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Heart Fail Clin 2020 Jul;16(3):317-330

Department of Translational Medical Sciences, "Federico II" School of Medicine, "Federico II" University of Naples, Via Pansini 5, Naples 80131, Italy; Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital. Electronic address:

Acute pulmonary embolism (PE) is the third most common acute cardiovascular condition, and its prevalence increases over time. D-dimer has a very high negative predictive value, and if normal levels of D-dimer are detected, the diagnosis of PE is very unlikely. The final diagnosis should be confirmed by computed tomographic scan. Read More

Indian J Crit Care Med 2020 Jan;24(Suppl 1):S6-S30

Department of Critical Care Medicine, Nayati Medicity, Mathura, Uttar Pradesh, India, , e-mail:

Background And Purpose: Short-term central venous catheterization (CVC) is one of the commonly used invasive interventions in ICU and other patient-care areas. Practice and management of CVC is not standardized, varies widely, and need appropriate guidance. Purpose of this document is to provide a comprehensive, evidence-based and up-to-date, one document source for practice and management of central venous catheterization. Read More

Cureus 2020 Mar 7;12(3):e7199. Epub 2020 Mar 7.

Emergency Medicine, Hamad Medical Corporation, Doha, QAT.

A 73-year-old man with a history of follicular lymphoma ten years ago with complete remission presented to the emergency room with a large unilateral left-leg swelling as the only symptom. Doppler ultrasonography ruled out deep vein thrombosis. Bedside point-of-care ultrasound (PoCUS) revealed left moderate hydronephrosis. Read More

Am Fam Physician 2020 03;101(5):275-285

Naval Hospital Jacksonville, Jacksonville, FL, USA.

Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. Read More

BMC Med Educ 2020 Jan 31;20(1):30. Epub 2020 Jan 31.

Department of Internal Medicine, Univ Groningen, University Medical Center Groningen, Huispostcode AA41, Postbus 30.0016, 9700, RB, Groningen, the Netherlands.

Background: Point-of-care Ultrasound is a relative new diagnostic tool for internists. Since 2019, it is a mandatory skill for internal medicine residents in the Netherlands but an ultrasound curriculum still has to be developed. In this study we explored the current ultrasound training program and educational wishes from internal medicine residents. Read More

J Ultrasound 2019 Nov 27. Epub 2019 Nov 27.

Intensive Care Physicians, Intensive Care Unit, Clínica Cruz Azul, 2651, 60 St, Necochea, 7630, Argentina.

Patients with high-risk pulmonary embolism (PE) have a significant mortality rate, and thus a timely diagnosis and early treatment are essential to improve outcomes. Since these groups of patients are often too ill to be transferred to the radiology department to perform a chest computed tomography angiography, offering a feasible, reliable and bedside diagnostic tool may be desirable in this setting. We report the case of a middle-aged woman presenting to the emergency department with shock who was diagnosed with massive pulmonary embolism based on point-of-care ultrasound (POCUS). Read More

Acta Inform Med 2019 Jun;27(2):119-122

Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Introduction: Deep vein thrombosis (DVT) is a common cause of admission to the emergency departments (ED). Doppler ultrasonography of the entire lower limb is the first-line imaging modality. But most EDs do not access to full-time radiologists which can lead to delayed diagnosis. Read More

J Gen Intern Med 2019 10 6;34(10):2062-2067. Epub 2019 Aug 6.

Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.

Background: Venous thromboembolism includes deep vein thrombosis (DVT) and pulmonary embolism. Compression ultrasonography is the most common way to evaluate DVT and is typically performed by sonographers and interpreted by radiologists. Yet there is evidence that ultrasound examinations can be safely and accurately performed by clinicians at the bedside. Read More

PLoS One 2019 31;14(5):e0217641. Epub 2019 May 31.

Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

We evaluated the safety and feasibility of ultrasound-guided peripherally-inserted central venous catheters (PICC) by a neurointensivist at the bedside compared to fluoroscopy-guided PICC and conventional central venous catheter (CCVC). This was a retrospective study of adult patients who underwent central line placement and were admitted to the neurosurgical intensive care unit (ICU) between January 2014 and March 2018. In this study, the primary endpoint was central line-induced complications. Read More

J Thromb Thrombolysis 2019 Apr;47(3):392-395

Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK.

Impaired endogenous fibrinolysis is an adverse prognostic biomarker in acute coronary syndrome (ACS). Abnormally dense in vitro fibrin thrombi have been demonstrated in ACS patients and related to hypofibrinolysis using cumbersome, laboratory-based methods. We aimed to assess endogenous fibrinolysis using a point-of-care technique and relate this to clot architecture. Read More

J Emerg Med 2019 Mar 8;56(3):288-293. Epub 2018 Dec 8.

Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida.

Background: Cerebral venous thrombosis (CVT) is a rare, difficult-to-diagnose form of venous thromboembolic disease and is considered a type of stroke. Its presentation is highly variable and may be easily confused for more common and less debilitating or life-threatening diagnoses such as migraine, seizure, or idiopathic intracranial hypertension.

Case Report: A 25-year-old woman presented with a complaint of bifrontal throbbing headache and blurry vision. Read More

BMC Med Educ 2018 Sep 20;18(1):217. Epub 2018 Sep 20.

Department of Medicine, University of Calgary, Calgary, AB, Canada.

Background: Significant gaps currently exist in the Canadian internal medicine point-of-care ultrasound (POCUS) curriculum. From a learner's perspective, it remains unknown what key POCUS skills should be prioritized. This needs assessment study seeks to establish educational priorities for POCUS for internal medicine residents at five Canadian residency training programs. Read More

South Med J 2018 07;111(7):382-388

From the Department of Medicine, Oregon Health & Science University, Portland, the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, the Division of Hospital Medicine, Denver Health, Denver, Colorado, and the Division of General Internal Medicine, University of Minnesota, Minneapolis, Minnesota.

Point of-care ultrasound (POCUS) has become a mainstream bedside tool for clinicians in several specialties and is gaining recognition in hospital medicine. There are many clinical applications in which the inpatient practitioner can use POCUS to improve his or her diagnosis, monitoring, and treatment of patients. POCUS is valuable in many clinical scenarios, including acute renal failure, increasing lower extremity edema, change in inpatient clinical status, and acute dyspnea. Read More

J Emerg Trauma Shock 2018 Apr-Jun;11(2):125-129

Department of Emergency Medicine, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India.

Objective: The objective of this study is to determine the accuracy of the bedside lung ultrasound in emergency (BLUE) protocol in giving a correct diagnosis in patients presenting with acute respiratory distress in emergency department.

Materials And Methods: Patients with acute respiratory distress were evaluated. Ultrasound findings such as artifacts (A line, B line), lung sliding, alveolar consolidation or pleural effusion, and venous analysis were recorded. Read More

Int J Cardiovasc Imaging 2018 Oct 30;34(10):1595-1605. Epub 2018 May 30.

Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Kniaziewicza 1/5, 91-347, Lodz, Poland.

Pulmonary embolism onset is frequently neglected due to the non-specific character of its symptoms. Pocket-size imaging devices (PSID) present an opportunity to implement imaging diagnostics into conventional physical examination. The aim of this study was to test the hypothesis that supplementation of the initial bedside assessment of patients with suspected pulmonary embolism (PE) with four-point compression venous ultrasonography (CUS) and right ventricular size assessment with the use of PSID equipped with dual probe could positively influence the accuracy of clinical predictions. Read More

Masui 2017 May;66(5):508-515

Ultrasonography is useful not only for screening, but also for evaluating pathological conditions and followup because it can be performed repeatedly and noninvasively at bedside. This paper discusses the importance of the functional assessment of vascular access, as well as the examination method and points for diagnosis of venous thrombosis. Read More

J Vasc Surg Venous Lymphat Disord 2018 07 27;6(4):450-456. Epub 2018 Mar 27.

Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address:

Objective: Transabdominal ultrasound (TAUS)-guided inferior vena cava filter (IVCF) placement currently uses an inferior vena cava (IVC) longitudinal plane with cross-section of the right renal artery or the transverse plane of the right renal vein (RRV)-IVC intersection. The goal of this study was to introduce a new method for TAUS-guided IVCF placement.

Methods: The study enrolled patients who were at high risk for or had pulmonary embolism from October 22, 2010, to June 30, 2016. Read More

J Clin Ultrasound 2018 Oct 12;46(8):555-557. Epub 2018 Feb 12.

Tulane University School of Medicine, Department of Internal Medicine, 1430 Tulane Ave., SL50, New Orleans, LA 70112.

Coronary sinus thrombosis is a rare and often overlooked diagnosis that can have fatal consequences. We report a case of acute coronary sinus thrombosis in a patient with systolic heart failure who had undergone recent right-heart catheterization. The patient presented with recurrent presyncope, syncope, and shortness of breath. Read More

J Fam Pract 2018 02;67(2):70-80

Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

Point-of-care ultrasound (POCUS) has been gaining greater traction in recent years as a way to quickly (and cost-effectively) assess for conditions including systolic dysfunction, pleural effusion, abdominal aortic aneurysms (AAA), and deep vein thrombosis (DVT). It involves limited and specific ultrasound protocols performed at the bedside by the health care provider who is trying to answer a specific question and, thus, help guide treatment of the patient. In this article, we will review the evidence for the use of POCUS in 4 areas: the cardiovascular exam, the lung exam, the screening exam for AAAs, and the evaluation for DVT. Read More

J Emerg Med 2018 05 3;54(5):656-664. Epub 2018 Jan 3.

Department of Biostatistics, University Hospital Reina Sofia, Córdoba, Andalucía, Spain.

Background: Compression ultrasonography is the most effective diagnostic tool in the emergency department (ED) for the diagnosis of deep vein thrombosis (DVT). It has been demonstrated to be highly accurate and cost-effective.

Objective: The objective of this study was to determine the accuracy of emergency physicians who performed three-point compression ultrasound (US) for suspected above-knee DVT within the context of using Wells score and D-dimer. Read More

Am J Emerg Med 2018 Jul 14;36(7):1145-1150. Epub 2017 Nov 14.

Legacy Emanuel Medical Center & Randall Children's Hospital, Portland, OR, United States.

Objective: The study objective was to investigate the combined accuracy of right heart strain on focused cardiac ultrasound (FOCUS) and deep vein thrombosis (DVT) on compression ultrasound (CUS) for identification of centrally located pulmonary embolism (PE) diagnosed on computed tomography pulmonary angiography (CTPA).

Methods: This was a prospective observational study using a convenience sample of patients undergoing CTPA in the emergency department (ED) for evaluation of PE. Patients received a FOCUS looking for right heart strain (McConnell's sign, septal flattening, right ventricular enlargement or tricuspid annular plane systolic ejection (TAPSE) <17mm) and a CUS looking for DVT. Read More

Am J Med 2018 03 10;131(3):e95-e96. Epub 2017 Oct 10.

University of South Carolina School of Medicine/Palmetto Health, Columbia. Electronic address:

Emerg Med Clin North Am 2017 Nov;35(4):879-888

Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.

Mesenteric ischemia has 4 etiologies: arterial embolus, arterial thrombosis, venous thrombosis, and nonocclusive. No history or physical examination finding can definitively diagnose the condition. A wide variety of presentations occur. Read More

J Emerg Med 2017 Aug 6;53(2):248-251. Epub 2017 Mar 6.

Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, Kansas.

Background: Inferior vena cava (IVC) filter and filter limb embolization is a known phenomenon, with a prevalence of up to 25% for certain filter types. Most commonly, the site of embolization is to the heart. Point-of-care ultrasound is an easily accessible imaging modality that should be utilized when considering IVC filter complications. Read More

Ann Am Thorac Soc 2017 03;14(3):456-458

1 Department of Critical Care Medicine, Western University, London, Ontario, Canada; and.

Acad Emerg Med 2017 03;24(3):270-280

Department of Emergency Medicine, Careggi University Hospital, Firenze.

Objective: Lung and venous ultrasound are bedside diagnostic tools increasingly used in the early diagnostic approach of suspected pulmonary embolism (PE). However, the possibility of improving the conventional prediction rule for PE by integrating ultrasound has never been investigated.

Methods: We performed lung and venous ultrasound in consecutive patients suspected of PE in four emergency departments. Read More

Crit Ultrasound J 2016 Dec 26;8(1):15. Epub 2016 Oct 26.

Emergency Medicine, San Luigi Gonzaga University Hospital, 10043, Turin, Italy.

Background: Point-of-care ultrasonography (POCUS) is a widely used tool in emergency and critical care settings, useful in the decision-making process as well as in interventional guidance. While having an impressive diagnostic accuracy in the hands of highly skilled operators, inexperienced practitioners must be aware of some common misinterpretations that may lead to wrong decisions at the bedside.

Objectives: This article provides a revision list of common POCUS misdiagnoses usually found in practice and offers useful tips to recognize and avoid them. Read More

J Assoc Physicians India 2016 06;64(6):80-81

Junior Resident, Laddhad Hospital, Post Graduate Institute for Medical Education and Research (DNB), Multispecialty Hospital, Buldana, Maharashtra.

A 32 yrs old man presented with shortness of breath and syncopal episode with preceding history of DVT 15days above. Patient has tachycardia hypoxia and hypotension, on evaluation ECG Showed S1 Q3 T3 Pattern, bedside Echo Showed visible thrombus of 3cm in pulmonary artery, successfully thrombolysed with tenecteplase and streptokinase. This case study is presented to stress importance of urgent bedside echo in all sudden onset dysponea and hypoxia to rule out pulmonary Embolism which can be successfully thrombolysed without delay. Read More

Ann Vasc Surg 2017 Feb 28;39:250-255. Epub 2016 Aug 28.

Division of Cardiology and Vascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Background: IVCFs are usually placed under fluoroscopic guidance in dedicated angiography suites. Bedside placement of inferior vena cava filters (IVCF) is possible in patients not suitable for transportation, but data regarding their use are limited. The objective of this study is to compare utilization, procedural outcomes, complications, and long-term patient outcomes associated with bedside placement of IVCFs using intravascular ultrasound (IVUS) and fluoroscopic placement of IVCF. Read More

Crit Care 2016 08 15;20(1):227. Epub 2016 Aug 15.

Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA.

Point-of-care ultrasonography (POCUS) is a useful imaging technique for the emergency medicine (EM) physician. Because of its growing use in EM, this article will summarize the historical development, the scope of practice, and some evidence supporting the current applications of POCUS in the adult emergency department. Bedside ultrasonography in the emergency department shares clinical applications with critical care ultrasonography, including goal-directed echocardiography, echocardiography during cardiac arrest, thoracic ultrasonography, evaluation for deep vein thrombosis and pulmonary embolism, screening abdominal ultrasonography, ultrasonography in trauma, and guidance of procedures with ultrasonography. Read More

Med Klin Intensivmed Notfmed 2017 Apr 25;112(3):246-251. Epub 2016 Jul 25.

I. Medizinische Klinik, Abteilung für Kardiologie, Pneumologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.

Pulmonary embolism (PE), mostly caused by deep vein thrombosis, is a life-threatening complication in critically ill patients in the intensive care unit. A potential strategy to prevent PE in patients with contraindication for anticoagulant therapy is the implantation of a vena cava filter (VCF), to provide fast and safe PE protection against ascending thrombi. We report the case of a 56-year-old woman with an intracranial hemorrhage, who developed a PE. Read More

J Vasc Access 2016 Jul 7;17(4):353-9. Epub 2016 Apr 7.

Professional Intravenous Team, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou - PR China.

Purpose: This is a single-center, descriptive report of the management and complications of venous catheter use in 19 severely burned passengers from a bus fire that occurred on July 5, 2014, in Hangzhou.

Methods: We recorded the parameters of the catheters insertion and indwelling. Sampling of each removed catheter was conducted to monitor for catheter-related infections. Read More

Radiographics 2016 May-Jun;36(3):640-59. Epub 2016 Apr 1.

From the Departments of Diagnostic and Therapeutic Radiology (S.W., R.K.) and Emergency Medicine (S.S.), Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand 10400; and Department of Radiology, Prince of Songkla University Hospital, Songkhla, Thailand (R.S.).

Acute thoracic symptoms are common among adults visiting emergency departments in the United States. Adults with these symptoms constitute a large burden on the overall resources used in the emergency department. The wide range of possible causes can make a definitive diagnosis challenging, even after clinical evaluation and initial laboratory testing. Read More

Dtsch Med Wochenschr 2016 Mar 3;141(5):317-21. Epub 2016 Mar 3.

Using bedside ultrasound in the emergency room includes point of care sonography (echoscopy) and several protocols (RUSH, FATE, etc.). The aim of these protocols is to evaluate the life threatening emergency care situation without interrupting the clinical work flow. Read More

J Clin Ultrasound 2016 Jul 18;44(6):360-7. Epub 2016 Feb 18.

Emergency Medicine Residency, New York-Presbyterian Hospital, New York, New York.

Purpose: To assess the interrater reliability and test characteristics of lower limb sonographic examination for the diagnosis of deep venous and proximal great saphenous vein thrombosis when performed by Emergency Physicians (EPs) as compared to that by the Department of Radiology (Radiology). The secondary objective was to assess the effects of patient body mass index and EP satisfaction with bedside ultrasound on sensitivity and specificity.

Methods: A prospective study was conducted for patients with clinical suspicion for lower extremity thrombus. Read More

Hematology Am Soc Hematol Educ Program 2015 ;2015:202-9

Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.

Because the clinical diagnosis of deep-vein thrombosis and pulmonary embolism is nonspecific, integrated diagnostic approaches for patients with suspected venous thromboembolism have been developed over the years, involving both non-invasive bedside tools (clinical decision rules and D-dimer blood tests) for patients with low pretest probability and diagnostic techniques (compression ultrasound for deep-vein thrombosis and computed tomography pulmonary angiography for pulmonary embolism) for those with a high pretest probability. This combination has led to standardized diagnostic algorithms with proven safety for excluding venous thrombotic disease. At the same time, it has become apparent that, as a result of the natural history of venous thrombosis, there are special patient populations in which the current standard diagnostic algorithms are not sufficient. Read More

Blood 2015 Nov;126(21):2376-82

Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.

Because the clinical diagnosis of deep-vein thrombosis and pulmonary embolism is nonspecific, integrated diagnostic approaches for patients with suspected venous thromboembolism have been developed over the years, involving both non-invasive bedside tools (clinical decision rules and D-dimer blood tests) for patients with low pretest probability and diagnostic techniques (compression ultrasound for deep-vein thrombosis and computed tomography pulmonary angiography for pulmonary embolism) for those with a high pretest probability. This combination has led to standardized diagnostic algorithms with proven safety for excluding venous thrombotic disease. At the same time, it has become apparent that, as a result of the natural history of venous thrombosis, there are special patient populations in which the current standard diagnostic algorithms are not sufficient. Read More

Anaesthesiol Intensive Ther 2015 18;47(5):471-81. Epub 2015 Nov 18.

Department of Intensive Care and High Care Burn Unit, Ziekenhuis Netwerk Antwerpen.

The use of ultrasound has gained its place in critical care as part of our day-to-day monitoring tools. A better understanding of ultrasound techniques and recent publications including protocols for the lungs, the abdomen and the blood vessels has introduced ultrasound to the bedside of our ICU patients. However, we will prove in this paper that early machines, dating back more than 25 years, were perfectly able to do the job as compared to modern laptop machines with more features but few additional advantages. Read More

Crit Care Med 2015 Nov;43(11):2479-502

1Los Angeles, CA. 2Foothills Medical Centre and the University of Calgary, Calgary, AL, Canada. 3National and Gulf Center for Evidence Based Health Practice, Riyadh, Saudi Arabia. 4King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 5Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 6Professor of Medicine, University of South Carolina School of Medicine, Department of Emergency Medicine, St. Francis Hospital, Columbus, GA. 7Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA. 8Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA. 9Aerospace and Critical Care Medicine, Mayo Clinic, Rochester, MN. 10President and CEO, Renown Health, Reno, NV. 11Department of Anesthesiology, University Hospital of the Sarrland, Homburg-Saar, Germany. 12Clinics of Anesthesiology, Intensive Care and Pain Therapy, Hospital of the Goethe University, Frankfurt, Germany. 13Royal Brompton Hospital, London, United Kingdom. 14Eastern Virginia Medical School, Norfolk, VA. 15Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA.

Objective: To establish evidence-based guidelines for the use of bedside ultrasound by intensivists and specialists in the ICU and equivalent care sites for diagnostic and therapeutic purposes for organs of the chest, abdomen, pelvis, neck, and extremities.

Methods: The Grading of Recommendations, Assessment, Development and Evaluation system was used to determine the strength of recommendations as either strong or conditional/weak and to rank the "levels" of quality of evidence into high (A), moderate (B), or low (C) and thus generating six "grades" of recommendation (1A-1B-1C-2A-2B-2C). Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for all questions with clinically relevant outcomes. Read More

World J Gastroenterol 2015 Aug;21(32):9457-60

Luciano Tarantino, Department of Surgery, Interventional Hepatology Unit, Andrea Tortora Hospital, 07020 Pagani, Italy.

Portal vein thrombosis (PVT) may occur in liver cirrhosis patients. Malignant PVT is a common complication in cirrhotic patients with concomitant hepatocellular carcinoma (HCC) and, in some cases, it may be even the initial sign of an undetected HCC. Detection of malignant PVT in a patient with liver cirrhosis heavily affects the therapeutic strategy. Read More

Indian J Palliat Care 2015 May-Aug;21(2):132-6

Department of Anaesthesia and Palliative Care, Dr. Bhimrao Ramji Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

Bedside ultrasound is an important tool in modern palliative care practice. It can be utilized for rapid diagnostic evaluation or as an image guidance to perform invasive therapeutic procedures. With advent of portable ultrasound machines, it can also be used in community or home care settings, apart from palliative care wards. Read More

J Emerg Med 2015 Sep 16;49(3):301-4. Epub 2015 May 16.

Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut.

Background: McConnell's sign (right ventricular [RV] free wall hypokinesis with apical sparing on echocardiography) is often described as very specific for the diagnosis of pulmonary embolism (PE). We present the case of a patient who, despite manifesting a classic McConnell's sign, was not found to have a PE.

Case Report: A 58-year-old woman presented to the emergency department with a cough, dyspnea, and leg swelling. Read More

Semin Thromb Hemost 2015 Jun 14;41(4):374-81. Epub 2015 Apr 14.

Department of Hematology and Transfusion Medicine, Azienda Ospedaliera Carlo Poma, Mantova, Italy.

Venous thromboembolism (VTE) is a prevalent and life-threatening condition that requires an accurate and timely diagnosis. The current diagnostic approach to this condition, entailing an efficient integration of clinical judgment, diagnostic imaging, and laboratory testing, is the result of decades of scientific and medical research. This article aims to present and discuss the major breakthroughs that have occurred in the diagnostic imaging of both deep vein thrombosis and pulmonary embolism, along with the various biological markers that have emerged from the laboratory bench and which have only marginally migrated to the bedside. Read More

J Emerg Med 2015 Jun 3;48(6):671-4. Epub 2015 Apr 3.

McLaren Medical Center-Macomb, Mount Clemens, Michigan.

Background: Deep vein thrombosis (DVT) is commonly encountered in the emergency department. Clinical models, such as the Wells criteria, allow physicians to estimate the probability of DVT in a patient. Current literature suggests a low pretest probability combined with a negative D-dimer laboratory study rules out DVT approximately 99% of the time. Read More

Ultrasound Med Biol 2015 Apr 17;41(4):929-35. Epub 2015 Feb 17.

Ultrasound Department, Third People's Hospital of Chengdu and Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu City, Sichuan Province, People's Republic of China.

Inferior vena cava filters (IVCFs) have been used clinically for approximately 45 y, but only a few studies of these devices have involved intensive care unit (ICU) patients who were critically ill and had multiple-organ dysfunction or were otherwise too unstable for transport. The purpose of this research was to assess the tolerability and efficacy of bedside ultrasound-guided IVCF placement in ICU patients. A retrospective analysis of both bedside ultrasound-guided and X-ray-guided ICVF placement was performed from November of 2011 to August of 2013. Read More

Emerg Med J 2014 Nov;31(11):944-6

A short cut review was carried out to establish the diagnostic utility of Emergency Physician performed ultrasound in confirming or refuting the diagnosis of deep vein thrombosis compared with a radiology scan. A systematic review incorporating 16 studies and two studies published subsequently were found to be relevant to the question. The clinical bottom line was that some studies demonstrated high sensitivity and specificity compared with the reference standard but this finding was not universal. Read More

Acad Emerg Med 2014 Sep;21(9):971-80

The Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; The Department of Emergency Medicine, Saint Michael's Hospital, Toronto, Ontario, Canada.

Objectives: Deep vein thrombosis (DVT) is both common and serious, yet the desire to never miss the diagnosis, coupled with the low specificity of D-dimer testing, results in high imaging rates, return visits, and empirical anticoagulation. The objective of this study was to evaluate a new approach incorporating bedside limited-compression ultrasound (LC US) by emergency physicians (EPs) into the workup strategy for DVT.

Methods: This was a cross-sectional observational study of emergency department (ED) patients with suspected DVT. Read More

Aviat Space Environ Med 2014 Jul;85(7):730-9

Since its initial introduction into the bedside assessment of the trauma patient via the Focused Assessment with Sonography for Trauma (FAST) exam, the use of point-of-care ultrasound has expanded rapidly. A growing body of literature demonstrates ultrasound can be used by nonradiologists as an extension of the physical exam to accurately diagnose or exclude a variety of conditions. These conditions include, but are not limited to, hemoperitoneum, pneumothorax, pulmonary edema, long-bone fracture, deep vein thrombosis, and elevated intracranial pressure. Read More

Indian J Crit Care Med 2014 Jun;18(6):376-81

Multidisciplinary Intensive Care Unit, Manipal Hospital, Bengaluru, Karnataka, India.

Point of care ultrasonography, performed by acute care physicians, has developed into an invaluable bedside tool providing important clinical information with a major impact on patient care. In Part II of this narrative review, we describe ultrasound guided central venous cannulation, which has become standard of care with internal jugular vein cannulation. Besides improving success rates, real-time guidance also significantly reduces the incidence of complications. Read More