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Die medizinische Versorgung von Patienten, die im Zusammenhang mit der pandemischen Coronaviruserkrankung 2019 („coronavirus disease 2019“, COVID-19) erkrankt sind, stellt für die staatlichen Gesundheitssysteme weltweit eine große Herausforderung dar. Das Virus mit dem Namen „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2) zeigt eine hohe Organspezifität zu den unteren Atemwegen. Da bislang weder eine wirksame Therapie noch Impfung gegen das Virus existieren, kommt der diagnostischen Früherkennung eine große Bedeutung zu. Durch den spezifischen Aspekt der überwiegend im peripheren Lungenparenchym beginnenden Infektion ist die Lungensonographie als bildgebende Diagnostikmethode geeignet, Verdachtsfälle bereits im Frühstadium der Erkrankung als solche zu identifizieren. Serielle Ultraschalluntersuchungen an Patienten mit bestätigter Infektion können bettseitig und zeitnah Veränderungen im betroffenen Lungengewebe nachweisen. Dieser Artikel fasst das diagnostische Potenzial der Lungensonographie im Hinblick auf Screening und therapeutische Entscheidungsfindung bei Patienten mit vermuteter oder bestätigter SARS-CoV-2-Pneumonie zusammen.

Context Early appropriate antimicrobial therapy leads to lower mortality rates associated with severe sepsis. The role of empirical combination therapy comprising at least 2 antibiotics of different mechanisms remains controversial. Objective To compare the effect of moxifloxacin and meropenem with the effect of meropenem alone on sepsis-related organ dysfunction. Design, Setting, and Patients A randomized, open-label, parallel-group trial of 600 patients who fulfilled criteria for severe sepsis or septic shock (n = 298 for monotherapy and n = 302 for combination therapy). The trial was performed at 44 intensive care units in Germany from October 16, 2007, to March 23, 2010. The number of evaluable patients was 273 in the monotherapy group and 278 in the combination therapy group. Interventions Intravenous meropenem (1 g every 8 hours) and moxifloxacin (400 mg every 24 hours) or meropenem alone. The intervention was recommended for 7 days and up to a maximum of 14 days after randomization or until discharge from the intensive care unit or death, whichever occurred first. Main Outcome Measure Degree of organ failure (mean of daily total Sequential Organ Failure Assessment [SOFA] scores over 14 days; score range: 0-24 points with higher scores indicating worse organ failure); secondary outcome: 28-day and 90-day all-cause mortality. Survivors were followed up for 90 days. Results Among 551 evaluable patients, there was no statistically significant difference in mean SOFA score between the meropenem and moxifloxacin group (8.3 points; 95% CI, 7.8-8.8 points) and the meropenem alone group (7.9 points; 95% CI, 7.5-8.4 points) (P = .36). The rates for 28-day and 90-day mortality also were not statistically significantly different. By day 28, there were 66 deaths (23.9%; 95% CI, 19.0%-29.4%) in the combination therapy group compared with 59 deaths (21.9%; 95% CI, 17.1%-27.4%) in the monotherapy group (P = .58). By day 90, there were 96 deaths (35.3%; 95% CI, 29.6%-41.3%) in the combination therapy group compared with 84 deaths (32.1%; 95% CI, 26.5%-38.1%) in the monotherapy group (P = .43). Conclusion Among adult patients with severe sepsis, treatment with combined meropenem and moxifloxacin compared with meropenem alone did not result in less organ failure. Trial Registration clinicaltrials.gov Identifier: NCT00534287

In the current coronavirus SARS-CoV-2 pandemic, certain patients are becoming seriously ill. Lung pathologies are common, and some patients even go on to develop acute respiratory distress syndrome (ARDS), which requires intubation and artificial respiration of the critically ill patient. Imaging of the lung is absolutely necessary to obtain a diagnosis, assess the course of disease and for treatment. Particularly in gynecology and obstetrics (OBGYN), ultrasound scans of the lung can be a useful additional tool when caring for pregnant patients in the delivery room. As obstetricians use ultrasound imaging a lot in routine clinical practice, in the current pandemic setting, routine prenatal imaging screening could be expanded by the addition of ultrasound scans of the lung. Lung sonography can offer important additional information, particularly in obstetrics where the indications for radiation-emitting imaging are particularly restrictive. If there is a sonographic suspicion of lung involvement, then, depending on the symptoms and the morphological extent of the ultrasound findings, it may be necessary to consider admitting the patient to hospital for close fetal and maternal monitoring.

Background Theoretical knowledge, visual perception, and sensorimotor skills are key elements in ultrasound education. Classroom-based presentations are used routinely to teach theoretical knowledge, whereas visual perception and sensorimotor skills typically require hands-on training (HT). We aimed to compare the effect of classroom-based lectures versus a case-based e-learning (based on clinical cases only) on the hands-on performance of trainees during an emergency ultrasound course. Participants and methods This is a randomized, controlled, parallel-group study. Sixty-two medical students were randomized into two groups [group 1 (G1) and group 2 (G2)]. G1 (n=29) was subjected to a precourse e-learning, based on 14 short screencasts (each 5 min), an on-site discussion (60 min), and a standardized HT session on the day of the course. G2 (n=31) received classroom-based presentations on the day of the course before an identical HT session. Both groups completed a multiple-choice (MC) pretest (test A), a practical postcourse test (objective structured clinical exam), and MC tests directly after the HT (test B) and 1 day after the course (test C). The Mann-Whitney U-test was used for statistical analysis. Results G1 performed markedly better in test A (median 84.2, 25%; 75% percentile: 68.5; 92.2) compared with G2 (65.8; 53.8; 80.4), who had not participated in case-based e-learning (P=0.0009). No differences were found in the objective structured clinical exam, test B, and test C. Conclusion e-learning exclusively based on clinical cases is an effective method of education in preparation for HT sessions and can reduce attendance time in ultrasound courses.

The analysis of lung artefacts has gained increasing importance as markers of lung pathology. B-line artefact (BLA), caused by a reverberation phenomenon, is the most important lung artefact. In this review, we discuss the current role of BLA in pneumology and explore open questions of the published consensus.We summarized current literature about BLA. Also, we presented observations on healthy subjects and patients with interstitial syndrome (pulmonary fibrosis and edema), to investigate technical factors influencing BLA visualization.BLA imaging is influenced by more factors than recently assumed. When multiple BLA is visualized in the lung, they represent a sign of increased density due to the loss of aeration in the lung periphery. This condition may indicate different diseases including cardiogenic pulmonary edema, diffuse or focal interstitial lung diseases (ILD), infections and acute respiratory distress syndrome (ARDS). Correct interpretation of BLA in lung ultrasound is strongly influenced by associated sonographic signs and careful integration of all relevant clinical information.BLA is useful to monitor clinical response, and may become crucial in directing the diagnostic process. Further research is warranted to clarify technical adjustments, different probe and machine factors that influence the visualization of BLA.

Lehrmethoden sind in der medizinischen Fort- und Weiterbildung zumeist Frontalprasentationen. In der Ultraschallausbildung ist neben der Vermittlung von Wissen auch das Erlernen der sensomotorischen und visuellen Perzeption notwendig. Dies erfordert neue Lehrmethoden. Wie neue Lehrmethoden von den Kursteilnehmern (KTN) aufgenommen werden, wurde bislang nur unzureichend untersucht. Es wurde festgestellt, welche Formen des Lernens KTN zur Vorbereitung, wahrend der Ultraschallkurse und zum Postkurs-Lernen bevorzugen (Analyse von „blended learning“) und wie viel Zeit KTN fur solche Angebote aufwenden mochten. Es handelte sich um eine empirische Befragung. Auf zertifizierten Kursen wurden die KTN am Ende des Kurstages gebeten, einen standardisierten Fragebogen, basierend auf einer visuellen Analogskala (VAS), auszufullen. Es wurden fur die Interpretation 3 Ergebniskategorien gebildet: Kategorie I: Pro-Votum (VAS 67–100 %) als Zweidrittelmehrheit; Kategorie II: einfache Zustimmung (50–67 %) und Kategorie III: Ablehnung (

The science of lung ultrasound has grown tremendously over the last two decades and lung ultrasound has not only entered the mainstream of point of care ultrasound but has become a dominant topic. Understanding lung ultrasound signs and artifacts is critical to being able to correlate findings with actual pathology and normal anatomy and physiology. Investigators have described multiple lung ultrasound artifacts and findings and it is important to understand both the physics and anatomic basis behind them. Additionally, ultrasound machine use and transducer selection can significantly affect results obtained on patient during an examination and the provider must carefully choose the correct settings. This manuscript describes the state of the art in ultrasound artifact recognition and correlation as well as management of ultrasound technology to optimize diagnostic success.

Introduction. The use of ultrasound during resuscitation is emphasized in the latest European resuscitation council guidelines of 2013 to identify treatable conditions such as pericardial tamponade. The recommended standard treatment of tamponade in various guidelines is pericardiocentesis. As ultrasound guidance lowers the complication rates and increases the patient’s safety, pericardiocentesis should be performed under ultrasound guidance. Acute care physicians actually need to train emergency pericardiocentesis.Methods. We describe in detail a pericardiocentesis ultrasound model, using materials at a cost of about 60 euros. During training courses of focused echocardiographyn=67,participants tested the phantom and completed a 16-item questionnaire, assessing the model using a visual analogue scale (VAS).Results. Eleven of fourteen questions were answered with a mean VAS score higher than 60% and thus regarded as showing the strengths of the model. Unrealistically outer appearance and heart shape were rated as weakness of the model. A total mean VAS score of all questions of 63% showed that participants gained confidence for further interventions.Conclusions. Our low-cost pericardiocentesis model, which can be easily constructed, may serve as an effective training tool of ultrasound-guided pericardiocentesis for acute and critical care physicians.

Die Entwicklung der modernen Lungensonographie bei kritisch Kranken beruht einerseits auf dem Ziel der klassischen Darstellung von anatomischen Strukturen, andererseits jedoch auf der Forderung nach Beurteilung typischer Artefakte, die Informationen uber den Luft- und Flussigkeitsgehalt der Lungen liefern. Dazu gehoren das Lungengleiten, der „Lungenpuls“, der „Lungenpunkt“, „B-Linien“ und Reverberationsartefakte sowie intrapleurale Flussigkeitsansammlungen und subpleurale Lungenkonsolidierungen. Vermehrte „B-Linien“ weisen unspezifisch auf eine erhohte Flussigkeitsmenge in den Lungen hin, wie sie z. B. beim Lungenodem oder einer Lungenkontusion zu finden ist. Durch den Nachweis subpleuraler Lungenkonsolidierungen konnen bettseitig Hinweise auf Pneumonien und Lungenembolien gewonnen werden. So kann uber die Detektion des Lungengleitens z. B. eine korrekte oder seitenungleiche Ventilation dargestellt oder ein Pneumothorax an dieser Stelle ausgeschlossen werden. Fur die Pneumothoraxdiagnostik wurde damit ein einfacher Algorithmus entwickelt: Bei Anwesenheit von Lungengleiten, „Lungenpuls“ oder „B-Linien“ kann ein Pneumothorax mit hoher Zuverlassigkeit ausgeschlossen werden; der nachgewiesene Lungenpunkt dagegen ist als sicheres Zeichen eines Pneumothorax zu bewerten. Die Sonographie bietet daruber hinaus die Moglichkeit, einen Pleuraerguss mit deutlich hoherer Sensitivitat als im Thoraxrontgenbild zu erkennen und die Ergusspunktion sicherer durchzufuhren.

Anasthesisten, Intensiv- und Notfallmediziner sind nahezu taglich mit Differenzialdiagnosen zu Dyspnoe oder Beatmungsproblemen oder mit der Versorgung von Traumapatienten befasst. Hierzu gehoren die Diagnose oder der Ausschluss von Pneumonie, Pneumothorax oder Pleuraerguss bzw. thorakalen oder abdominellen Blutungen. Oft mussen auch Entscheidungen zu invasiven Masnahmen, wie z.B. zur Pleurapunktion, oder zur Anlage einer dilatativen Tracheotomie abgewogen werden. Mit der thorakoabdominellen Sonografie als ”visuellem Stethoskop“ steht dem Akutmediziner ein Verfahren zur Verfugung, das die Anzahl von Rontgenaufnahmen, CT-Untersuchungen sowie risikoreichen Transporten von beatmeten Patienten reduzieren kann. Deren kompetente Anwendung bedarf einer systematischen und intensiven Ausbildung, fur die das hier vorgestellte curriculare Trainingsmodul der DGAI die Grundlage schaffen soll.

Background. Lung ultrasound has become an emerging tool in acute and critical care medicine. Combined theoretical and hands-on training has been required to teach ultrasound diagnostics. Current computer technology allows for display, explanation, and animation of information in a remote-learning environment.Objective. Development and assessment of an e-learning program for lung ultrasound.Methods. An interactive online tutorial was created. A prospective learning success study was conducted with medical students using a multiple-choice test (Trial A). This e-learning program was used as preparation for a certified course followed by an evaluation of trained doctors (Trial B) by linear analogue scales. Pretests were compared with postcourse tests and sustainability tests as well as a posttest of a one-day custom classroom training.Results. In Trial A, during the learning success study (n=29), the increase of correct answers was 11.7 to 17/20 in the post-test and to 16.6/20 in the sustainability test (relative change 45.1%,P<0.0001). E-learning almost equalled scores of classroom-based training regarding gain and retention of factual knowledge. In Trial B, nineteen participating doctors found a 79.5% increase of knowledge (median, 95% CI: 69%; 88%).Conclusion. The basics of lung ultrasound can be taught in a highly effective manner using e-learning.

Dieses Kapitel soll neue konzeptionelle Moglichkeiten der Point-of-care-Sonographie fur Notfalle aufzeigen. Die Autoren greifen hier aktuelle Ergebnisse der Wissenschaft und Technologie auf und wollen darauf hinweisen, dass in diesem Beitrag Innovationen aufgezeigt werden, die noch nicht uberall etabliert sind. Die Beschreibung der Verfahren und Prozessveranderungen jedoch kann jeder Fachabteilung von hohem Nutzen sein.

Die Sonographie der Lunge und Pleura hat sich im letzten Jahrzehnt als wichtige Untersuchungstechnik in der Notfall- und Intensivmedizin etabliert. Die Tatsache, dass in der Lungensonographie neben wenigen einfachen sonomorphologischen Strukturen vor allem Artefakte dargestellt und interpretiert werden, fuhrt dazu, dass diese Untersuchungsmodalitat auch fur ultraschallunerfahrene Untersucher relativ schnell und einfach zu erlernen ist. Im folgenden Kapitel sollen die Grundlagen der Lungensonographie, der Untersuchungsgang sowie typische Befunde akutmedizinisch relevanter Krankheitsbilder anhand von Originalbefunden dargestellt werden.

Background and Study objective. Focused lung ultrasound (LUS) examinations are important tools in critical care medicine. There is evidence that LUS can be used for the detection of acute thoracic lesions. However, no validated training method is available. The goal of this study was to develop and assess an objective structured clinical examination (OSCE) curriculum for focused thorax, trachea, and lung ultrasound in emergency and critical care medicine (THOLUUSE).Methods. 39 trainees underwent a one-day training course in a prospective educational study, including lectures in sonoanatomy and -pathology of the thorax, case presentations, and hands-on training. Trainees’ pre- and posttest performances were assessed by multiple choice questionnaires, visual perception tests by interpretation video clips, practical performance of LUS, and identification of specific ultrasound findings.Results. Trainees postcourse scores of correct MCQ answers increased from56±4%to82±2%(mean± SD;P<0.001); visual perception skills increased from54±5%to78±3%(P<0.001); practical ultrasound skills improved, and correct LUS was performed in 94%. Subgroup analysis revealed that learning success was independent from the trainees’ previous ultrasound experience.Conclusions. THOLUUSE significantly improves theoretical and practical skills for the diagnosis of acute thoracic lesions. We propose to implement THOLUUSE in emergency medicine training.

Anesthesiologists and Critical Care Physicians are confronted with the differential diagnoses of dyspnea, complications of mechanical ventilation or rapid assessment of trauma patients on a nearly daily basis. This requires the timely diagnosis or exclusion of a wide variety of disease processes including pleura effusion, pneumonia, pneumothorax as well as thoracical or abdominal bleeding. Furthermore, the anaesthesiologist or intensivist often makes decisions leading to invasive procedures like thoracentesis or percutaneous dilatational tracheostomy. Bedside ultrasound as the "visual stethoscope" of the acute care physician offers an alternative to other imaging modalities like X-ray and CAT scan and can reduce associated high-risk transportation of mechanically ventilated patients. In this article, we introduce a new training module based on the DGAI curriculum.

We applaud the British Thoracic Society (BTS) for its efforts to improve patient care through scientific evidence. We thus recognise the recent guidelines on pleural procedures and thoracic ultrasound (TUS) as an important attempt to develop a rational approach to chest sonography.1 However, we are concerned that the BTS has reached conclusions based on a less complete review of TUS. The guidelines state that ‘the utility of thoracic ultrasound for diagnosing a pneumothorax is limited in hospital practice due to the ready availability of chest x-rays (CXR) and conflicting data from published reports’.1 This conclusion appears to be based on a small (but landmark) study of 11 patients from 1986 to 1989, two small studies with only four pneumothoraces in …

Background Emergency ultrasound is gaining importance in medical education. Widespread teaching methods are frontal presentations and hands-on training. The primary goal of our study was to evaluate the impact of frontal presentations (PS) by analysis of retained knowledge rate (RKR) and learning load (LL). Methods Our study was conducted during four introductory courses in emergency ultrasound covering Extended Focused Assessment with Sonography for Trauma (E-FAST) and Focused Echocardiography Evaluation in Life Support (FEEL). Standardized PS (length of 10 to 50 min) were presented by experienced trainers, who were asked to provide keywords, key messages, and images and assign a score to each. Group 1 consisted of 11 medical students with no prior ultrasound experience, and group 2 consisted of 80 physicians. Each group was audience to seven to eight standard PS and requested to answer a free text questionnaire after 0 h, 2.5 h, 24 h, and 14 days. Results In group 1, 168/176 questionnaires were analyzed, and 161/202 were analyzed in group 2. RKR in group 1 was 32.5%, 15%, 16%, and 12% at 0 h, 2.5 h, 24 h, and 2 weeks. The physicians' RKR were 23%, 20.5%, and 22.4% after 0, 2.5, and 24 h of a respective PS. The LL was 1.6/min for students and 1.2/min for physicians. There was no difference in RKR when comparing PS with higher and lower LL for both groups; shorter or case-based PS were associated with a higher RKR (p Conclusions Our study provides evidence that only a limited amount of information can be processed at a time. Only 12% of knowledge is retained after 2 weeks. Presentations of short duration can increase the retained knowledge rate. Therefore, frontal presentations and classroom-based ultrasound training and teaching should be adapted.

Background Point-of-care ultrasound (POC-US) is gaining importance in almost all specialties. E-learning has been used to teach theoretical knowledge and pattern recognition. As social media are universally available, they can be utilized for educational purposes. We wanted to evaluate the utility of the sandwich e-learning approach defined as a pre-course e-learning and a post-course learning activity using Facebook after a one-day point-of-care ultrasound (POC-US) course and its effect on the retention of knowledge. Methods A total of 62 medial students were recruited for this study and randomly assigned to one of four groups. All groups received an identical hands-on training and performed several tests during the study period. The hands-on training was performed in groups of five students per instructor with the students scanning each other. Group 1 had access to pre-course e-learning, but not to post-course e-learning. Instead of a pre-course e-learning, group 2 listened to presentations at the day of the course (classroom teaching) and had access to the post-course learning activity using Facebook. Group 3 had access to both pre- and post-course e-learning (sandwich e-learning) activities, while group 4 listened classroom presentations only (classroom teaching only). Therefore only groups 2 and 3 had access to post-course learning via Facebook by joining a secured group. Posts containing ultrasound pictures and videos were published to this group. The students were asked to “like” the posts to monitor attendance. Knowledge retention was assessed 6 weeks after the course. Results After 6 weeks, group 3 achieved comparable results when compared to group 2 (82.2 % + −8.2 vs. 84.3 + −8.02) (p = 0.3). Students who participated in the post-course activity were more satisfied with the overall course than students without post-course learning (5.5 vs. 5.3 on a range from 1 to 6). Conclusions In this study, the sandwich e-learning approach led to equal rates of knowledge retention compared to classroom lectures and post-course learning. Students appreciate new media for learning experiences and are more satisfied with their learning activity. The sandwich e-learning can be used to maximize hands-on training during courses. Electronic supplementary material The online version of this article (doi:10.1186/s13089-016-0037-9) contains supplementary material, which is available to authorized users.