Governance Considerations for Point-of-Care Ultrasound: a HIMSS-SIIM Enterprise Imaging Community Whitepaper in Collaboration with AIUM.

Point-of-care ultrasound (POCUS) has emerged as a standard of care across a variety of healthcare settings due to its ability to provide critical clinical information and as well as procedural guidance to clinicians directly at the bedside. Implementation of enterprise imaging (EI) strategies is needed such that POCUS images can be appropriately captured, indexed, managed, stored, distributed, viewed, and analyzed. Because of its unique workflow and educational requirements, reliance on traditional order-based workflow solutions may be insufficient.

Just the facts: brachial plexus blocks for upper extremity injuries in the emergency department.

Ultrasound-guided nerve blocks (UGNBs) are becoming a more common method for pain control in the emergency department. Specifically, brachial plexus blocks have shown promise for acute upper extremity injuries as well as an alternative to procedural sedation for glenohumeral reductions. Unfortunately, there is minimal discussion in the EM literature regarding phrenic nerve paralysis (a well-known complication from brachial plexus blocks).

Does needle positioning with magnetic field induction improve central venous catheterization performance by novice learners?

Objective: The novel ultrasound magnetic needle navigation technique can visualize the entire needle and identify its projected trajectory. We hypothesized that this technique increases the first-attempt success rate of central venous puncture by novice learners compared with the conventional needle navigation technique.

Methods: This prospective, randomized, controlled trial with a crossover design included 50 participants with limited prior experience in US-guided procedures.

Evaluation of Soft-Tissue Hematomas With Real-Time, Contrast-Enhanced Ultrasound: A Pilot Study With Preliminary Findings.

In this study, we investigated the feasibility of using contrast-enhanced ultrasound (CEUS) to detect active hemorrhage in patients presenting with soft-tissue hematomas. Adult patients with clinically suspected, actively bleeding hematomas were prospectively enrolled. Contrast-enhanced ultrasound was used to assess for contrast extravasation.

Precise Limb Tourniquet Arterial Occlusion Pressure Determination using Real-Time Ultrasonography and a Capacitive-Based Force Sensor.

Background: Hemorrhage control prior to shock onset is increasingly recognized as a time-critical intervention. Although tourniquets (TQs) have been demonstrated to save lives, less is known about the physiologic parameters underlying successful TQ application beyond palpation of distal pulses. The current study directly visualized distal arterial occlusion via ultrasonography and measured associated pressure and contact force.

Real-time Ultrasound-Guided Manual Testicular Detorsion: A Case Report.

Introduction: Acute testicular torsion is a surgical emergency due to acute testicular ischemia. Manual testicular detorsion is a testis-saving, bedside therapeutic when performed correctly and in a timely fashion. This procedure is most commonly performed blindly with pain relief as the endpoint for detorsion.

Point-of-Care Ultrasound Diagnosis of a Giant Left Atrial Mass.

• Cardiac myxomas can cause cardiac, embolic, and/or constitutional symptoms. • POCUS augments emergency care and assists in clinical decision-making. • Multimodality imaging can help discern CMs from thrombi and other tumors.

Cardiac Tamponade Caused by Gastrointestinal Obstruction-A Rare Complication in Esophagectomy Patients.

• Postoperative anatomical changes can cause unique disease presentations. • Tamponade physiology can occur secondary to GI obstruction in esophagectomy patients. • Point-of-care ultrasound imaging leads to expedited diagnosis and disposition.

Ultrasound-Guided Great Saphenous Vein Access: Revisiting an Old Friend in a New Location.

Background: Early recognition of difficult intravenous (i.v.) access and use of ultrasound-guided techniques prior to multiple attempts are important steps in improving patient care in the emergency department (ED).

"Swirling right ventricular" sign as a marker of right ventricular dysfunction in two patients with submassive pulmonary embolism.

Assessing the right ventricular function in patients with submassive pulmonary embolism (PE) is pivotal when determining the appropriate treatment pathway. We describe two cases of submassive PE requiring systemic thrombolysis, in which intravenous saline contrast demonstrated a noticeable lack of forward flow in the right ventricle. This technique potentially may indicate impending right ventricular functional collapse and the need for more aggressive intervention.

Ruptured Ectopic Pregnancy with an Intrauterine Device: Case Report and Sonographic Considerations.

Introduction: Ectopic pregnancy carries a high morbidity and mortality; patients are at risk for rupture and life-threatening hemorrhage.

Case Report: We present a rare case of ruptured abdominal ectopic pregnancy in a patient with a well-positioned intrauterine device (IUD) and discuss the diagnostic utility that transabdominal point-of-care ultrasound (POCUS) can have when performed at the bedside.

Conclusion: While pregnancy with an IUD in place is rare, when it is encountered the emergency provider should maintain a high degree of suspicion for extrauterine pregnancy and perform prompt evaluation for hemorrhagic shock using diagnostic POCUS.

Increased body mass index is associated with decreased imaging quality of point-of-care abdominal aortic ultrasonography.

Background: Given that abdominal aorta is a retroperitoneal structure, increased body mass index (BMI) may have an adverse effect upon the quality of aortic ultrasonographic imaging.

Purpose: To assess the hypothesis that increased BMI is associated with worsening point-of-care abdominal aortic ultrasonographic image quality.

Methods: This is a retrospective single-center study of point-of-care abdominal aortic ultrasound examinations performed in an academic emergency department (ED) with fellowship-trained emergency ultrasonography faculty performing quality assurance review.

Increased body mass index does not impact the imaging quality of focused assessment with sonography in trauma.

Background: Many clinicians believe that a patient's body mass index (BMI) affects the likelihood of obtaining high quality ultrasound images.

Objectives: To assess the hypothesis that increased BMI is associated with worsening focused assessment with sonography in trauma (FAST) image quality.

Methods: We conducted a retrospective single-center study of FAST examinations performed in a large academic emergency department (ED) with fellowship-trained emergency ultrasonography faculty performing quality assurance review.

The Efficacy of Novel Commercial Tourniquet Designs for Extremity Hemorrhage Control: Implications for Spontaneous Responder Every Day Carry.

Introduction: Tourniquets (TQs) save lives. Although military-approved TQs appear more effective than improvised TQs in controlling exsanguinating extremity hemorrhage, their bulk may preclude every day carry (EDC) by civilian lay-providers, limiting availability during emergencies.

Study Objective: The purpose of the current study was to compare the efficacy of three novel commercial TQ designs to a military-approved TQ.

Effect of two tourniquet techniques on peripheral intravenous cannulation success: A randomized controlled trial.

Objectives: Peripheral intravenous (IV) cannulation is the most common procedure performed in the emergency department (ED). Elastic tourniquets (ETs) and blood pressure cuffs (BPCs) are frequently used for venodilation. Although BPCs lead to increased venodilation and decreased compressibility, it is unclear whether this translates into a meaningful patient-centered outcome.

Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial.

Background: Treatment for epistaxis includes application of intranasal vasoconstrictors. These medications have a precaution against use in patients with hypertension. Given that many patients who present with epistaxis are hypertensive, these warnings are commonly overridden by clinical necessity.

Emergency and critical care applications for contrast-enhanced ultrasound.

Introduction: Contrast-enhanced ultrasound (CEUS) using intravascular microbubbles has potential to revolutionize point-of-care ultrasonography by expanding the use of ultrasonography into clinical scenarios previously reserved for computed tomography (CT), magnetic resonance imaging, or angiography.

Methods: We performed a literature search and report clinical experience to provide an introduction to CEUS and describe its current applications for point-of-care indications.

Results: The uses of CEUS include several applications highly relevant for emergency medicine, such as solid-organ injuries, actively bleeding hematomas, or abdominal aortic aneurysms.

Point-of-Care Ultrasound Diagnosis of Traumatic Abdominal Wall Hernia.

Traumatic abdominal wall hernias due to blunt abdominal trauma in pediatric patients can pose a diagnostic challenge because of spontaneous hernia reduction. Ultrasonography may be superior to computed tomography for this indication in some cases because of the ability to dynamically and repeatedly assess the area of injury. Herniation can be induced or exaggerated via Valsalva maneuvers, which can facilitate its detection during dynamic assessment.

Identification of Peroneal Tenosynovitis by Point-of-Care Ultrasonography.

Background: Ankle pain is a frequent chief complaint, and although peroneal tendon disorders are relatively uncommon, if treated inappropriately they may cause persistent pain and dysfunction. Peroneal tendon disorders, including the tendon sheath inflammatory condition tenosynovitis, are a major cause of chronic lateral ankle pain. Although magnetic resonance imaging has emerged as the modality of choice to assess the majority of these injuries, dynamic ultrasonography detects tendon pathology such as tenosynovitis.

Diagnosis of metacarpal fracture with equivocal x-ray by point-of-care ultrasound: a case report.

Metacarpal fractures represent a very common injury among patients presenting to the emergency department. Diagnosis is of utmost importance given the high morbidity associated with lack of full hand function. We report a case of a 37-year-old man who sustained extremity trauma after a mechanical fall.

[Thoracoabdominal sonography (E-FAST plus) -AI training module 5 in anaesthesiologist: performed focussed sonography].

Anesthesiologists and Critical Care Physicians are confronted with the differential diagnoses of dyspnea, complications of mechanical ventilation or rapid assessment of trauma patients on a nearly daily basis. This requires the timely diagnosis or exclusion of a wide variety of disease processes including pleura effusion, pneumonia, pneumothorax as well as thoracical or abdominal bleeding. Furthermore, the anaesthesiologist or intensivist often makes decisions leading to invasive procedures like thoracentesis or percutaneous dilatational tracheostomy.