scholarly journals Challenges and opportunities in point-of-care ultrasound: A qualitative exploration of respiratory physiotherapists’ experiences of lung ultrasound training and its adoption in critical care

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110341
Author(s):  
Simon Hayward ◽  
Sue Innes ◽  
Mike Smith
Keyword(s):  
Critical Care ◽  
Clinical Practice ◽  
Lung Ultrasound ◽  
Imaging Modality ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Online Appendix ◽  
Adoption And Implementation ◽  
Patient Pathways ◽  
Challenges And Opportunities

Introduction Diagnostic lung ultrasound (LUS) is gaining popularity among respiratory physiotherapists as an imaging modality to aid pulmonary assessments, guide intervention selection, and monitor the efficacy of chosen interventions. The ability of respiratory physiotherapists to incorporate LUS into their clinical practice is influenced by multiple factors to adoption and implementation. The aim of this study was to explore the experiences of senior respiratory physiotherapists who have attempted to adopt and implement LUS into their clinical practice in critical care. It is hoped these experiences will inform the development of educational and adoption strategies for the future implementation of LUS. Methods Following a national call out, eight senior critical care respiratory physiotherapists were purposively selected to be interviewed using semi-structured questions exploring their varied experiences of LUS adoption into clinical practice in critical care. The transcribed data were thematically analysed. Results Five main themes emerged from the participants’ responses: (i) support for physiotherapists using LUS, (ii) knowledge and understanding of LUS evidence, (iii) governance, (iv) physiotherapists’ motivation to use LUS, and (v) resources. Quotes for each of the five themes are given as exemplars. Conclusion Participants reported a range of factors that influenced their ability to adopt and implement LUS into practice several were enabling, and others were barriers to progress. Online Appendix 1 contains recommendations from the authors to help guide managers and clinicians wishing to adopt LUS into respiratory physiotherapy services and patient pathways.

Paediatric ultrasound

2019 ◽  
pp. 217-224
Author(s):  
Jason Fischer ◽  
Lianne McLean
Keyword(s):  
Critical Care ◽  
Abdominal Pain ◽  
Pyloric Stenosis ◽  
Imaging Modality ◽  
Point Of Care ◽  
Adult Patients ◽  
Point Of Care Ultrasound ◽  
Lung Pathology ◽  
Skull Fractures ◽  
Body Habitus

This chapter highlights the increasing use of point-of-care ultrasound (PoCUS) in children. The size and body habitus of infants and children are often ideal for sonographic visualization and make PoCUS an ideal imaging modality for paediatric patients. PoCUS applications that have been traditionally used for adult patients are increasingly being adopted for the care of children. Paediatric-specific applications are also being developed for problems common and unique to paediatrics. Focused abdominal scans for appendicitis, intussusception, and pyloric stenosis are now frequently used in patients presenting with abdominal pain or vomiting. PoCUS can differentiate lung pathology and is helpful in the assessment of suspected skull fractures in non-verbal infants. Ongoing integration of PoCUS into shock, trauma, and triage algorithms support its increasing role in paediatric emergency and critical care.

scholarly journals Fluid Volume Status Assessment by Lung Ultrasonography in Patients with Kidney Disease.

2021 ◽  
Vol 4 (03) ◽  
Author(s):  
Navid Saigal
Keyword(s):  
Critical Care ◽  
Kidney Disease ◽  
Physical Examination ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Fluid Management ◽  
Point Of Care Ultrasound ◽  
Lung Ultrasonography ◽  
Lung Water ◽  
Status Assessment

Point-of-care ultrasound (POCUS) has become firmly established in acute and critical care settings and has now emerged as an important tool in the assessment of the Extra Vascular Lung Water (EVLW). Lung ultrasound (LUS) can be performed quickly and easily in critically ill patients. It has a higher diagnostic accuracy than physical examination and chest radiography combined. It enhances safety by avoiding ionizing radiation and the need for potentially dangerous transfers within the hospital. LUS can also be used to guide fluid management.

scholarly journals Signs and lines in lung ultrasound

2021 ◽  
Vol 21 (86) ◽  
pp. e225-e233
Author(s):  
Rohit Bhoil ◽  
◽  
Ajay Ahluwalia ◽  
Rajesh Chopra ◽  
Mukesh Surya ◽  
...  
Keyword(s):  
Critical Care ◽  
Pleural Effusion ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Colour Doppler ◽  
Lung Density ◽  
Pathological Conditions ◽  
B Lines ◽  
Lung Point

Point-of-care ultrasound has become firmly established in acute and critical care settings, and is now increasingly being used as an important tool in the assessment of the lungs. In this article, we briefly describe the technique of lung ultrasound and the various lines and signs commonly encountered during sonography of the lung, namely the normally visualised A- and T-lines and the bat sign, sliding sign (power slide sign on colour Doppler), sea-shore sign, curtain sign, and the lung pulse. We have also described signs seen in various pathological conditions like B-lines seen in cases of increased lung density; the quad sign, sinusoid sign, thoracic spine sign, plankton sign and the jelly fish sign seen in pleural effusion; the stratosphere sign and the lung point sign seen in pneumothorax; the shred/fractal sign and tissue-like sign in consolidation, and the double lung point sign seen in transient tachypnoea of the newborn. With adequate and appropriate training, lung ultrasound can be effectively utilised as a pointof-care investigation.

scholarly journals Not Just Hocus POCUS: Implementation of a Point of Care Ultrasound Curriculum for Internal Medicine Trainees at a Large Residency Program

2019 ◽  
Vol 184 (11-12) ◽  
pp. 901-906 ◽  
Author(s):  
Thomas E Mellor ◽  
Zachary Junga ◽  
Sarah Ordway ◽  
Timothy Hunter ◽  
William T Shimeall ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Critical Care ◽  
Clinical Practice ◽  
Residency Program ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Ultrasound Guided ◽  
Absolute Increase ◽  
Post Test ◽  
Academic Year

Abstract Introduction In 2018, the American College of Physicians formally acknowledged the importance of Point of Care Ultrasound (POCUS) to the practice of internal medicine (IM). For the military internist, POCUS training is critical for care of the trauma patient in austere environments, mass casualty events and natural disasters. While emergency medicine and critical care training programs have adopted POCUS education, few IM programs have integrated POCUS into their core curricula. We designed and implemented an iterative POCUS curriculum for trainees at a large military IM residency program over a two-year period. Methods In collaboration with our critical care and simulation departments, we developed a pilot curriculum consisting of five, 60-minute courses offered on a voluntary basis at monthly intervals throughout 2017. Based on the pilot’s success we incorporated a POCUS curriculum into the core academics received by all IM trainees during the 2017–2018 academic year. Trainees attended seven, 3-hour sessions during their scheduled academic time taught by subspecialists with POCUS expertise in an on-site simulation center. Baseline surveys and knowledge assessment examinations were administered during orientation and repeated at the end of the academic year. Comparison of results before and after the POCUS curriculum was the primary outcome evaluated. Results Intervention #1: Pilot, 2016–2017 Academic Year 45 trainees attended at least one course with an average of 1.8 sessions per trainee. Baseline survey data showed 91% of trainees believe POCUS is quite or extremely beneficial for their patients, but 73% feel slightly or not at all confident in POCUS knowledge. The pre-test mean and median scores were 71% and 77% respectively, which both increased to a post-test mean and median of 81%. Post-test mean percentage correct for trainees attending 1, 2, or 3 courses was 74%, 82%, and 91% respectively. Intervention #2: Incorporation of POCUS into Core Academics, 2017–2018 Academic Year All 75 trainees participated in training with an average of 3.77 sessions attended per trainee. Survey analysis revealed significant improvement in confidence of performing ultrasound-guided procedures (p = 0.0139), and a 37% absolute increase in respondents who anticipate using ultrasound in their clinical practice (p = 0.0003). The mean pre-test score was 67.8% with median of 63.6% while mean and median post-test scores were 82.1% and 81.8%, with an absolute improvement of 14.3% and 18.2% respectively (p = 0.0004). Conclusion A structured POCUS curriculum was successfully incorporated at a large multiservice military IM residency program, with demonstrated retention of knowledge, improved confidence in performance of ultrasound guided invasive procedures, and increased interest in the use of POCUS in future clinical practice. Similar programs should be implemented across all IM programs in military graduate medical education to enhance operational readiness and battlefield care.

Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 13-14
Author(s):  
Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽  
Maryam Al Ali, MBBS
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Critical Care Unit ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

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

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Arif Hussain ◽  
Gabriele Via ◽  
Lawrence Melniker ◽  
Alberto Goffi ◽  
Guido Tavazzi ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Expert Panel ◽  
Point Of Care ◽  
Expert Consensus ◽  
Future Research ◽  
Point Of Care Ultrasound ◽  
The Past ◽  
Modified Delphi ◽  
Grade Methodology

AbstractCOVID-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. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

Current Clinical Practice in Point-of-Care Ultrasound Use in the PICUs Across Europe

2020 ◽  
Vol 21 (9) ◽  
pp. e716-e722
Author(s):  
Martien H. Humblet ◽  
Yogen Singh ◽  
Cecile Tissot ◽  
Daniele De Luca ◽  
Piet L. Leroy
Keyword(s):  
Clinical Practice ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Current Clinical Practice

scholarly journals Interstitial syndrome-lung ultrasound B lines: a potential marker for pulmonary metastases? A case series

2018 ◽  
Vol 12 (3) ◽  
pp. 223-226 ◽  
Author(s):  
Maria Viviana Carlino ◽  
Costantino Mancusi ◽  
Giovanni De Simone ◽  
Filomena Liccardi ◽  
Mario Guarino ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Point Of Care ◽  
Case Series ◽  
Point Of Care Ultrasound ◽  
Interstitial Syndrome ◽  
Potential Marker ◽  
Bilateral Lung ◽  
Enhanced Computed Tomography

Four patients presented to the Emergency Department with dyspnea and they underwent point-of-care ultrasound. Lung ultrasound showed a diffuse bilateral B-profile pattern-interstitial syndrome, they underwent contrast-enhanced computed tomography scan of thorax that showed multiple bilateral lung metastases. The detection, in a dyspneic patient, of a diffuse Bprofile pattern not attributable to traditional interstitial syndrome conditions (pulmonary fibrosis, acute respiratory distress syndrome, acute pulmonary edema, interstitial pneumonia) could be indicative of multiple pulmonary metastases.

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