, and pelvis was used in MDCT scanning. The findings were compared with the final radiological diagnosis of the MDCT data made on a picture archiving and communicating system (PACS) workstation, the operative findings, and the clinical follow-up. The evaluation from the scanner’s console enabled diagnosis of all potentially life-threatening injuries, the sensitivity for all injuries being 60% and specificity 98%.The effects of MDCT on the treatment of patients in a 12-bed medical-surgical ICU were observed prospectively. Sixty-four patients with an ICU stay longer than 48 h had had inconclusive findings with other modalities of radiological imaging. They underwent altogether 82 MDCT examinations. Fifty examinations (61%) resulted in a change in treatment, and 20 (24%) of them otherwise contributed to or supported clinical decision-making. Twelve examinations (15%) failed to provide any additional information relevant to the patient’s treatment. MDCT examination was helpful in general ICU patients, with inconclusive findings with other imaging modalities. CT images of 127 mixed medical-surgical ICU patients were retrospectively reviewed for the previously determined findings. Forty-three of these patients underwent open cholecystectomy, revealing eight cases with a normal gallbladder (GB), 26 with an edematous GB, and nine with necrotic acute acalculous cholecystitis (AAC). Abnormal CT findings were present in 96% of all the ICU patients. Higher bile density in the GB body and subserosal edema were associated with an edematous GB. The most specific findings predicting necrotic AAC were gas in the GB wall or lumen, lack of GB wall enhancement, and edema around the GB. The frequent prevalence of nonspecific abnormal imaging findings in the GB of ICU patients limits the diagnostic value of CT scanning. Academic dissertation to be presented with the assent of the Faculty of Medicine of the University of Oulu for public defence in Auditorium 7 of Oulu University Hospital, on 16 April 2010, at 12 noonAbstract Technical improvements in computed tomography (CT) scanners have provided new possibilities to exploit the resources of this imaging modality in the evaluation of patients with multiple injuries or patients being treated in an intensive care unit (ICU). The purpose of this study was to assess the significance of multi-detector computed tomography (MDCT) in diagnostics and treatment decisions concerning multiple trauma and critically ill patients. Findings of MDCT using a dedicated trauma protocol in 133 patients exposed to high-energy blunt trauma were retrospectively evaluated. Diagnostic information about the injuries that would enable planning of treatment was sought. The imaging protocol consisted of axial scanning of the head and helical scanning of the facial bones, cervical spine, thorax, abdomen, and pelvis. Ninety-nine of the patients (74%) had at least one finding consistent with trauma. Nineteen false negative findings and two false positive findings were made. The overall sensitivity of MDCT was 94%, specificity 100%, and accuracy 97%. The reliability of a structured 5-min evaluation of MDCT images from the scanner’s console was prospectively evaluated in 40 high-energy trauma patients. The dedicated trauma protocol covering the thorax, abdomen, and pelvis was used in MDCT scanning. The findings were compared with the final radiological diagnosis of the MDCT data made on a picture archiving and communicating system (PACS) workstation, the operative findings, and the clinical follow-up. The evaluation from the scanner’s console enabled diagnosis of all potentially life-threatening injuries, the sensitivity for all injuries being 60% and specificity 98%. The effects of MDCT on the treatment of patients in a 12-bed medical-surgical ICU were observed prospectively. Sixty-four patients with an ICU stay longer than 48 h had had inconclusive findings with other modalities of radiological imaging. They underwent altogether 82 MDCT examinations. Fifty examinations (61%) resulted in a change in treatment, and 20 (24%) of them otherwise contributed to or supported clinical decision-making. Twelve examinations (15%) failed to provide any additional information relevant to the patient’s treatment. MDCT examination was helpful in general ICU patients, with inconclusive findings with other imaging modalities. CT images of 127 mixed medical-surgical ICU patients were retrospectively reviewed for the previously determined findings. Forty-three of these patients underwent open cholecystectomy, revealing eight cases with a normal gallbladder (GB), 26 with an edematous GB, and nine with necrotic acute acalculous cholecystitis (AAC). Abnormal CT findings were present in 96% of all the ICU patients. Higher bile density in the GB body and subserosal edema were associated with an edematous GB. The most specific findings predicting necrotic AAC were gas in the GB wall or lumen, lack of GB wall enhancement, and edema around the GB. The frequent prevalence of nonspecific abnormal imaging findings in the GB of ICU patients limits the diagnostic value of CT scanning

    Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch

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    This book considers diagnosis and treatment of abdominal and thoracic aortic aneurysms. It addresses vascular and cardiothoracic surgeons and interventional radiologists, but also anyone engaged in vascular medicine. The book focuses amongst other things on operations in the ascending aorta and the aortic arch. Surgical procedures in this area have received increasing attention in the last few years and have been subjected to several modifications. Especially the development of interventional radiological endovascular techniques that reduce the invasive nature of surgery as well as complication rates led to rapid advancements. Thoracoabdominal aortic aneurysm (TAAA) repair still remains a challenging operation since it necessitates extended exposure of the aorta and reimplantation of the vital aortic branches. Among possible postoperative complications, spinal cord injury (SCI) seems one of the most formidable morbidities. Strategies for TAAA repair and the best and most reasonable approach to prevent SCI after TAAA repair are presented
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