A National Point‐of‐Care Ultrasound Competition for Medical Students

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146850/1/jum14670_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146850/2/jum14670.pd

Risk Stratification of Chest Pain Patients in the Emergency Department by Assessing Diastolic Function Using Tissue Doppler Imaging of Left Ventricular Wall Segments

BACKGROUND Chest pain is one of the most common chief complaints seen within emergency departments (ED). Diagnostic tests are therefore key to parsing out high risk and low risk chest pain patients. Tissue Doppler Imaging (TDI) is a means of assessing myocardial tissue motion in order to assess the function of the myocardium. Specifically, TDI can detect impaired relaxation of the heart during early diastole, which precedes ischemic changes on electrocardiogram (EKG) and ischemic systolic wall dysfunction on echocardiography. In this proof-of-concept study, we propose that the use of TDI in the ED can function as an objective tool allowing emergency providers to more accurately stratify chest pain patients into high-risk and low-risk groups. METHODS Early diastolic left ventricular wall movement (E’) was measured in a total of 60 patients using the TDI method at the medial, lateral, anterior, and posterior/inferior mitral annulus. Normal tissue velocity was defined as \u3e9 cm/s for the lateral, anterior, and posterior/inferior walls, and a septal wall speed of \u3e7 cm/s. Studies were performed by two independent operators. Patients with one or more abnormal TDI value by either echocardiographer were considered positive for an abnormal study. The results of the study were compared to a diagnosis of ischemic chest pain determined by the gold standard cardiac workup including EKG findings, HEART score for major cardiac events, troponin levels, stress test, and any further intervention. RESULTS The specificity of TDI for detecting ischemic causes was 72.55% (95% CI of 58.02-83.67) with a sensitivity of 100% (95% CI of 39.60-100.00). In addition, the test demonstrated a positive predictive value (PPV) of 22.22% (95% CI of 7.37-48.10) and a negative predictive value (NPV) of 1 (95% CI of 88.29-100.00). Likelihood ratios were calculated as a positive likelihood ratio of 3.64 (95% CI of 2.33-5.70) and a negative likelihood ratio of 0. CONCLUSION This proof-of-concept study demonstrated a high specificity and sensitivity for detecting ischemic causes of chest pain and can serve as an adjunct to the current standard chest pain workup and aid in decision making. The study does not imply that TDI can replace other modalities of current chest pain workup. Further studies are needed to investigate the limitations of TDI as well as its indications in the management of patients presenting to the ED with chest pain

Time to correct the flow of corrected flow time

Abstract Recently published study of Ma et al. evaluates two relatively novel measures of fluid responsiveness, carotid blood flow and corrected carotid flow time (ccFT). Both measures have been recently quoted as possibly useful, technically simple, and noninvasive dynamic tools in predicting fluid responsiveness. Recently, more research interest has been focused on ccFT and, intrigued by the data presented in this study, we discuss here the impact of the data presented in the paper of Ma et al. to the significance of this metric as a potential tool in the assessment of fluid responsiveness

Role of Ultrasound in the Identi cation of Longitudinal Axis in Soft-Tissue Foreign Body Extraction

Identification and retrieval of soft-tissue foreign bodies (STFB) poses significant challenges in the emergency department. Prior studies have demonstrated the utility of ultrasound (US) in identification and retrieval of STFBs, including radiolucent objects such as wood. We present a case of STFB extraction that uses US to identify the longitudinal axis of the object. With the longitudinal axis identified, the foreign body can be excised by making an incision where the foreign body is closest to the skin. The importance of this technique as it pertains to minimizing surrounding tissue destruction and discomfort for patients has not been previously reported

False Positive Appendicitis on Bedside Ultrasound

NA (Image report

Role of Ultrasound in the Identification of Longitudinal Axis in Soft-Tissue Foreign Body Extraction

Identification and retrieval of soft tissue foreign bodies (STFBs) poses significant challenges in the emergency department. Prior studies have demonstrated the utility of ultrasound in identification and retrieval of STFBs, including radiolucent objects such as wood. We present a case of STFB extraction that utilizes ultrasound to identify the longitudinal axis of the object.  With the longitudinal axis identified, the foreign body can be excised by making an incision where the foreign body is closest to the skin. The importance of this technique as it pertains to minimizing surrounding tissue destruction and discomfort for patients has not been previously reported

Utility of ultrasound in managing acute medical conditions in space: a scoping review.

BACKGROUND: In long-distance spaceflight, the challenges of communication delays and the impracticality of rapid evacuation necessitate the management of medical emergencies by onboard physicians. Consequently, these physicians must be proficient in tools, such as ultrasound, which has proven itself a strong diagnostic imaging tool in space. Yet, there remains a notable gap in the discourse surrounding its efficacy in handling acute medical scenarios. This scoping review aims to present an updated analysis of the evidence supporting the role of ultrasound in diagnosing acute conditions within microgravity environments. METHODS: A systematic search was executed across three bibliographic databases: PubMed, EMBASE (Embase.com), and the Web of Science Core Collection. We considered articles published up to February 25, 2023, that highlighted the application of ultrasound in diagnosing acute medical conditions in either microgravity or microgravity-simulated settings. Exclusions were made for review papers, abstracts, and in-vitro studies. RESULTS: After removing duplicates, and filtering papers by pre-determined criteria, a total of 15 articles were identified that discuss the potential use of ultrasound in managing acute medical conditions in space. The publication date of these studies ranged from 1999 to 2020. A relatively similar proportion of these studies were conducted either on the International Space Station or in parabolic flight, with one performed in supine positioning to simulate weightlessness. The included studies discuss acute pathologies, such as abdominal emergencies, decompression sickness, deep venous thrombosis, acute lung pathologies, sinusitis, musculoskeletal trauma, genitourinary emergencies, and ocular emergencies. CONCLUSIONS: While ultrasound has shown promise in addressing various acute conditions, significant knowledge gaps remain, especially in gastrointestinal, cardiac, vascular, and reproductive emergencies. As we venture further into space, expanding our medical expertise becomes vital to ensure astronaut safety and mission success

Ultrasound detected increase in optic disk height to identify elevated intracranial pressure: a systematic review

Abstract Background Elevated intracranial pressure (eICP) is a serious medical emergency that requires prompt identification and monitoring. The current gold standards of eICP detection require patient transportation, radiation, and can be invasive. Ocular ultrasound has emerged as a rapid, non-invasive, bedside tool to measure correlates of eICP. This systematic review seeks to explore the utility of ultrasound detected optic disc elevation (ODE) as an ultrasonographic finding of eICP and to study its sensitivity and specificity as a marker of eICP. Methods This systematic review followed the preferred reporting items for systematic reviews and meta-analyses guidelines. We systematically searched PubMed, EMBASE, and Cochrane Central for English articles published before April 2023; yielding 1,919 total citations. After eliminating duplicates, and screening the records, we identified 29 articles that addressed ultrasonographically detected ODE. Results The 29 articles included a total of 1249 adult and pediatric participants. In patients with papilledema, the mean ODE ranged between 0.6 mm and 1.2 mm. Proposed cutoff values for ODE ranged between 0.3 mm and 1 mm. The majority of studies reported a sensitivity between 70 and 90%, and specificity ranged from 69 to 100%, with a majority of studies reporting a specificity of 100%. Conclusions ODE and ultrasonographic characteristics of the optic disc may aid in differentiating papilledema from other conditions. Further research on ODE elevation and its correlation with other ultrasonographic signs is warranted as a means to increase the diagnostic accuracy of ultrasound in the setting of eICP

Ultrasound detected increase in optic disk height to identify elevated intracranial pressure: a systematic review.

BackgroundElevated intracranial pressure (eICP) is a serious medical emergency that requires prompt identification and monitoring. The current gold standards of eICP detection require patient transportation, radiation, and can be invasive. Ocular ultrasound has emerged as a rapid, non-invasive, bedside tool to measure correlates of eICP. This systematic review seeks to explore the utility of ultrasound detected optic disc elevation (ODE) as an ultrasonographic finding of eICP and to study its sensitivity and specificity as a marker of eICP.MethodsThis systematic review followed the preferred reporting items for systematic reviews and meta-analyses guidelines. We systematically searched PubMed, EMBASE, and Cochrane Central for English articles published before April 2023; yielding 1,919 total citations. After eliminating duplicates, and screening the records, we identified 29 articles that addressed ultrasonographically detected ODE.ResultsThe 29 articles included a total of 1249 adult and pediatric participants. In patients with papilledema, the mean ODE ranged between 0.6 mm and 1.2 mm. Proposed cutoff values for ODE ranged between 0.3 mm and 1 mm. The majority of studies reported a sensitivity between 70 and 90%, and specificity ranged from 69 to 100%, with a majority of studies reporting a specificity of 100%.ConclusionsODE and ultrasonographic characteristics of the optic disc may aid in differentiating papilledema from other conditions. Further research on ODE elevation and its correlation with other ultrasonographic signs is warranted as a means to increase the diagnostic accuracy of ultrasound in the setting of eICP

Adiponectin levels are associated with coronary artery disease across Caucasian and African-American ethnicity.

The hypothesis was tested that plasma levels of adiponectin would be associated with coronary artery disease (CAD) across African-American and Caucasian ethnicity and gender. Adiponectin levels, cardiovascular risk factors, and extent of CAD were measured in 453 subjects (173 African-American and 280 Caucasian men and women). The distribution of adiponectin levels differed significantly between African-Americans and Caucasians (P<0.0001). Among African-Americans, the adiponectin distribution was skewed toward lower levels. For women, adiponectin levels were higher among Caucasians compared with African-Americans (P<0.001), whereas no interethnic difference was observed for men. Irrespective of ethnic group, subjects with CAD had lower levels of adiponectin than did subjects without CAD. Adiponectin was negatively and significantly associated with waist-hip ratio, body mass index, diastolic blood pressure, insulin level, and homeostasis model assessment-insulin resistance in both ethnic groups. Among lipid parameters, total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels were negatively correlated with adiponectin, whereas the high-density lipoprotein cholesterol level correlated positively for both African-Americans and Caucasians. In a multiple regression model, controlling for gender, ethnicity, and other CAD risk factors, adiponectin levels were negatively associated with CAD (P<0.05). The results indicate that, across gender and ethnicity, low adiponectin levels may be an independent risk factor for CAD