Brief Risk Communication for Emergency Department Patients With Sustained Asymptomatic Hypertension.

Introduction: Sustained asymptomatic hypertension in ED patients is a powerful predictor of chronic uncontrolled hypertension. In this study, we assess the feasibility of using a storyboard video and communicating real-time cardiovascular imaging results on blood pressure control and primary care engagement.

Methods: This was a prospective observational exploratory sub-study.

Stage B Heart Failure Is Ubiquitous in Emergency Patients with Asymptomatic Hypertension.

Introduction: Hypertension is the leading risk factor for morbidity and mortality throughout the world and is pervasive in United States emergency departments (ED). This study documents the point prevalence of subclinical heart disease in emergency patients with asymptomatic hypertension.

Method: This was a prospective observational study of ED patients with asymptomatic hypertension conducted at two urban academic EDs that belong to an eight-hospital healthcare organization in New York.

International consensus conference recommendations on ultrasound education for undergraduate medical students.

Objectives: The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students.

Methods: 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions.

Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus.

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus.

Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week.

Focused transthoracic echocardiography (TTE) during cardiac arrest resuscitation can enable the characterization of myocardial activity, identify potentially treatable pathologies, assist with rhythm interpretation, and provide prognostic information. However, an important limitation of TTE is the difficulty obtaining interpretable images due to external and patient-related limiting factors. Over the last decade, focused transesophageal echocardiography (TEE) has been proposed as a tool that is ideally suited to image patients in extremis-those in cardiac arrest and periarrest states.

Including Insonation in Undergraduate Medical School Curriculum.

Insonation, or the use of ultrasound, has been proposed to be included in the medical school curriculum, both for education and bedside physical examination. It is important to consider what impact insonation should have on medical student education. Increasingly students are exposed to ultrasound use on clinical rotations, but to what extent should ultrasound be an integrated part of the preclinical curriculum in the United States? Ultrasound can serve to augment an existing curriculum in anatomy, physiology, physical examination, and disease assessment and treatment.

Point-of-care ultrasound diagnosis of stump appendicitis in the emergency department.

Background: Stump appendicitis (SA) is a rare entity in patients with a history of appendectomy and may result in missed or delayed diagnosis. We report a case of SA diagnosed by emergency department (ED) point-of-care ultrasound (PoCUS) in an elderly woman, thus expediting her care.

Case Presentation: An elderly female patient with a history of appendectomy 27 years ago was referred by her physician to the ED with right lower quadrant pain for 2 days.

CLEAR: A Novel Approach to Ultrasound Equipment Homeostasis.

Protocols for the sanitation and maintenance of point-of-care ultrasound (US) equipment are lacking. This study introduces the CLEAR protocol (clean, locate, energize, augment supplies, and remove patient identifiers) as a tool to improve the readiness of US equipment, termed US equipment homeostasis. The state of US equipment homeostasis in the emergency department of a single academic center was investigated before and after implementing this protocol, with an improvement in outcomes.

Variability in Interpretation of Cardiac Standstill Among Physician Sonographers.

Study Objective: Cardiac standstill on point-of-care ultrasonography has been widely studied as a marker of prognosis in cardiac arrest. Return of spontaneous circulation has been reported in as few as 0% and as many as 45% of patients with cardiac standstill. When explicitly documented, the definition of cardiac activity in these studies varied from any slight change in echogenicity of the myocardium to any kinetic cardiac activity.

Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial.

Objectives: To compared outcomes of regional nerve blocks with those of standard analgesics after hip fracture.

Design: Multisite randomized controlled trial from April 2009 to March 2013.

Setting: Three New York hospitals.

Point-Of-Care Ultrasound Diagnosis of Intravascular Air After Lower Extremity Intraosseous Access.

Background: Vascular air embolism is a rare but potentially deadly phenomenon. Early diagnosis allows providers to initiate measures aimed at preventing further air entry, preventing the migration of air to the lungs, and mitigating the hemodynamic effects of pulmonary air embolism.

Case Report: An emergency physician used point-of-care ultrasound to identify intravascular air before embolization to the pulmonary vasculature.

Seeing Is Believing: Evaluating a Point-of-Care Ultrasound Curriculum for 1st-Year Medical Students.

Problem: Point-of-care ultrasound has been a novel addition to undergraduate medical education at a few medical schools. The impact is not fully understood, and few rigorous assessments of educational outcomes exist. This study assessed the impact of a point-of-care ultrasound curriculum on image acquisition, interpretation, and student and faculty perceptions of the course.

Feasibility and Safety of Substituting Lung Ultrasonography for Chest Radiography When Diagnosing Pneumonia in Children: A Randomized Controlled Trial.

Background: Chest radiography (CXR) is the test of choice for diagnosing pneumonia. Lung ultrasonography (LUS) has been shown to be accurate for diagnosing pneumonia in children and may be an alternative to CXR. Our objective was to determine the feasibility and safety of substituting LUS for CXR when evaluating children suspected of having pneumonia.

Evaluation of an Obstetric Ultrasound Curriculum for Midwives in Liberia.

Objectives: Point-of-care ultrasound is an effective tool for clinical decision making in low- and middle-income countries, but lack of trained providers is a barrier to its utility in these settings. In Liberia, given that midwives provide most prenatal care, it is hypothesized that training them in prenatal ultrasound through an intensive condensed training course is both feasible and practical.

Methods: This quantitative prospective study of preobservational and postobservational assessment evaluated a 1-week ultrasound curriculum consisting of 4 modules, each comprising a didactic component, a practical session, and supervised patient encounters.

Point-of-Care Ultrasound and the Rapid Response System.

Over the years, the use of ultrasound has moved solely from the domain of the radiologist to that of the intensivist and emergentologist for use in acute care settings. By virtue of its ease of use and rapid learning curve to proficiency, we are now seeing an increased desire by internists to learn the modality and apply it at the patient's bedside. The rapid response system represents a rational starting point for the introduction of point-of-care ultrasound to the inpatient ward setting.

Point-of-Care Cardiac Ultrasound: Feasibility of Performance by Noncardiologists.

Cardiac ultrasound has been used for decades to assess a wide variety of structural and functional pathology, as well as to monitor response to therapy. It offers the advantages of noninvasive, real-time dynamic functional assessment without the risk of radiation. Cardiologists have traditionally employed this modality and have established robust guidelines on the use of echocardiography.