Inside the November 2023 Issue

Benjamin T. Galen – This is a very exciting time for POCUS Journal. As the world’s leading point of care ultrasound journal, we remain free for both authors and readers.  Our content brings the POCUS community together as we strive to showcase POCUS use by clinicians from a wide variety of fields in every possible clinical setting.

High Tech POCUS Education in Remote Environments: An App Review

Jeremy J. Webb; Chad Mosby; John Stadnyk; Michael Jones – In recent years, the development of hand-held devices have intrigued POCUS enthusiasts due to improved affordability, portability, and ease of use. They also provide extra functionality for image storage and transmission for remote provider-to-provider communication and review. Due to these capabilities, portable ultrasound has found its use expanded to pre-hospital, wilderness, and austere settings, where cart-based machines and other imaging modalities are not an option.

Rekindling the Relevance of Obstetrical Transvaginal POCUS: Overcoming Barriers to Ensure Patient-Centered Care

Alexis Salerno; Resa E. Lewiss – The transvaginal pelvic point of care ultrasound (POCUS) examination remains a patient-centered and relevant examination. Since 2008, emergency medicine physicians are required to learn, perform, and interpret POCUS examinations to deliver safe and patient-centered diagnostic and procedural care. Pelvic POCUS is one of these core applications in the emergency physician scope of practice. A pelvic POCUS examination seeks to answer the focused question, “Is there an intrauterine pregnancy (IUP)” and risk stratifies the patient when ectopic pregnancy is a clinical concern.

Obstetric-Focused POCUS Training for Medical Students

Koral Cohen; Jennifer Kidd; Emily Schill; Agata Kantorowska; Wendy Kinzler; Martin Chavez – Point of care ultrasound (POCUS) is rapidly expanding throughout the United States. Due to its ability to quickly and accurately diagnose and guide therapy for critical conditions, POCUS is becoming routine in many specialties, with established guidelines in fields such as emergency medicine and critical care.

Asteroid Hyalosis: A Mimicker of Vitreous Hemorrhage on Point of Care Ultrasound: A Case Report.

Eniola C. Gros; Lauren R. McCafferty – Ocular point of care ultrasound (POCUS) can help make timely recognition of multiple emergent ocular conditions and differentiate these from more benign conditions. While asteroid hyalosis (AH) is benign, it can easily mimic the more potentially serious vitreous hemorrhage on ocular POCUS, as both consist of numerous echogenic opacities within the vitreous with a classic “washing machine” appearance with eye movement.

The Use of Point of Care Ultrasound in Diagnosis of Peritonsillar Abscess

Brian Kohen; Melanie Perez; Jheanelle McKay; Rolando Zamora; Curtis Xu – The use of point of care ultrasound (POCUS) for diagnosis and treatment of peritonsillar abscess (PTA) is increasing [1]. Proven advantages include improved diagnostic accuracy and treatment success rates as well as decreased otolaryngology consultation, computed tomography (CT) usage, return visits to the emergency department (ED), and length of stay [1]. We present a case of a patient with a PTA that was diagnosed and successfully treated utilizing POCUS, avoiding the need for otolaryngology consultation and CT.

Acute Type A Aortic Dissection Diagnosed by POCUS in a 29-year-old Man

Vladimir Cárdenas López; Pablo Blanco – Aortic dissection (AD) is a medical emergency with a poor prognosis if not recognized early and treated promptly. In this setting, clinical data may be equivocal, while electrocardiogram, laboratory tests, and chest radiography often show nonspecific findings. In contrast, cardiac point of care ultrasound (POCUS) has proven useful in the diagnosis and detection of complications of AD. We present the case of a 29-year-old man with marfanoid habitus presenting with chest pain and acute heart failure, in whom cardiac POCUS aided in the rapid diagnosis of type A AD and pulmonary edema.

Cough Causing Abdominal Pain? A Rapid POCUS Diagnosis of Rectus Sheath Hematoma

William Noel; Brian B. Donahue – A 59-year-old man with past medical history including obesity status post gastric banding surgery and atrial fibrillation on rivaroxaban, presented to the emergency department with a complaint of focal pain to his right abdomen along with areas of visible bruising. He noted that since his diagnosis of COVID-19 a week prior, he had been having paroxysms of coughing. During one episode of coughing a few days prior to seeking medical care, the patient recalled a “ripping” sensation in his right abdomen followed by intermittent achiness and bruising to that area.

The Importance of Serial POCUS Exams – Dual Pathologies in Play

Rahul Nair; Jonathan Zuo; Ariel L. Shiloh – Serial point of care ultrasound (POCUS) exams are essential to assess acute pericardial effusions which can rapidly evolve into cardiac tamponade. A typical presentation includes dyspnea, tachycardia, and chest pain. Importantly, serial cardiac exams in such high-risk patients can detect other concurrent pathologies. We present an unusual case of a patient who initially presented with an acute circumferential pericardial effusion and upon serial POCUS exams developed an unexpected Takotsubo cardiomyopathy in the setting of cardiac tamponade.

Optimizing Care for High-Risk Multiple Pregnancy with POCUS – A Case of Quadruplet Pregnancy Early Diagnosis

Bernardo Vidal Pimentel; Christopher Tsoutsoulas; Kristin Lythgoe; Frank Myslik – Managing multiple pregnancies is challenging and requires careful evaluation. Point of care ultrasound (POCUS) has emerged as a potentially crucial tool in assessing suspected first-trimester pregnancies. However, its role in evaluating multiple pregnancies remains uncertain. We present the case of a 36-year-old Ghanaian female who presented with acute vaginal bleeding after undergoing in vitro fertilization. A bedside transabdominal POCUS identified four intrauterine gestations with fetal poles and cardiac activity, suggesting a quadruplet viable pregnancy. A subsequent transvaginal ultrasound confirmed the findings.