Point-of-Care Emergency Ultrasonography in Non-Traumatic Cardiac Arrest and Near-Arrest Emergency Patients; A Pilot Trial

Background: In this study, we evaluated the applicability and interpretation of point-of-care emergency ultrasound (POCEUS) performed by an emergency physician (EP) in non-traumatic adult cardiac arrest and near-arrest patients at presentation to the Emergency Department (ED).   Methods: POCEUS was performed in 5 steps on 73 adults to assess; 1. Qualitative global cardiac function, cardiac chambers and presence of pericardial effusion; 2. Presence of pleural sliding, B-lines, A-lines or consolidation on anterior-superior; 3. Presence of an abdominal aorta aneurysm and pelvic free fluid; 4. Presence of pleural effusion, consolidation, free fluid on lateral-inferior; 5. Qualitative width and collapsibility of the inferior vena cava. A fulfilled checklist and real-time images of ultrasonography were sent by WhatsApp to the head of the study to generate the evidence and collect the data. The process of patient care, in-hospital diagnosis and survival were retrieved from digital hospital records. This prospective multicenter sample study was conducted from November 16, 2015, to January 5, 2016.   Results: The most common findings of POCEUS were performed and interpreted to have a first prediction of patients’ acute clinic problem by EPs were compatible with global systolic dysfunction (n = 16, 22.9%), pulmonary edema (n = 17, 23.3%), pulmonary embolus (n = 6, 8.2%), distributive/hypovolemic shock (n = 12, 16.4%), cardiac tamponade or pericardial effusion (n = 5, 6.8%), and pneumonia (n = 31, 42.5%) at presentation. The kappa correlation coefficient value of the POCEUS at presentation versus the final, traditional clinical diagnosis of the admitted ward, was 0.773 (95% CI, 0.747–0.892; p = 0.064, McNemar).   Conclusions: POCEUS performed by an EP at presentation had a good agreement between in qualitative prediction of the first differential diagnosis in life-threatened patients and the last diagnosis obtained during hospitalization. Furthermore, this study showed the requirement of evidence in comparison of measurements to the qualitative manner and new descriptive processes in POCEUS for unexplained situations and questions

The First Imaging Of Patient Performed by Emergency Medicine Physician in ED: Multi-Centered and Blind Questionnaire On Patient Relatives

Introduction: The study aim was to identify the knowledge and awareness about Point-of-Care Ultrasound (POCUS) and expectations of patients relatives regarding the first imaging method performed on patients in Emergency Departments (EDs). Materials and Method: This prospective, cross-sectional, random survey study was approved by our University Ethics Committee. A paper based questionnaire requiring chosen answers in multi choices about POCUS features was given to relatives of patients in 15 EDs. The suitability of the data structure for factor analysis was determined by using the KaiserMeyerOlkin (KMO) and the Bartlett Sphericity Test. The KMO was 0.94. The Bartlett Sphericity Test resulted in a chi-square value of 2408.9 (p = 0.0001). The SPSS 23.0 software package was used for statistical analysis of the data. Results: A total of 363 completed questionnaires were studied. The major findings were that the first imaging method - should be performed as quickly as possible by the ED physician (57.9%, n = 210), be performed at bedside (49.6%, n = 180), be harmless and risk-free (55.9%, n = 203), differentiate -the first clinical diagnosis (53.7%,n=195) n = 195), and improve ED patient survival (64.2%, n = 233). Conclusions: The patients relatives could not discriminate between the main features of POCUS and those of other ED imaging methods or were unaware of their rights regarding its use