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Can the Use of Bedside Lung Ultrasound Reduce Transmission Rates in The Case of The COVID-19 Patient? – A Narrative Review

Sheena Bhimji-Hewitt MAppSc; DMS, CRGS, RDMS – Novel Corona Virus Disease-19 (nCov-19, COVID-19) was recognised as a pandemic by the World Health Organization on March 11, 2020. As of June 14, 2020, this contagious viral disease has afflicted 188 out of 195 countries in the world with 7,893,700 confirmed cases and 432,922 global deaths.Canada has 98,787 people infected and 8,146 deaths. COVID-19 is thought to transmit through contact, droplets and aerosolization. A rapid review showed limited information on the benefits of conducting lung ultrasound (LUS) versus chest radiograph (CXR) or studies correlating lung ultrasound to chest computed Tomography (CT) in patients positive for Covid-19.

Shedding light on a hidden source of septic shock with POCUS

by Miguel Lourenço Varela; Rita Martins Fernandes; Maria Luísa Melão; Javier Moreno; Cristina Granja –
A 77-year old male was admitted in the emergency department for septic shock, yet no clear source of infection was noted upon physical examination and a portable chest x-ray. Due to his unstable condition, bedside ultrasound was performed. A heterogeneous mass in the liver was noted, hence a tentative diagnosis of liver abscess was made. This was latter confirmed by abdominal computed tomography. This case highlights that point-of-care ultrasound, when performed by expert physicians, can significantly decrease time to diagnosis for septic patients.

Postpartum Hemorrhage Emergency Management Using Focused Assessment With Sonography For Obstetrics (FASO): A Case Report

by C. Rincón ; J. Cubillos; C. Arzola –
Postpartum hemorrhage is the leading cause of maternal death around the world according to World Health Organization [1]. While cesarean delivery is a risk factor, uterine atony is the main etiology [2]. Cesarean delivery and concomitant tubal sterilization are a known risk of postoperative intra-abdominal bleeding, which can be insidious and difficult to diagnose in the recovery period. Furthermore, a late diagnosis can lead to a less than optimal management. Point-of-care ultrasonography is an available technique that can contribute to a prompt diagnosis and accurate decision-making [3]. We present a case of a patient in postoperative care after cesarean delivery and tubal sterilization who developed hypovolemic shock symptoms, without any sign of uterine atony or vaginal bleeding. Focused assessment with sonography for obstetrics (FASO) was quickly performed in the recovery room to diagnose intra-abdominal bleeding and decision-making to perform an emergency surgical intervention.

Perceived Barriers and Facilitators to the use of Point-of-Care Ultrasound for Clinicians in Oregon

by Camellia Dalai; Renee K. Dversdal –
The use of Point-of-Care Ultrasound (POCUS) to provide clinical data beyond the history and physical examination is a relatively new practice for primary care providers and hospitalists. It takes many hours of dedicated ultrasound (US) training and practice to achieve POCUS proficiency; further, perceptions and attitudes of clinicians play a major role in adopting POCUS into daily clinical repertoire.

Point-of-Care Ultrasound Training for Family Medicine Residents: Examining the outcomes and feasibility of a pilot ultrasound curriculum

by Gordon Yao; Taeyoung Peter Hong; Philip Lee; Joseph Newbigging; Brent Wolfrom –
It is estimated that 50% of deaths due to abdominal aortic aneurysms (AAA) could be prevented by a national screening program. Thanks to technological ad­vancements and cost reductions, point-of-care ultrasound (POCUS) in family medicine (FM) is becoming more prev­alent [4, 5]. Despite the potential utility of POCUS in FM, of 224 FM residency programs surveyed, only 21% had developed a curriculum.

Minding the Gap(s): Hospitalists Experience Aspirational, Safety, and Knowledge Deficits That Prevent Them From Practicing POCUS

by Stephanie Conner; David Chia; Farhan Lalani; Meghan O’Brien; James Anstey; Nima Afshar; Trevor Jensen –
Point-of-care ultrasound (POCUS) has been a mainstay of clinical decision-making in the intensive care unit and emergency department for more than a decade, but adoption into hospital medicine has lagged behind. Recently, internal medicine residency programs have started to develop POCUS curricula for trainees, though concurrent hospitalist training programs have been limited to date, with little consensus on what hospitalist-oriented curricula should entail. As such, there is wide variability amongst hospitalists with respect to utilization of, training in, and proficiency in POCUS.

Simulator-Based Training in FoCUS with Skill-Based Metrics for Feedback: An Efficacy Study

by Robert Morgan; Bradley Sanville; Shashank Bathula; Shaban Demirel; R. Serene Perkins; Gordon E. Johnson –
Focused Cardiac Ultrasound (FoCUS) is a relatively new technology that requires training and mentoring. The use of a FoCUS simulator is a novel training method that may prompt greater adoption of this technology by physicians at different levels of training and experience. The objective of this study was to determine if simulation training using an advanced echo simulator (Real Ultrasound®) is a feasible means of delivering training in FoCUS.

Unexpected cyst within ascites

by Jeff Ames, MD; Steven Montague, MD –

A 59-year-old man, with known alcohol-induced liver cirrhosis and diuretic refractory ascites, was seen in General Internal Medicine clinic for a therapeutic paracen­tesis. The tense large volume ascites caused abdominal pain, which had been previously relieved with paracen­tesis on several occasions. In preparation for paracen­tesis, routine POCUS was performed to landmark for the procedure.

A case of Fournier’s gangrene diagnosed with POCUS

by Marco Badinella Martini, MD; Antonello Iacobucci, MD –

An 87-year-old man with a history of type 2 diabetes and severe Alzheimer disease was admitted to the emergency department with a lesion of the perineum for two days. The patient appeared agitated and not collaborating on the visit. His vital signs were normal. Physical examination revealed an edematous, suppurative, and foul-smelling perineal-scrotal lesion, with possible subcutaneous emphysema.

POCUS for pleural assessment and intervention

by Nicholas Grubic, BScH; Barry Chan, MD –

The use of point-of-care thoracic (lung) ultrasound is an integral part of clinical practice that has shown diagnostic accuracy to help guide clinical decision making for pleural interventions.