Using lung ultrasound to differentiate patients in acute dyspnea in the prehospital emergency setting

The diagnosis and treatment of dyspnea in the emergency department and in the prehospital setting is a challenge faced by the emergency physician and other prehospital care providers. While the use of lung ultrasound as a diagnostic tool in dyspneic patients has been well researched, there has been limited evaluation of its use in the prehospital setting. In the previous issue of Critical Care, Prosen and colleagues study the accuracy of lung ultrasound compared with both N-terminal pro-brain natriuretic peptide and the clinical examination for differentiating between acute decompensated congestive heart failure and chronic obstructive pulmonary disease exacerbations for patients in the prehospital setting. Their article adds to the growing body of evidence demonstrating the diagnostic efficacy of lung ultrasound in differentiating between these two disease processes in the acutely dyspneic patient

Pilot Point-of-Care Ultrasound Curriculum at Harvard Medical School: Early Experience

Introduction: Point-of-care ultrasound (POCUS) is expanding across all medical specialties. As the benefits of US technology are becoming apparent, efforts to integrate US into pre-clinical medical education are growing. Our objective was to describe our process of integrating POCUS as an educational tool into the medical school curriculum and how such efforts are perceived by students. Methods: This was a pilot study to introduce ultrasonography into the Harvard Medical School curriculum to first- and second-year medical students. Didactic and hands-on sessions were introduced to first-year students during gross anatomy and to second-year students in the physical exam course. Student-perceived attitudes, understanding, and knowledge of US, and its applications to learning the physical exam, were measured by a post-assessment survey. Results: All first-year anatomy students (n=176) participated in small group hands-on US sessions. In the second-year physical diagnosis course, 38 students participated in four sessions. All students (91%) agreed or strongly agreed that additional US teaching should be incorporated throughout the four-year medical school curriculum. Conclusion: POCUS can effectively be integrated into the existing medical school curriculum by using didactic and small group hands-on sessions. Medical students perceived US training as valuable in understanding human anatomy and in learning physical exam skills. This innovative program demonstrates US as an additional learning modality. Future goals include expanding on this work to incorporate US education into all four years of medical school

Young Woman with a Fever and Chest Pain

A 26-year-old female presented to the emergency department with three days of subjective fevers, dry cough and pleuritic chest discomfort. On exam, her vital signs were significant for a heart rate of 106/minute and oxygen saturation of 95% on room air. Her lung exam revealed decreased breath sounds at the right base. A bedside lung ultrasound and a chest radiograph were performed (Figure 1a, Figure 2, and Video)

Young Woman with a Fever and Chest Pain

A 26-year-old female presented to the emergency department with three days of subjective fevers, dry cough and pleuritic chest discomfort. On exam, her vital signs were significant for a heart rate of 106/minute and oxygen saturation of 95% on room air. Her lung exam revealed decreased breath sounds at the right base. A bedside lung ultrasound and a chest radiograph were performed (Figure 1a, Figure 2, and Video)