Archives

Postpartum reverse-Takotsubo from pheochromocytoma diagnosed by bedside point-of-care ultrasound: A case report

Jordan K. Leitch, MD, FRCPC; Anthony M.-H. Ho, MD, FRCPC, FCCP; Rene Allard, MD, FRCPC; Glenio B. Mizubuti, MD, MSc – Point-of-care ultrasound is invaluable in the setting of obstetric anesthesia, where the differential diagnosis for dyspnea, hypoxemia and/or hemodynamic abnormalities is broad. This report describes a previously apparently healthy parturient with an uncomplicated pregnancy at 35-weeks gestation who underwent an emergency cesarean section under general anesthesia due to severe acute abdominal pain and fetal bradycardia.

The Focused Assessment with Sonography in Cancer (FASC) Examination

Peter C. Nauka; MD; Benjamin T. Galen, MD – Malignant effusions occur frequently in patients with cancer and are important to diagnose and treat. In this report, we describe a novel point-of-care ultrasound (POCUS) protocol to rapidly identify pleural effusion, pericardial effusion, and ascites: The Focused Assessment with Sonography in Cancer (FASC). This protocol utilizes six standard sonographic positions to identify the presence of fluid in common anatomic spaces. The FASC examination is intended for widespread use by oncologists and other clinicians who treat patients with cancer.

Developing and Evaluating a Remote Quality Assurance System for Point-of-Care Ultrasound for an Internal Medicine Residency Global Health Track

Steven Fox, MD; Michelle Fleshner, MD MPH; Collin Flanagan, DO; Thomas Robertson, MD; Ayako Wendy Fujita, MD; Divya Bhamidipati, MD; Abdulrahman Sindi, MD; Raghunandan Purushothaman, MD; Thuy Bui, MD – A quality assurance system is vital when using point-of-care ultrasound (POCUS) to ensure safe and effective ultrasound use. There are many barriers to implementing a quality assurance system including need for costly software, faculty time, and extra work to log images.

Accelerated Remote Consultation Tele-POCUS in Cardiopulmonary Assessment (ARCTICA)

Jeffrey Lam, MD; Sherwin Wong, BHSc MD; Nicholas Grubic, BScH; Salwa Nihal, MD(MBBS) MPhil MSc; Julia E. Herr, MSc; Daniel J. Belliveau, MD; Stephen Gauthier, MD; Steven J. Montague, MD; Amer M. Johri MD MSc FRCPC FASE – The ability of point-of-care ultrasound (POCUS) to provide rapid and accurate bedside assessment of both the heart and lungs allows it to be a powerful tool in the management of patients presenting with dyspnea. However, while ultrasound equipment is readily available even in remote healthcare settings in Canada, physicians lack effective training opportunities to develop expertise in this potentially life-saving skill.

Point-of-Care Ultrasound is Having Its Moment

Resa E. Lewiss, MD; Rachel B. Liu MD; Robert Strony DO – Ultrasound performed at the point of care (POCUS) is having its moment. The COVID-19 pandemic has seemingly caused the acceleration of POCUS acceptance by hospital leaders, and POCUS examinations are increasingly performed by specialists outside of emergency medicine. What is driving this rapid culture change?

Orbital Mass Detected with POCUS

by Daniel Rusiecki, HBSc; Andrew Helt, MD; Kathryn McCabe, MD FACEP; Colin Bell, MD FRCPC – A previously healthy 46-year-old female patient presented to the Emergency Department (ED) with a primary complaint of binocular diplopia worsening over the past 48 hours. Physical exam revealed minor left inferior lid ecchymosis and was significant for proptosis.

Interscalene Block in an Anesthetized Adult with Hypertrophic Obstructive Cardiomyopathy Undergoing Clavicle Fracture Reduction

Anthony M.-H. Ho, MD, FRCPC, FCCP; Joel Parlow, MD, FRCPC; Rene Allard, MD, FRCPC; Michael McMullen, MD, FRCPC; Glenio B. Mizubuti, MD, MSc – Whether regional anesthesia procedures should be performed in heavily sedated/anesthetized adults remains controversial. One of the purported advantages of performing regional nerve blocks in conversant patients is early warning against major nerve injury and, arguably, early detection of local anesthetic systemic toxicity.

The Hybrid POCUS-to-Echo Feasibility Study: Provision of Expedited Cardiac Point of Care Ultrasound Service (e-POCUS) by the Echocardiography Lab

Hanane Benbarkat, MD; Tony Sanfilippo, MD; Jian Zhang, RDCS; Amer M. Johri, MD MSc FRCPC FASE – Comprehensive transthoracic echocardiography (CTE) provides information vital to the care of acutely ill and unstable patients, but may not be readily available. Cardiac point of care ultrasound (POCUS) is well suited to providing key information at the bedside to expedite decision making. Our objective was to evaluate the feasibility of expedited-POCUS (e-POCUS) provided by the echo lab for internal medicine, cardiology and intensive care services.

The Master Clinician’s Elective: Integrating Evidence-Based Physical Examination and Point of Care Ultrasonography in Modern Clinical Medicine

Maria Gabriela Frank MD; Cason Pierce MD; Noelle Northcutt MD; Joseph Walker Keach MD; Gerard Salame MD; Rebecca Allyn MD – Many internal medicine residency programs have incorporated ultrasonography into their curriculum; however, its integration with physical examination skills teaching at a graduate medical level is scarce. The program’s aim is to create a reproducible elective that combines physical exam and bedside ultrasound as a method for augmenting residents’ knowledge and competence in these techniques with the ultimate goal of improving patient care.

Demonstration of a Longitudinal Medical Education Model (LMEM) Model to Teach Point-of-Care Ultrasound in Resource-Limited Settings

Michael Yao; Lauren Uhr; George Daghlian; Junedh M. Amrute; Ramya Deshpande; Benji Mathews, MD; Sanjay A. Patel, MD; Ricardo Henri, MD; Gigi Liu, MD; Kreegan Reierson, MD; Gordon Johnson, MD –
Short-term medical missions prevail as the most common form of international medical volunteerism, but they are ill-suited for medical education and training local providers in resource-limited settings. Objective: The purpose of this study is to evaluate the effectiveness of a longitudinal educational program in training clinicians how to perform point-of-care ultrasound (POCUS) in resource-limited clinics. Design: A retrospective study of a four-month POCUS training program was conducted with clinicians from a rural hospital in Haiti. The model included one-on-one, in-person POCUS teaching sessions by volunteer instructors from the United States and Europe. The Haitian trainees were assessed at the start of the program and at its conclusion by a direct objective structured clinical examination (OSCE), administered by the visiting instructors, with similar pre- and post- program ultrasound competency assessments.