Delphi Consensus Recommendations for the Development of the Emergency Medicine Point of Care Ultrasound (POCUS) Curriculum in Nepal

Anmol P. Shrestha, Wolfgang Blank, Ursula H. Blank, Rudolf Horn, Susane Morf, Sanu K. Shrestha, Shailesh P. Shrestha, Samjhana Basnet, Anjana Dongol, Raj Kumar DangalRoshana Shrestha – Emergency Medicine Point of Care Ultrasound (EM-POCUS) is a diagnostic bedside tool for quick and accurate clinical decision-making. Comprehensive training in POCUS is a mandatory part of EM training in developed countries.

Acknowledgments

Dear Readers, We extend our deepest gratitude to Bill and June Gladwish for their recent philanthropic support of point-of-care ultrasound research. Having benefited from the specialized care at Kingston Health Science Center over the years, their passion for advancing healthcare is evident in their generous contribution. This issue was partially supported by their contribution to […]

Inside the April 2024 Issue

Benjamin T. Galen, MD – We are thrilled to bring you the first issue of the ninth volume of POCUS Journal. Published since 2016, POCUS Journal is the only multi-disciplinary, peer-reviewed, POCUS-focused journal that is free for authors and readers alike. We are grateful for the vision of our founder Dr. Amer Johri and for the support of CINQUILL Medical Publishers, Inc. as we enter our ninth year of publication.

Pediatric Emergency Medicine Ultrasound Fellowship Programs

Sigmund Kharasch, MD; Matthew Moake, MD PhD; Antonio Riera, MD – Point of care ultrasound (POCUS) has undergone important growth in the field of Pediatric Emergency Medicine (PEM) in the last 14 years and is recognized as a critical diagnostic tool in the care of ill and injured children. The first PEM POCUS fellowship was established in 2010. Now, there are currently 30 ultrasound fellowships that offer training to PEM physicians. In 2014, 46 PEM POCUS leaders established the P2 (PEM POCUS) Network (www.P2network.org). This serves as a platform for sharing expertise, building research collaborations, and offering mentorship in the use of POCUS in PEM.

Vaginal Bleeding in a Peri-Menopausal Woman

Ambika Shivarajpur, DO; Brian Kohen, MD – Point of care ultrasound (POCUS) is a useful modality to initially identify a molar pregnancy. In this case, we describe a 51-year-old perimenopausal woman who presented to the emergency department (ED) with vaginal bleeding. A transvaginal POCUS was performed, revealing findings concerning for a molar pregnancy. These findings led to prompt diagnosis and treatment.

Point of Care Ultrasound Identification and Aspiration of a Neck Lymph Node

Andrew Moore, DO; Ali Mrad, MD; Leonard Riley, MD; Sonia M. Castillo MD – The tissue diagnosis and staging of all types of lung cancer is foundational for prognosis and establishing the optimal treatment plan. In order to appropriately stage lung cancer, the highest stage should be established using the 8th edition TNM criteria, where tumor size (T), nodal involvement (N), and metastasis (M) are all taken into account. Establishing a tissue diagnosis may involve the use of CT guided biopsy, navigational bronchoscopy, endobronchial biopsy, endobronchial ultrasound, percutaneous lymph node biopsy and/or excisional biopsy of supraclavicular nodes.

Hematometra: A Rare Case of Pelvic Pain in Females Identified with Point of Care Ultrasound

Andrew R. Helber, MD; Margaret Provencher, MD; Christy Moore, BS; Nova Panebianco, MD – The differential diagnosis for abdominal or pelvic pain in women of child-bearing age that present to the emergency department is broad. A rare cause of abdominal and pelvic pain is hematometra, or a collection of blood products within the uterus. While blood is normally expelled through menses, this process is disrupted in some patients due to congenital or acquired abnormalities.

VExUS to Guide Ultrafiltration in Hemodialysis: Exploring a Novel Dimension of Point of Care Ultrasound

Abhilash Koratala, MD; Mohamed Ibrahim, MD; Sirisha Gudlawar, MD – Venous Excess Ultrasound (VExUS) is a valuable bedside tool for nephrologists within a multi-organ point of care ultrasound (POCUS) framework. VExUS can address limitations of conventional physical examination in identifying hemodynamic congestion and monitoring treatment efficacy. A 53-year-old man with heart failure and end-stage kidney disease on hemodialysis presented with elevated liver function tests.

Point of Care Ultrasound Diagnosis of Maxillary Artery Pseudoaneurysm in the Emergency Department

Marwa L. Ali, MD; Sean Beckman, DO; Stephen Alerhand, MD – A pseudoaneurysm results from a tear in a vessel wall. This leads to extravasation of blood into adjacent tissue and eventual formation of a fibrous sac that maintains continuity with the lumen. These vascular injuries very rarely occur in deeper vessels of the face (e.g. maxillary artery) due to protection from structures like the bony mandible and parotid gland. If left untreated, these pseudoaneurysms can lead to infection, thromboembolism, hemorrhage, and compression of surrounding structures such as facial nerve branches

Hemodialysis Catheter-Associated Right Atrial Thrombus Diagnosed via Point of Care Transesophageal Echocardiogram

Heather Andrade, MD; Julie Carroll, MD; Evan Tomkiewicz, MD; Edwin Jackson, DO MBA RDCS – Catheter-associated right atrial thrombus (CRAT) is a potential complication of central venous catheter placement and is associated with an increase in morbidity and mortality. The precise incidence of CRAT is unknown, and there is a lack of clear screening and management guidelines for this condition. Additionally, the diagnosis is often missed when using transthoracic echocardiography (TTE) alone. Here, we present a case of a 64-year-old female admitted to the medical intensive care unit with multiorgan dysfunction who was diagnosed with hemodialysis catheter-associated right atrial thrombus (HDCRAT) via intensivist-performed point of care transesophageal echocardiography (TEE) after an initial TTE was negative.

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