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Case Presentation: A 63-year-old female presented to our emergency department with altered mental status and hypotension. She was transferred from the outpatient interventional radiology suite after becoming unresponsive during the removal of an inferior vena cava filter. The patient arrived somnolent with no other history available. Her physical exam was unremarkable. We used point-of-care-ultrasound to perform a rapid ultrasound for shock and hypotension (RUSH) exam. A large pericardial effusion along with signs of cardiac tamponade were identified. The cardiothoracic surgery team was notified, and the patient was taken to the operating room where pericardial blood and a large hematoma were evacuated. She recovered uneventfully and was discharged one week later.Discussion: The above case describes a very unstable patient whose diagnosis was obtained using the RUSH exam. History and physical did not point to a clear etiology. Options were very limited. She was too unstable to go for computed tomography, and other tests such as electrocardiogram, chest radiograph, and lab work would have been non-diagnostic. It was only after the cardiac view of the RUSH exam was obtained that a pericardial effusion and developing tamponade were identified, facilitating timely management. The RUSH exam, like the extended focused assessment with sonography for trauma, is used to help determine pathologies that need immediate intervention. Incorporation in the evaluation of critically ill patients reduces the time to diagnosis. Our case is a unique example of how point-of-care ultrasound can be used to urgently identify a life-threatening pathology.

Introduction: Point-of-care ultrasound (POCUS) is a screening and diagnostic modality frequently used in the emergency department to assess patients with abdominal pain.Case Report: We present a case describing the unusual finding of intraperitoneal fluid with loculations visualized in the right upper quadrant of the abdomen in a patient ultimately diagnosed with pelvic inflammatory disease (PID) with ruptured tubo-ovarian abscess caused by group A streptococcus (GAS), a pathogen rarely implicated in the disease.Conclusion: Uncommon findings on abdominal POCUS should trigger further investigation. In a patient not responding to antibiotics administered for typical PID coverage, GAS should be considered as a possible etiology and a penicillin-based antibiotic administered to prevent progression to tubo-ovarianabscess formation, peritonitis, and sepsis.

Case Presentation: An 8-month-old infant presented to a general emergency department with chief complaints of rhinorrhea, decreased activity, and fever. A point-of-care lung ultrasound (LUS) was performed at bedside with potential early findings of pneumonia. Based on these findings on LUS, a chest radiograph (CXR) was ordered and performed with no acute findings. He was discharged without antibiotics based on these findings; unfortunately, he returned two days later with worsening symptoms requiring chest tube placement, mechanical ventilation, and prolonged hospitalization for complicated bacterial pneumonia.Discussion: Pneumonia is a major cause of pediatric morbidity and mortality worldwide. Despite evidence supporting the utilization of LUS for the diagnosis of pediatric pneumonia, CXR remains the default imaging for clinical decision-making in most settings. In this case, earlier antibiotics and higher reliance on LUS for clinical decision-making may have prevented the morbidity associated with this hospitalization.

Introduction: Diagnosing deep venous thromboses and venous thromboemboli (DVT/VTE) in pregnant patients presents a unique challenge for emergency physicians. The risk of DVT/VTE increases during pregnancy, and the potential consequences of misdiagnoses are severe. Point-of-care ultrasonography (POCUS) is frequently a first-line diagnostic imaging modality. However, recent studies have shown a high incidence of thromboses proximal to the common femoral vein during pregnancy, and these would not be visualized using compressive ultrasonography, which traditionally can only visualize thromboses distal to the femoral vein.Case Report: A 38-year-old female, 25-weeks primiparous, presented to the emergency department with a three-day history of left lower extremity swelling. Point-of-care three-point compression testing was used to evaluate for a DVT; however, no thrombus was visualized. Given high clinical suspicion, color and spectral Doppler testing were performed and demonstrated turbulent flow and reduced respiratory variation in the common femoral vein. This prompted further additional testing for a proximal DVT using magnetic resonance venography, which revealed an occlusive left external iliac thrombus. The patient was subsequently started on daily subcutaneous enoxaparin and discharged home with close follow-up.Conclusion: Emergency physicians play a critical role in evaluations for the presence of DVT/VTE, particularly in pregnant patients. We endorse the use of POCUS with three-point compression testing, as well as color and spectral Doppler imaging, to help identify proximal DVTs in this patient population. This case report can aid physicians in the diagnosis of this pathological condition that if left untreated can have severe consequences.

Case Presentation: We describe the presentation, evaluation, and management of a young female patient presenting to the emergency department with atraumatic orbital emphysema, a rare condition. This patient was diagnosed using point-of-care ultrasound and computed tomography and was managed expectantly.Discussion: Atraumatic orbital emphysema is a rare clinical condition more common in early middle-aged female patients with certain historical features such as chronic sinusitis, facial surgery or trauma, tobacco smoking, or current upper respiratory symptoms. While most cases will resolve spontaneously, rarely this condition can lead to vision-threatening orbital compartment syndrome, requiring lateral canthotomy or needle decompression.

Introduction: Point-of-care ultrasound (POCUS) performed by emergency physicians (EP) has emerged as an effective alternative to radiology department ultrasounds for the diagnosis of lower extremity deep vein thrombosis (DVT). Systematic reviews suggested good sensitivity and specificity overall for EP-performed POCUS for DVT diagnosis, yet high levels of heterogeneity were reported.Methods: In this systematic review and meta-analysis, we aimed to provide the most up-to-date estimates of the accuracy of EP-performed POCUS for diagnosis of DVT and to explore potential correlations with test performance. We performed systematic searches in MEDLINE and Embase for original, primary data articles from January 2012–June 2021 comparing the efficacy of POCUS performed by EPs to the local standard. Quality Assessment of Diagnostic Accuracy Studies-2 for individual articles are reported. We obtained summary measures of sensitivity, specificity, and their corresponding 95% confidence intervals (CI) using bivariate mixed-effects regression models. We performed meta-regression, subgroup, and sensitivity analyses as planned in the protocol CRD42021268799 submitted to PROSPERO.Results: Fifteen publications fit the inclusion criteria, totaling 2,511 examinations. Pooled sensitivity and specificity were 90% (95% CI 82%–95%) and 95% (CI 91%–97%), respectively. Subgroup analyses by EP experience found significantly better accuracy for exams performed by EP specialists (93%, CI 88%–97%) vs trainees (77%, CI 60%–94%). Specificity for EP specialists (97%, CI 94%–99%) was higher than for trainees (87%, CI 76%–99%, P = 0.01). Three-point compression ultrasound (CUS) was more sensitive than two-point CUS but was only statistically significant when limited to EP specialists (92% vs 88%, P = 0.07, and 95% vs 88%, P = 0.02, respectively).Conclusion: Point-of-care ultrasound performed by emergency physicians is sensitive and specific for the diagnosis of suspected DVT when performed by trained attending EPs. Three-point compression ultrasound examination may be more sensitive than two-point CUS.

Introduction: Numerous studies have demonstrated the accuracy of point-of-care ultrasound (POCUS). Portable, handheld devices have expanded the clinical scope of POCUS at a fraction of the cost of traditional, cart-based models. There is a paucity of data assessing the diagnostic accuracy of portable devices. Our objective in this study was to compare the diagnostic accuracy of a portable device with a cart-based model.Methods: This was an institutional review board-approved, observational, prospective, randomized clinical trial (NCT05196776) of a convenience sample of adult patients who presented to a university-based health system. Patients who required a cardiac, lung, renal, aorta, or biliary POCUS were randomized to a portable device or to a cart-based model. We hypothesized that the cart-based model would have a 90% diagnostic accuracy vs 70% for the handheld device. To detect a 20% difference, the sample size was calculated to be 98, with 49 patients randomized to each arm. We used standard 2x2 tables to calculate test characteristics with 95% confidence intervals (CI).Results: A total of 110 patients were enrolled, with 56 patients randomized to the cart-based model and 54 to the handheld device. The sensitivity, specificity, and diagnostic accuracy of the cart-based vs handheld were 77.8% (40–97.2) vs 92.9% (66.1–99.8), 91.5% (79.6–97.6) vs 92.3% (79.1–98.4%), and 89.3% (78.1–96) vs 92.5% (81.8–97.9), respectively.Conclusion: The diagnostic accuracy of a portable, handheld device is similar to that of a cart-based model.

Background: Acute bronchiolitis (AB) is the most common lower respiratory tract infection in infants. Clinician diagnosis and management vary due to limited objective assessment tools. Point-of-care lung ultrasound (LUS) offers a promising diagnostic and prognostic tool in the emergency department (ED), however, the time to perform LUS is of concern in the emergency setting. Methods: Infants ≤ 12 months diagnosed with AB in the emergency department were enrolled. Two LUS techniques were performed sequentially: a 12-segment "lawnmower" approach and a posterior paravertebral "waterfall" technique. LUS were scored (0–36 for lawnmower; 0–6 for waterfall). Respiratory support (RS) was categorized into three levels: no RS (room air), low RS (wall O2 or heated high flow nasal cannula < 1L/kg), and high RS (heated high flow nasal cannula ≥ 1L/kg or positive pressure). Clinical data, including RS at 12 and 24 h, maximum RS, disposition, and length of stay, were extracted via chart review and compared to mean LUS scores for each technique. Calculated areas under the curve (AUC) were compared using the Youden Index (J). Results: 82 infants were enrolled. The mean waterfall scanning time was 1.65 min (SD 0.55) compared to the lawnmower's 7.65 min (SD 1.45). The difference between mean LUS scores for the waterfall technique was statistically significant for all disposition comparisons and nearly all RS comparisons. While the lawnmower AUC was greater than the waterfall AUC for all RS and disposition comparisons, the Youden Index (J) was statistically significantly different for only two of the eight comparisons. Conclusion: The posterior-only LUS technique is faster than the lawnmower technique, provides comparable information for disposition, and has a stronger association with LOS, but is less associated with RS. The waterfall technique may be a suitable alternative to more time-intensive, thorough techniques. [ABSTRACT FROM AUTHOR]

Background: Research demonstrates that Point-of-care ultrasound (POCUS) improves clinical outcomes for patients. Improving clinician satisfaction with POCUS should promote utilization into everyday practice, leading to improved clinical outcomes. Despite this benefit, there are still barriers to use including POCUS workflow. This project was undertaken to improve the functionality of the existing POCUS workflow and move toward an "encounter-based" system by automating worklist generation. It aimed to streamline the POCUS workflow, primarily determine if there was improved clinician satisfaction with the new workflow, and secondarily determine the change in revenue generation from decreased errors in data entry. Methods: A new workflow was created which automatically populated every registered Emergency Department (ED) patient into the worklist upon patient registration. Clinician feedback on their use of the new workflow was sought via survey after implementation. The number of medical record number (MRN) entry errors prior to and following implementation was manually reviewed and calculated. Results: There was a strong preference for the new workflow, with 36 of 38 (94.7%) clinicians finding it to be more convenient and 37 of 38 (97.4%) finding it to be preferable to use compared to the old workflow. Implementation also resulted in a 36% reduction in database studies containing an MRN data entry error. Conclusions: An "encounter-based" workflow is strongly preferred over manual data entry for POCUS workflow among clinicians. Additionally, there was no cost to the intervention and the total data entry errors were significantly reduced, allowing for improved quality review and increased revenue. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) is a valuable skill for generalist physicians, nurse practitioners (NPs), and nurses; however, its utilization remains limited. This study was performed to investigate the current status, barriers, and facilitators of POCUS implementation among physicians, NPs, and nurses in family and hospital medicine in Japan and to identify differences in influencing factors between physicians and NPs/nurses. Results: A web-based survey was distributed via the mailing lists of four major academic societies in general medicine in Japan—the Japanese Society of Hospital General Medicine, the Japan Primary Care Association, the Japanese Association for Home Care Medicine, and the Japan Society of Nurse Practitioner—from April to June 2024. The respondents included physicians, NPs, and nurses affiliated with these societies. Responses from other professions, duplicate entries, and incomplete surveys were excluded from the analysis, resulting in 913 valid responses (692 physicians and 221 NPs/nurses). Physicians reported a higher POCUS implementation rate than NPs/nurses (73.0 vs. 63.4%, p = 0.006). The top two barriers were consistent across both groups: lack of training opportunities (p = 0.385) and lack of image acquisition skills (p = 0.369). However, NPs/nurses reported significantly greater barriers than did physicians, including lack of mentors (p < 0.001), lack of interpretation skills (p = 0.007), lack of confidence (p < 0.001), poor access to ultrasound devices (p < 0.001), and absence of institutional guidelines (p < 0.001). The top facilitators for both groups were good access to ultrasound devices (p = 0.078) and increased training opportunities (p = 0.240), with no significant differences between them. Compared with physicians, NPs/nurses expressed a significantly higher demand for nearby mentors (p < 0.001), institutional support (p < 0.001), and POCUS certification (p = 0.005). Conclusions: There is currently a lack of POCUS training opportunities across all professional roles. To promote POCUS adoption among NPs and nurses, it is essential to develop mentorship programs, establish institutional guidelines, and create an environment that enables NPs and nurses to perform POCUS confidently through measures such as certification programs. [ABSTRACT FROM AUTHOR]

Introduction: Fluid overload is a frequent and serious complication in hemodialysis patients. The combination of multiple point-of-care ultrasound (POCUS) measurements can identify significant venous congestion, but its usefulness to determine ultrafiltration (UF) requirements and dry weight is unknown. Therefore, we evaluated prospectively patients in maintenance hemodialysis to establish the correlations between changes in venous congestion parameters and fluid removal. Methods: This was a prospective, single-center, observational study. POCUS venous congestion measurements were performed in 22 patients during 32 online post-dilutional hemodiafiltration sessions, and findings were correlated with UF volume, central venous pressure, and body water composition determined by multifrequency bioelectric impedance analysis (BIA). Results: The pre-dialysis weight was on average 1.9 kg above the BIA estimated dry weight, the average initial inferior vena cava (IVC) diameter was <2 cm. An initial abnormal hepatic vein (HV) waveform was present in 26% (8) of the measurements. The average UF volume was 2,084 ± 655 mL and correlated with changes in IVC diameter (R = 0.34, 95% CI: [0.18, 0.56], p < 0.05) but not with any other POCUS venous congestion parameters. Normalization of the IVC diameter and HV waveform was observed during the first UF hour in all initially altered measurements. Diameter reduction in the IVC correlated with total body water volume reduction estimated with BIA when measured immediately after fluid removal (R = 0.34, 95% CI: [0.08, 0.56], p < 0.05). Conclusion: Reduction in IVC diameter had a modest but significant correlation with UF volume in our patients on maintenance hemodiafiltration. POCUS may be used to monitor patients during UF. [ABSTRACT FROM AUTHOR]

Objectives: Skeletal muscle wasting is a common occurrence in critical illness, often resulting in intensive care unit (ICU)‐acquired weakness. This study aims to identify clinical factors associated with muscle decay in mechanically ventilated critically ill children. Utilizing point‐of‐care ultrasound, a noninvasive and cost‐effective tool, we assess muscle decay through ultrasound of the quadriceps femoris. Methods: A prospective observational study was conducted in a single‐center quaternary‐care pediatric intensive care unit at a children's hospital. A convenience sample of 103 sedated and mechanically ventilated patients were enrolled in this study. Ultrasound measurements of quadriceps femoris muscle thickness were taken, and daily muscle decay rates were calculated. Demographic, clinical, and outcome data were analyzed for correlations with muscle decay. Results: Among the enrolled patients, 67 had repeat measurements. Muscle thickness change aligned with prior studies, with a mean daily change of −1.9% [IQR −0.8, −5.0]. Adequate cumulative caloric intake (>60% of goal) correlated with less muscle decay compared with inadequate intake (−1.8 vs −2.4%, P <.001). Average daily muscle change correlated with both ICU and hospital length of stay (LOS) (r =.328, P =.007 and r =.393, P =.001). No significant correlations emerged between muscle change and mortality, disease severity, fluid balance, early mobilization, steroid exposure, or sedative and paralytic use. Conclusion: This study demonstrates early and frequent muscle decay in critically ill children, as detected by point‐of‐care ultrasound. Average daily muscle decay was associated with longer ICU and hospital LOS. Adequate cumulative caloric intake is linked to reduced muscle decay. These findings contribute to understanding muscle wasting in critically ill pediatric patients. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Introduction: Recent international consensus statements advocate for the integration of Point-of-Care Ultrasound (PoCUS) into the global undergraduate medical curriculum. Some medical schools outside Saudi Arabia have already incorporated PoCUS into their undergraduate curricula to enhance anatomy, physiology and pathology instruction. However, there are no data on the potential role of PoCUS in the preclinical training of medical students in Saudi Arabia. Given constraints on resources for medical education, a formal needs assessment was conducted to evaluate the potential utility of PoCUS within the basic science curriculum at our institution. Methods: All final year medical students at our institution were invited to complete a validated online survey. The questionnaire utilized a 5-point Likert scale to assess student perceptions of the potential for PoCUS to improve their understanding of basic sciences and their desire for its incorporation into the preclinical curriculum. Results: A total of 229 students participated (response rate 76%; male 134/200; female 95/100). Our survey demonstrated good internal consistency (Cronbach's alpha: learning basic sciences 0.81, need for curriculum integration 0.83). The vast agreed that learning PoCUS would enhance their understanding of anatomy (95%) and pathology (75%). While only 52% agreed that learning PoCUS would improve their understanding of physiology, a substantial majority (80%) agreed that all medical schools should incorporate PoCUS into their undergraduate curricula. Furthermore, 62% agreed that offering PoCUS training would make the medical school more attractive to prospective applicants. No significant differences were observed between the responses of male and female students. The results of a confirmatory factor analysis provide strong support for the hypothesized three-factor model. All factor loadings are significant (P < 0.001), Conclusions: Medical students in Saudi Arabia perceive that PoCUS would be a valuable tool to learn anatomy and pathology, aligning with the recommendations of the consensus conference on PoCUS integration in undergraduate medical education organized by the World Interactive Network Focused on Critical Ultrasound (WINFOCUS) and the Society of Ultrasound in Medical Education (SUSME). Introducing PoCUS training into preclinical medical curricula may also enhance the attractiveness of medical schools to potential applicants. Take home message: Aligning with Global Trends: Integrating PoCUS into Undergraduate Medical Education. Our study adds to the growing momentum for Point-of-Care Ultrasound (PoCUS) training in medical education. Building upon the recent proposal for a global PoCUS curriculum by WINFOCUS and SUSME, our findings demonstrate that Saudi Arabian medical students perceive PoCUS as a valuable tool for enhancing their grasp of basic sciences. This strong student support reinforces the case for integrating PoCUS into pre-clinical medical curricula throughout Saudi Arabia. The survey instrument developed for this study (Appendix 1) is a valuable tool for universities worldwide, allowing them to conduct similar needs assessments tailored to their specific contexts and contribute to the global adoption of PoCUS education. [ABSTRACT FROM AUTHOR]

Background: As Point-of-Care Ultrasound (POCUS) education is increasingly incorporated in undergraduate medical education (UME), evaluation of the effectiveness of various ultrasound-related curricula is a developing field. The Extended Focused Assessment with Sonography (EFAST) is a POCUS exam widely used in emergency medicine. This project examines third-year osteopathic medical (OMS III) students' perceptions of the impact of a focused introduction to EFAST training curriculum on their performance ability and utilization of EFAST during third-year clinical rotations. Furthermore, we assessed student perceptions of barriers to the use of POCUS during third-year clinical rotations. Methods: The introduction to EFAST curriculum was developed using competency-based backward design and was delivered in July 2022 to incoming OMS III students. The curriculum involved didactics, hands-on ultrasound practice with standardized patients, and a comprehensive OSCE assessment, where students performed the EFAST exam. In July/August 2023, curriculum participants were anonymously surveyed regarding the effectiveness of the EFAST curriculum and perceived barriers to EFAST and POCUS utilization during their third-year clerkships. Descriptive and thematic analyses were performed on quantitative and qualitative data. Results: Twenty-one of 69 (30.4%) participants responded to the survey, with 17 (24.6%) participants completing the entire survey. Respondents reported increased knowledge and confidence in performing and interpreting EFAST, with 82.4% indicating increased likelihood of performing EFAST and POCUS in general. 76.4% performed EFAST at least once during third-year clerkships, with 11.8% performing it 15 times or more. Students reported valuing the safe simulated learning environment of the EFAST training, and identified lack of patients with indications for EFAST, time constraints, lack of ultrasound machine availability and clinician comfort level as barriers to EFAST utilization. Conclusions: This study presents the implementation of a focused EFAST curriculum developed through competency-based deliberate backward design based on professional guidelines and the anticipated educational needs of our institution and community. Student perceptions provided valuable insight into access and barriers to EFAST and POCUS use in subsequent clinical clerkships, indicating student perception of POCUS curriculum effectiveness may provide insight to continual curriculum improvement. [ABSTRACT FROM AUTHOR]

Introduction/Purpose Methods Results Conclusion Teleultrasound connects expert point‐of‐care ultrasound (POCUS) users with remote community and rural sites. Evolving technologies including handheld devices, upgraded image quality, and the ability to transmit over low bandwidth connections increase POCUS education, accessibility, and clinical integration. Potential teleultrasound venues include low‐resource settings, prehospital care, and austere environments (high altitudes, microgravity, conflict zones, etc.). This scoping review assesses current teleultrasound uses and identifies implementation enablers and barriers.Using the PRISMA‐ScR checklist, PubMed, Embase, and Cochrane were searched on 16 August 2024 for teleultrasound studies. Two reviewers independently screened results and abstracted data using a data collection table. 165 articles met the following inclusion criteria: research studies describing teleultrasound, involving humans, including healthcare workers, with remote point‐of‐care or medical ultrasound use, in any setting, and in English.Teleultrasound studies were reported in most specialties and across all continents. Most were prospective (100 studies), review articles (27), or case studies (14). Study quality was variable, with 28 high quality, 77 moderate, 54 low, and 6 very low (GRADE assessment tool). Common themes that emerged include (1) type of image transmission method utilised, (2) remote provider training and curriculum development, (3) feedback methods between expert and novice users, (4) technologies and devices used, and (5) enablers and barriers to guide future teleultrasound implementation and training strategies.Overall, the teleultrasound literature is heterogeneous in setting, design, and quality outcomes. As teleultrasound technology evolves and the use expands, future studies should standardise protocols and ensure image quality fidelity to optimise remote patient care. [ABSTRACT FROM AUTHOR]

The article discusses the use of venous Doppler ultrasound to guide ultrafiltration in hemodialysis patients, focusing on the relationship between sonographic markers of venous congestion and ultrafiltration volume. The study highlights the challenges and considerations for point-of-care ultrasound research in hemodialysis patients, emphasizing the need for expert training and interpretation. It also addresses the limitations of using VExUS as a direct measure of volume overload and the importance of integrating multiple Doppler waveforms for accurate assessment. The article suggests future research should focus on high-risk subsets and standardized protocols to ensure meaningful conclusions for patient care. [Extracted from the article]

Background There is limited evidence on point-of-care ultrasound for tuberculosis (TB), but studies suggest high sensitivity, especially for lung ultrasound (LUS). However, insufficient data are available on specificity of the examination and its generalizability to a broader patient population. Aims Our study aimed to establish accuracy for lung, chest, and abdominal ultrasound, individually and in combination, for TB diagnosis. Methods We conducted a prospective diagnostic accuracy study among consecutive adult out- and inpatients with probable TB in three German referral hospitals. We applied a comprehensive standardized ultrasound protocol. TB diagnosis was established by a microbiological reference standard including polymerase chain reaction and culture. Results A total of 102 participants originating from 30 different countries were enrolled. HIV prevalence was 7/99 (7%) and 73/102 (72%) had confirmed TB. TB was limited to the lungs in 15/34 (44%) of refugees and 27/39 (69%) in nonrefugees. Focused assessment with sonography for HIV-associated tuberculosis had a sensitivity of 40% (95% confidence interval [CI], 30–52) and specificity of 55% (95% CI, 38–72). Additional findings, such as small subpleural consolidations on LUS had a high sensitivity (88%; 95% CI, 78–93), but a low specificity (17%; 95% CI, 8–35). Larger consolidations in the lung apices had a sensitivity of 19% (95% CI, 12–30) and a specificity of 97% (95% CI, 83–100). Conclusions Our study establishes the first data on LUS performance against a comprehensive reference standard. Overall, our data suggest that ultrasound does not meet the requirements for triage but previously described and novel ultrasound targets in combination could aid in the clinical decision making. Registry: DRKS00026636 [ABSTRACT FROM AUTHOR]

Background: Type A acute aortic dissection (TAAAD) is a serious cardiovascular disease with a high mortality rate and prompt diagnosis is the key to survival. However, misdiagnosis is common in the Emergency Department (ED). The aim of this study is to evaluate the rate of misdiagnosis, factors associated with misdiagnosis and patient outcomes. Methods: This retrospective cohort study recruited 91 patients with TAAAD at the ED of a tertiary university hospital in Hong Kong from 2013 to 2022. Patients were divided into the following two groups: correct diagnosis (60 patients) and misdiagnosis (31 patients) of TAAAD. Clinical symptoms, signs, and investigations were analyzed as factors associated with misdiagnosis by multivariate analysis. In‐patient mortality, 30‐day mortality, 1‐year mortality, and hospital length of stay (LOS) were compared between the two groups. Results: The misdiagnosis rate of TAAAD was 34.1% (31/91). Absence of severe intensity pain (OR = 6.01, 95% confidence interval [CI] = 1.41–25.63, p = 0.015), less urgent triage category (OR = 4.46, 95% CI = 1.77–11.22, p = 0.002), and absence of point‐of‐care ultrasound exam (POCUS) (OR = 13.00, 95% CI = 3.05–55.40, p = 0.001) were associated with misdiagnosis. There were no statistically significant differences between correct diagnosis and misdiagnosis groups in patient outcomes including in‐hospital mortality (28.3% vs. 38.7%), 30‐day mortality (28.3% vs. 38.7%), 1‐year mortality (30.0% vs. 41.9%), or hospital LOS (15.5 ± 15.6 days vs. 14.7 ± 15.5 days). Conclusions: One‐third of cases in our study were misdiagnosed. The absence of severe intensity pain, less urgent triage category, and absence of POCUS ultrasound exam were independent factors associated with misdiagnosis. More widespread use of POCUS of the aorta and heart may help to improve the diagnosis of TAAAD in the ED. [ABSTRACT FROM AUTHOR]

Introduction: Point‐of‐Care Ultrasound (POCUS) has become an indispensable tool for diagnosis, monitoring, and procedure guidance in various medical specialties. Structured POCUS training is essential to provide users with the knowledge and skills needed for clinical practice. Many medical schools have integrated POCUS into their curriculum to familiarize their students with this technology early on in their medical careers. Objective: This review aims to explore the integration of POCUS into the undergraduate medical education curriculum, discussing its benefits, challenges, barriers, and strategies for effective implementation. Discussion: The POCUS educational framework uses various methods that combine the delivery of theoretical knowledge with practical skills training. It is highly recommended that medical schools include the fundamentals of ultrasound physics and knobology, structural anatomy, physiology, basic pathology of various organs, and basic instructions on ultrasound needle guidance for procedures in their POCUS curriculum. Importantly, the curriculum should include a comprehensive plan for assessing competency. The integration of POCUS into undergraduate medical education offers several benefits, including facilitating the teaching of basic sciences, enhancing physical examination skills, improving clinical problem‐solving abilities, preparing students for future clinical work, and enhancing the overall educational experience. However, there are challenges associated with this integration, such as a limited availability of qualified instructors, the high financial and logistical investment required, and the complexities of incorporating POCUS into an already compact medical curriculum. With the advancements in ultrasound technology and the integration of artificial intelligence, future research studies are needed to assess how these developments influence the integration of POCUS in undergraduate medical education. [ABSTRACT FROM AUTHOR]

Acute scrotum is a frequent occurrence in the pediatric emergency department, and ultrasound is often utilized to narrow the difference in diagnosis. Point-ofcare ultrasound (POCUS) is gradually utilized and has the potential to detect pediatric testicular torsion. The term "acute scrotum" refers to "the occurrence of new-onset pain, swelling, and/or tenderness in the intrascrotal contents." Depending on the etiology, cases might document the onset of symptoms as quickly as a few minute or as long as one to two days. A range of disease processes are encompassed by the term 'acute scrotum.'" "Acute scrotum." Acute testicular torsion is a serious condition that is reversible, but its time dependency necessitates rapid evaluation and diagnosis. A median raphe subdivides the scrotum into two compartments, which are fibromuscular sacs. The wall consists of skin, cremasteric fascia, internal and external spermatic fascia, superficial fascia, and dartos muscle ranging from superficial to deep. Along with the dartos muscle, the raphe is continuous. The testes are characterized by a homogeneous structure composed of fine, medium-level echoes and take on an ovoid shape at US. Prepuberal testes have lower echogenicity. In elderly cases, the testicular parenchyma may exhibit a "striated" pattern, that is believed to be the result of increasing interstitial fibrosis and atrophy of glandular elements. [ABSTRACT FROM AUTHOR]

Purpose: Point-of-care ultrasound (POCUS) is used in various clinical specialties to improve diagnostic and procedural accuracy and has many potential applications in palliative care. However, it is unclear what is the current state of training and use of POCUS in palliative care in Canada. Our objectives were to understand the current state of training and use of POCUS in Canadian Palliative Medicine subspecialty residency programs and to develop and implement a local training workshop for POCUS in palliative care. Methods: We surveyed residency program leaders regarding formal training and clinical applications of POCUS for faculty and residents in their programs. The results from the national survey informed the design of a workshop for POCUS at our institution. Faculty and resident participants completed pre- and post-workshop surveys evaluating their comfort with using and teaching POCUS. Results: Most residency programs provided between one to ten hours of POCUS teaching to residents. Clinical application was generally limited to assessing ascites and performing paracentesis. Lack of POCUS-trained faculty was identified as the most common barrier to more widespread use of POCUS. On a limited budget, we successfully implemented a POCUS training workshop at our institution that improved participant confidence and comfort in using and teaching POCUS. Conclusions: Although POCUS is viewed as a beneficial skill for enhancing patient care and is a competency in palliative medicine residency programs, there are gaps in both training and utilization. A POCUS workshop is an effective and low-cost “first-step” intervention that can be easily replicated in other programs. [ABSTRACT FROM AUTHOR]

Objectives: Point‐of‐care ultrasound (POCUS) use is widespread in EDs and throughout those practising medicine. Between institutions and specialities, there is widespread variety and training. With this comes risk of patient harm and backlash to a clinically useful modality. Our objective is to form a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs. Methods: Emergency Medicine Ultrasound Group (EMUG) identified this gap and volunteers from the group undertook a literature search of current best practice and institution guidelines relating to POCUS programs. They contacted colleagues from other specialities to find and get access to other countries and colleges' POCUS guidelines. EMUGs regularly run discussion forums (Collab‐labs) and points from these were considered. Recommendations were then formed from these and recurrent unpublished obstacles the group had encountered. The result was reviewed by Clinical Leads in Ultrasound and POCUS users in Australasia. Results: The recommendations were organised under five pillars: Infrastructure, Governance, Administration, Education and Quality. Conclusion: These recommendations complement existing guidelines and are not intended to replace them; however, we hope to promote discussion and provide reference support for those developing POCUS programs. Implementing a comprehensive and robust ED POCUS program will ensure safe, effective, and standardised high‐quality POCUS use, with the aim of improving patient care across Australia and New Zealand. Patient safety will be enhanced through effective risk management and quality assurance and there will be consistency in POCUS education, training and credentialing across institutions. [ABSTRACT FROM AUTHOR]

Objectives: Point‐of‐care ultrasound (POCUS) use is widespread in EDs and throughout those practising medicine. Between institutions and specialities, there is widespread variety and training. With this comes the risk of patient harm and backlash to a clinically useful modality. Our objective is to form a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs. Methods: Emergency Medicine Ultrasound Group (EMUG) identified this gap and volunteers from the group undertook a literature search of current best practice and institution guidelines relating to POCUS programs. They contacted colleagues from other specialities to find and get access to other countries and colleges' POCUS guidelines. EMUGs regularly run discussion forums (Collab‐labs) and points from these were considered. Recommendations were then formed from these and recurrent unpublished obstacles the group had encountered. The result was reviewed by clinical leaders in ultrasound and POCUS users in Australasia. Results: The recommendations were organised under five pillars: Infrastructure, Governance, Administration, Education and Quality. Conclusion: These recommendations complement existing guidelines and are not intended to replace them; however, we hope to promote discussion and provide reference support for those developing POCUS programs. Implementing a comprehensive and robust ED POCUS program will ensure safe, effective and standardised high‐quality POCUS use, with the aim of improving patient care across Australia and New Zealand. Patient safety will be enhanced through effective risk management and quality assurance and there will be consistency in POCUS education, training and credentialing across institutions. [ABSTRACT FROM AUTHOR]

Objectives: Although it is the most performed invasive procedure, peripheral intravenous catheter (PIVC) insertion in children can be difficult. The primary objective of the study was to identify the factors associated with difficult intravenous access (DIVA) in the paediatric ED, including patient, proceduralist and situational factors. Methods: This was a single‐centre prospective observational cohort study conducted over 28 consecutive days. Research assistants observed PIVC insertion attempts for children under 16 years of age and recorded data for variables relating to the patient, proceduralist and event. Univariate logistic regression modelling was performed to identify factors associated with DIVA, defined as unsuccessful PIVC insertion on the first attempt. Results: A total of 134 participants were recruited; 66 were male (49%) with a median age of 5.7 years. Fifty‐two (39%) were classified as having DIVA. There was a total of 207 PIVC insertion attempts with two or more attempts needed for 48 children (36%). Patient factors associated with DIVA included age of 3 years or less and limited vein options. Proceduralist factors included gestalt of 50% or less chance of success, use of a larger gauge (smaller bore) PIVC and less PIVC insertion experience. Situational factors included a combative child, higher pain score and loud ambient noise. Conclusions: The present study identified multiple patient, proceduralist and situational factors that were associated with DIVA in the paediatric ED. Future studies should explore the development and implementation of a package to address DIVA in children, with the patient‐centred goals of reducing pain and improving success. [ABSTRACT FROM AUTHOR]

Summary: Background: Semaglutide is a long‐acting glucagon‐like peptide‐1 receptor agonist known to delay gastric emptying. Despite a growing body of evidence, its peri‐operative safety profile remains uncertain, particularly with regard to the risk of increased residual gastric content and aspiration of gastric contents during anaesthesia. We hypothesised that semaglutide interruption of ≤ 10 days before elective surgical procedures is insufficient to reduce or normalise the residual gastric content, despite fasting intervals that comply with current guidelines. Methods: In this prospective observational study, we recruited patients who received pre‐operative once‐weekly subcutaneous semaglutide within 10 days of the procedure (semaglutide group) and control patients who had not been exposed to semaglutide (non‐semaglutide group). On the day of surgery, all patients underwent pre‐operative point‐of‐care gastric ultrasound to evaluate their residual gastric content. Increased residual gastric content was defined as any solid content or > 1.5 ml.kg‐1 of clear fluids as assessed by gastric ultrasound. Results: We recruited 220 patients, 107 in the semaglutide group and 113 in the non‐semaglutide group. Increased residual gastric content was found in 43/107 patients (40%) in the semaglutide group and 3/113 (3%) in the non‐semaglutide group (p < 0.001). In propensity‐weighted analysis, semaglutide use (OR 36.97, 95%CI 16.54–99.32), age (OR 0.95, 95%CI 0.93–0.98) and male sex (OR 2.28, 95%CI 1.29–4.06) were significantly associated with increased residual gastric content. There were no cases of pulmonary aspiration of gastric contents. Conclusion: Pre‐operative semaglutide use within 10 days of elective surgical procedures was independently associated with increased risk of residual gastric content on pre‐operative gastric ultrasound assessment. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) is becoming increasingly utilized, with the focus of training aimed at physicians. However, the role of neonatal nurse practitioners (NNPs) in the development of POCUS programs is not well described. Purpose: To describe the NNP role in the implementation of a NICU POCUS program and exemplify the potential to expand the professional scope and educational advancement of NNPs. Methods: In 2018, a multidisciplinary team assembled to develop a POCUS program in the NICU at Lucile Packard Children's Hospital (LPCH). Three NNPs received formal POCUS training in order to provide onsite training, perform and supervise POCUS imaging, and participate in quality assurance sessions. NNPs also assisted with the development of a REDCap database and imaging protocols. Results: The LPCH POCUS NNP providers contributed to the advancement of the profession by practicing to the full scope of their role, providing leadership in program development, research, and education. Incorporating NNPs into the programmatic structure of a POCUS program can be a model for others. With advancing skill set, NNPs can be positioned to be national leaders and educators. Implications for practice and research: NICUs developing POCUS programs can benefit from the integration of NNPs to serve as consistent content experts to expand the number of trained providers while assuring the quality of image capture. POCUS is becoming increasingly essential to the care of newborns. NNPs can play a central role in performing POCUS, participating in quality improvement and research, and educating other NICU providers. [ABSTRACT FROM AUTHOR]

Cardiac point-of-care ultrasound (POCUS) can evaluate for systolic and diastolic dysfunction to inform care in the Emergency Department (ED). However, accurate assessment can be limited by user experience. Artificial intelligence (AI) has been proposed as a model to increase the accuracy of cardiac POCUS. However, there is limited evidence of the accuracy of AI in the clinical environment. The objective of this study was to determine the diagnostic accuracy of AI for identifying systolic and diastolic dysfunction compared with expert reviewers. This was a prospective, observational study of adult ED patients aged ≥45 years with risk factors for systolic and diastolic dysfunction. Ultrasound fellowship-trained physicians used an ultrasound machine with existing AI software and obtained parasternal long axis, parasternal short axis, and apical 4-chamber views of the heart. Systolic dysfunction was defined as ejection fraction (EF) < 50 % in at least two views using visual assessment or E-point septal separation >10 mm. Diastolic dysfunction was defined as an E:A < 0.8, or ≥ 2 of the following: septal e' < 7 cm/s or lateral e' < 10 cm/s, E:e' > 14, or left atrial volume > 34 mL/m2. AI was subsequently used to measure EF, E, A, septal e', and lateral e' velocities. The gold standard was systolic or diastolic dysfunction as assessed by two independent physicians with discordance resolved via consensus. We performed descriptive statistics (mean ± standard deviation) and calculated the sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) of the AI in determining systolic and diastolic dysfunction with 95 % confidence interval (CI). Subgroup analyses were performed by body mass index (BMI). We enrolled 220 patients, with 11 being excluded due to inadequate images, resulting in 209 patients being included in the study. Mean age was 60 ± 9 years, 51.7 % were women, and the mean BMI was 31 ± 8.1 mg/kg2. For assessing systolic dysfunction, AI was 85.7 % (95 %CI 57.2 % to 98.2 %) sensitive and 94.8 % (95 %CI 90.6 % to 97.5 %) specific with a LR+ of 16.4 (95 %CI 8.6 to 31.1) and LR- of 0.15 (95 % CI 0.04 to 0.54). For assessing diastolic dysfunction, AI was 91.9 % (95 %CI 85.6 % to 96.0 %) sensitive and 94.2 % (95 %CI 87.0 % to 98.1 %) specific with a LR+ of 15.8 (95 %CI 6.7 to 37.1) and a LR- of 0.09 (0.05 to 0.16). When analyzed by BMI, results were similar except for lower sensitivity in the BMI ≥ 30 vs BMI < 30 (100 % vs 80 %). When compared with expert assessment, AI had high sensitivity and specificity for diagnosing both systolic and diastolic dysfunction. [ABSTRACT FROM AUTHOR]

Purpose of Review: The purpose of this review is to describe the evidence behind various blood and imaging-based biomarkers that can improve the identification of congestion when not clearly evident on routine examination. Recent Findings: The natriuretic peptides (NPs) BNP and NT-proBNP have been shown to closely correlate with intra-cardiac filling pressures, both at baseline and when trended following improvement in congestion. Additionally, NPs rise well before clinical congestion is apparent so can be used as a tool to help identify subclinical HF decompensation. Additional serum-based biomarkers including MR-proANP and CA-125 can be helpful in assisting with diagnostic certainty when BNP or NT-proBNP are in the "grey zone" or when factors are present which may confound NP levels. Additionally, the emerging use of ultrasound techniques may enhance our ability to fine-tune the assessment and treatment of congestion. Summary: Biomarkers, including the blood-based natriuretic peptides and markers on bedside point of care ultrasound, can be used as non-invasive indices of hemodynamic congestion. These biomarkers are particularly valuable to incorporate when the degree of a patient's congestion is not apparent on clinical exam, and they can provide important prognostic information and help guide clinical management. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) in children is associated with increased mortality and morbidity including the need for prolonged stay in pediatric intensive care unit (PICU) and longer duration of mechanical ventilation. Technological advancements have expanded the array of bedside tools available to clinicians for patient evaluation beyond the traditional physical examination. Point-of-care ultrasound (POCUS) has emerged as a crucial tool for clinicians to quickly diagnose kidney pathology and assess the volume status. This is especially useful in the PICU setting as clinicians seek to optimize fluid requirements, modify dialysis settings based on fluid overload status, and differentiate causes of shock. Herein, we review the role of POCUS focusing on management of critically ill children with AKI, and the improvements in technology and artificial intelligence (AI) in POCUS that allow for better outcomes. [ABSTRACT FROM AUTHOR]

The use of point-of-care ultrasonography in primary care is increasing. Primary care physicians are introduced to ultrasonography at short workshops with little guidance for implementation of the technology in clinical routines and medical decision-making. This article introduces a framework for longitudinal ultrasound education tailored for office-based general practice, building on the best available evidence and established teaching principles. The framework includes three teaching seminars over three months, a curriculum of 10 ultrasound applications, an online learning platform providing educational support before, during, and after the teaching seminars and continuous support and feedback from allocated mentors. The framework aims to reduce primary care physicians’ absence from the clinic, scaffold the learning process to build a solid and sustainable foundation of knowledge, and support implementation and appropriate use of the technology in the unselected patient population in primary care setting. Evaluation of the framework demonstrated high satisfaction with the educational elements among both participants and teachers. [ABSTRACT FROM AUTHOR]

Venous congestion, often associated with elevated right atrial pressure presents a clinical challenge due to its varied manifestations and potential organ damage. Recognizing the manifestations of venous congestion through bedside physical examination or laboratory tests can be challenging. Point-of-care ultrasound (POCUS) is emerging as a valuable bedside tool for assessing venous congestion, with the Venous Excess Ultrasound (VExUS) technique gaining prominence. VExUS facilitates non-invasive quantification of venous congestion, relying on measurements of the inferior vena cava (IVC) size and Doppler assessments of the hepatic vein (HV), portal vein (PV), and intrarenal vein, thereby providing real-time insights into hemodynamic status and guiding therapeutic interventions. The grading system outlined in VExUS aids in stratifying the severity of congestion. However, achieving proficiency in VExUS requires a comprehensive understanding of Doppler techniques and their clinical applications. This review article provides practical guidance on performing VExUS, encompassing equipment requirements, preparation, machine settings, and examination techniques for assessing the inferior vena cava (IVC), hepatic vein (HV), portal vein (PV), and intrarenal vein. Potential pitfalls and troubleshooting strategies are discussed to ensure accurate interpretation of Doppler waveforms. [ABSTRACT FROM AUTHOR]

Introduction: Acute aortic occlusion (AAO) is a rare vascular emergency with significant associated morbidity and mortality Methods: This case report discusses a 39‐year‐old gentleman with methamphetamine‐associated cardiomyopathy (MACM) who presented with bilateral lower limb ischaemia. A POCUS was performed to rapidly evaluate the patient on arrival, which demonstrated AAO. A literature review was conducted to identify similar cases where AAO was detected by POCUS. Results: POCUS showed a left ventricular thrombus (LVT), an embolus in the distal abdominal aorta and no flow distal to the embolus, which is consistent with AAO. The patient was successfully reperfused and had a good outcome after a timely diagnosis and management. Discussion: This case report outlines a rare pathology in an uncommon age group where POCUS can expedite diagnosis and management. Conclusion: POCUS is a valuable tool, which can expedite and facilitate rapid revascularisation of AAO. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) was once considered avant-garde. However, AI permeates every industry today, impacting work and home lives in many ways. While AI-driven diagnostic and therapeutic applications already exist in medicine, a chasm remains between the potential of AI and its clinical applications. This article reviews the status of AI-powered ultrasound (US) applications in anaesthesiology and perioperative medicine. A literature search was performed for studies examining AI applications in perioperative US. AI applications for echocardiography and regional anaesthesia are the most robust and well-developed. While applications are available for lung imaging and vascular access, AI programs for airway and gastric US imaging solutions have yet to be available. Legal and ethical challenges associated with AI applications need to be addressed and resolved over time. AI applications are beneficial in the context of education and training. While low-resource settings may benefit from AI, the financial burden is a considerable limiting factor. [ABSTRACT FROM AUTHOR]

Pulmonary aspiration in the perioperative period carries the risk of significant morbidity and mortality. As such, guidelines have been developed with the hopes of minimizing this risk by recommending fasting from solids and liquids over a specified amount of time. Point-of-care ultrasound has altered the landscape of perioperative medicine; specifically, gastric ultrasound plays a pivotal role in perioperative assessment. Further, the advent of glucagon-like-peptide-1 receptor agonists, the widespread use of cannabis, and Enhanced Recovery program carbohydrate beverage presents new challenges when attempting to standardize fasting guidelines. This review synthesizes the literature surrounding perioperative fasting guidelines specifically with regard to the use of point-of-care ultrasound in assessing for gastric contents and minimizing the risk of aspiration. [ABSTRACT FROM AUTHOR]

Background: In consideration of patient out-of-pocket costs in low- and middle-income countries, this observational cohort study sought to quantify the travel expenses associated with receiving free cardiac services in India and create a point-of-care ultrasound (POCUS) referral model. Methods: In a tertiary hospital that offers free services in Bangalore, India, we interviewed outpatients awaiting cardiac evaluation regarding their out-of-pocket expenses. A subgroup underwent POCUS for signs of left atrial enlargement, inferior vena cava plethora, and extravascular lung water, and subsequent chart review for significant findings on echocardiography or need for immediate care. A model was tested in which a normal POCUS would negate the requirement for referral. Results: Patients (N = 219), of age (mean ± SD) 49.0 ± 12.9 y, traveled [median (IQR)] 1178 miles (248–1240), spent $104 ($26-$195), and lost 4.5 (0–10) days of work at a daily wage of $3.90 ($1.95-$6.50). The one-way travel cost equated to 27 days of daily pay. In the POCUS subgroup, symptoms were commonly chest pain (57%) and dyspnea (48%) and were less than moderate in severity (71%). Abnormal echo findings were present in 54% of patients, of whom 29% needed immediate care, and 71% were dismissed without follow-up. POCUS signs were related to an abnormal echo (p < 0.001), but not immediate care (p = 0.50). POCUS-based referral would have prevented 51% (35/68) of unnecessary referrals and missed 13% (9/68) of cases that required immediate care. Conclusions: Out-of-pocket costs, relative to income, can be significant for those seeking free cardiac care. POCUS performed locally could potentially reduce the costs of travel but would risk missing cases, depending on symptom type. [ABSTRACT FROM AUTHOR]

The article "Unlocking the Potential: Can Point-of-Care Ultrasound-Guided Resuscitation Impact the Clinical Care for Adults With Shock?" published in Critical Care Medicine discusses the use of point-of-care ultrasound (POCUS) in managing critically ill patients with shock. The study found that POCUS-guided resuscitation led to a reduction in 28-day mortality rates, but other outcomes such as hospital length of stay showed mixed results. The article emphasizes the need for enhanced training methods, practical strategies for incorporating POCUS into daily practice, and the appropriate utilization of POCUS throughout a patient's care to fully realize its potential in shock management. [Extracted from the article]

Heart failure (HF) is associated with significant morbidity, mortality, and health care costs. Stage B HF is defined as structural heart disease prior to developing symptomatic HF. If identified early in the disease process, preventative measures may be implemented to slow disease progression to Stage C (symptomatic) or Stage D (refractory) HF. Previous research has focused on outpatient screening for HF in the primary care setting; however, there are limited data on Stage B HF screening in the Emergency Department (ED) setting. The objective of this study was to determine the prevalence of undiagnosed Stage B HF among those with cardiovascular risk factors in the ED setting and identify which risk factors were associated with a greater risk of having Stage B HF. A prospective, observational study was performed in a single, urban academic ED from 07/2023 to 05/2024. Inclusion criteria were age ≥ 45 years with hypertension, diabetes, obesity, coronary heart disease, previous cardiotoxic chemotherapy, or family history of HF. Exclusion criteria included signs or symptoms of HF, known history of HF, valvular disease, current atrial fibrillation, or primary language other than English. A focused cardiac ultrasound was performed and interpreted by ultrasound-fellowship trained emergency physicians. Sonographers assessed systolic function as ejection fraction <50 % using visual assessment in at least two different views. Sonographers assessed diastolic dysfunction as an E/A ratio < 0.8, or if ≥2 of the following were present: septal e' < 7 cm/s or lateral e' < 10 cm/s, E/e' ratio > 14, or left atrial volume > 34 mL/m2. Descriptive statistics were performed, followed by comparative analyses and regression modeling. 209 participants were included in the study, with a mean age of 60 years and 51.7 % women. Of these, 125 (59.8 %) had undiagnosed Stage B HF, with 13 (10.4 %) having systolic dysfunction and 112 (89.6 %) having isolated diastolic dysfunction. Among those with isolated diastolic dysfunction, 44 (39.3 %) were grade I, 66 (58.9 %) were grade II, and 2 (1.8 %) were grade III. Predictors of undiagnosed Stage B HF included age (odds ratio 1.06; 95 % CI 1.02 to 1.10) and BMI (odds ratio 1.06; 95 % CI 1.01 to 1.10). A large majority of ED patients with cardiovascular risk factors had undiagnosed Stage B HF. Age and obesity were associated with a higher risk of Stage B HF. This provides an opportunity for early identification and intervention for patients with undiagnosed Stage B HF to reduce progression to more severe HF. [ABSTRACT FROM AUTHOR]

Introduction: Point-of-care ultrasound (POCUS) is a screening and diagnostic modality frequently used in the emergency department to assess patients with abdominal pain. Case Report: We present a case describing the unusual finding of intraperitoneal fluid with loculations visualized in the right upper quadrant of the abdomen in a patient ultimately diagnosed with pelvic inflammatory disease (PID) with ruptured tubo-ovarian abscess caused by group A streptococcus (GAS), a pathogen rarely implicated in the disease. Conclusion: Uncommon findings on abdominal POCUS should trigger further investigation. In a patient not responding to antibiotics administered for typical PID coverage, GAS should be considered as a possible etiology and a penicillin-based antibiotic administered to prevent progression to tubo-ovarianabscess formation, peritonitis, and sepsis. [ABSTRACT FROM AUTHOR]

Introduction: We developed a mobile phone logbook application called LogMyScan. The study objectives were to evaluate a number of domains as per the technology acceptance model. Methods: A prospective pilot cohort study was conducted using a version of LogMyScan and reported according to Statement on Reporting of Evaluation studies in Health Informatics. Prospective participants were directed to a website which provided information and links. Participants were recruited via email distribution lists and social media. A task list was provided, which included entering simulated scan data and navigating the application, prior to completing a questionnaire. Questions were aligned to technology acceptance model domains, and Cronbach's alpha was calculated to assess reliability. Results: There were 49 participants and 7 were unable to complete the image upload and editing step. Levels of agreement for usability, educational and governance/security aspects were generally good. The desirability of existing and proposed features was high for images and video clip handling, feedback and reflection and less for motivational notifications and benchmarking. Comments identified some limitations and issues on the Android platform. Cronbach's alpha demonstrated good to excellent reliability: 0.87 (95% confidence interval, 0.79–0.91) for usability, educational and governance/security and 0.86 (95% confidence interval, 0.78–0.91) for desirability of existing and proposed features. Conclusion: There was generally high perceived ease of use, usefulness, attitude towards use and behavioural intention to use LogMyScan. Further research is needed to evaluate LogMyScan for future iterations, allowing recruitment of a larger number of participants and evaluating user expectations prior to using, and at timed intervals after using. [ABSTRACT FROM AUTHOR]