Patient with progressive chest pain and dyspnea after aortic valve replacement.

A 45-year-old man presented to the emergency department (ED) with progressive chest pain and dyspnea 3 months after aortic valve replacement. He had been evaluated by his primary care physician and cardiologist and no diagnosis had been made. On arrival, the emergency physicians performed point-of-care ultrasonography, which showed a large hypoechoic collection compressing the right ventricle.

Correlation of OSCE performance and point-of-care ultrasound scan numbers among a cohort of emergency medicine residents.

Background: Point-of-care ultrasound (POCUS) is an important clinical tool for a growing number of medical specialties. The current American College of Emergency Physicians (ACEP) Ultrasound Guidelines recommend that trainees perform 150-300 ultrasound scans as part of POCUS training. We sought to assess the relationship between ultrasound scan numbers and performance on an ultrasound-focused observed structured clinical examination (OSCE).

A randomized trial of ultrasound-guided peripheral IV catheter placement in difficult access patients using a guidewire approach.

Objective: The purpose of this pilot study was to investigate whether use of a guidewire improves successful placement of ultrasound-guided peripheral IVs (PIV) in difficult intravenous access patients in the emergency department (ED).

Methods: This was an unblinded, prospective, randomized trial performed by emergency medicine (EM) clinicians at a single academic ED. Eligible participants were randomized to ultrasound-guided PIV placement with or without the use of a guidewire.

Diagnosing centrally located pulmonary embolisms in the emergency department using point-of-care ultrasound.

Objective: The study objective was to investigate the combined accuracy of right heart strain on focused cardiac ultrasound (FOCUS) and deep vein thrombosis (DVT) on compression ultrasound (CUS) for identification of centrally located pulmonary embolism (PE) diagnosed on computed tomography pulmonary angiography (CTPA).

Methods: This was a prospective observational study using a convenience sample of patients undergoing CTPA in the emergency department (ED) for evaluation of PE. Patients received a FOCUS looking for right heart strain (McConnell's sign, septal flattening, right ventricular enlargement or tricuspid annular plane systolic ejection (TAPSE) <17mm) and a CUS looking for DVT.

Point-of-Care Ultrasound Use, Accuracy, and Impact on Clinical Decision Making in Rwanda Hospitals.

Objectives: Few studies of point-of-care ultrasound training and use in low resource settings have reported the impact of examinations on clinical management or the longer-term quality of trainee-performed studies. We characterized the long-term effect of a point-of-care ultrasound program on clinical decision making, and evaluated the quality of clinician-performed ultrasound studies.

Methods: We conducted point-of-care ultrasound training for physicians from Rwandan hospitals.

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.

Intensive point-of-care ultrasound training with long-term follow-up in a cohort of Rwandan physicians.

Objective: We delivered a point-of-care ultrasound training programme in a resource-limited setting in Rwanda, and sought to determine participants' knowledge and skill retention. We also measured trainees' assessment of the usefulness of ultrasound in clinical practice.

Methods: This was a prospective cohort study of 17 Rwandan physicians participating in a point-of-care ultrasound training programme.

Evaluation of the Aortic Arch from the Suprasternal Notch View Using Focused Cardiac Ultrasound.

Background: The suprasternal notch view (SSNV) is an additional echocardiographic view not routinely used by emergency physicians (EPs) performing focused cardiac ultrasound (FOCUS).

Objective: This pilot study determined the ease and self-perceived accuracy of the SSNV as performed by EPs. Additionally, we assessed the accuracy of FOCUS including the SSNV in thoracic aortic measurements compared to chest CT angiography (CTA).

Point-of-care ultrasonography for the diagnosis of small bowel obstruction in the emergency department.

Small bowel obstruction (SBO) is a common cause of acute abdominal pain presenting to the emergency department (ED). Although the literature is limited, point-of-care ultrasonography (POCUS) has been found to have superior diagnostic accuracy for SBO compared to plain radiography; however, it is rarely used in North America for this. We present the case of a middle-aged man who presented with abdominal pain where POCUS by the emergency physician early in the hospital course expedited the diagnosis of SBO and led to earlier surgical consultation.

A practical guide to self-sustaining point-of-care ultrasound education programs in resource-limited settings.

The value of point-of-care ultrasound education in resource-limited settings is increasingly recognized, though little guidance exists on how to best construct a sustainable training program. Herein we offer a practical overview of core factors to consider when developing and implementing a point-of-care ultrasound education program in a resource-limited setting. Considerations include analysis of needs assessment findings, development of locally relevant curriculum, access to ultrasound machines and related technological and financial resources, quality assurance and follow-up plans, strategic partnerships, and outcomes measures.

Positive FAST without hemoperitoneum due to fluid resuscitation in blunt trauma.

Background: The focused assessment with sonography in trauma (FAST) examination is an important screening tool in the evaluation of blunt trauma patients.

Objectives: To describe a case of a hemodynamically unstable polytrauma patient with positive FAST due to fluid resuscitation after blunt trauma.

Case Report: We describe a case of a hemodynamically unstable polytrauma patient who underwent massive volume resuscitation prior to transfer from a community hospital to a trauma center.

Emergency ultrasound diagnosis of ovarian hyperstimulation syndrome: case report.

Background: Ovarian hyperstimulation syndrome (OHSS) is an exaggerated response to ovulation induction therapy. It is a known complication of ovarian stimulation in patients undergoing treatment for infertility. As assisted reproductive technology and the use of ovulation induction agents expands, it is likely that there will be more cases of OHSS presenting to the Emergency Department (ED).

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.