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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.

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: 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]

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: 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]

Background: Point-of-care ultrasound (POCUS) has gained popularity as a bedside diagnostic imaging modality. In obstetrical populations, particularly in acute care settings, POCUS serves as a valuable complement to clinical assessment. Despite its many applications, only a few have been defined and validated in the obstetric population. This scoping review aims to delineate literature on the diagnostic applications of POCUS in obstetric anesthesia and critical care. Methods: This review will adhere to the Joanna Briggs Institute methodology for scoping reviews, as updated by Arksey and O'Malley and in stages elaborated by Levac et al. Relevant literature will be identified using Medical Subject Headings (MeSH), keyword, and proximity searches and combined using Boolean operators in PubMed, Embase, and Web of Science from January 1, 2000, to the present. Two independent reviewers will screen literature against predefined eligibility criteria in abstract and full-text forms. A third reviewer will be consulted if consensus cannot be reached. Data extraction will be systematic, focusing on pre-specified variables aligned with the review's aims. Descriptive statistical and thematic analysis will follow data extraction, with findings presented in graphical and tabular forms. The reporting will follow Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Conclusion: This review will present the scope of the current literature on diagnostic POCUS in obstetric anesthesia and critical care, highlighting both strengths and gaps in existing knowledge. The insights gained will support future research, knowledge synthesis, and development of educational programs. The findings will be disseminated through peer-reviewed journal publications, conferences, and social media platforms. Systematic review registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Ultrasound technology is indispensable in perinatal care due to its non-invasive and painless nature, offering vital insights into foetal development and childbirth. With the academisation of midwifery in Germany, there is a growing necessity to incorporate ultrasound training into midwifery education. This paper discusses the development and implementation of an introductory obstetric ultrasound curriculum tailored for midwifery students, focusing on fundamental ultrasound techniques in obstetrics. Materials and methods: We used Kern's six-step approach of curricular development comprising [1] problem identification and general needs assessment [2], needs assessment of the targeted learners [3], goals and objectives [4], educational strategies [5], implementation, and [6] evaluation and feedback. The individual components of the curriculum were meticulously designed based on comprehensive literature reviews, thorough consultations with experienced ultrasound experts and evaluated needs of participants prior to the course instruction. Results: Twenty-seven ultrasound-naive midwifery students participated in the newly developed obstetric ultrasound course. Structured as a modular and integrated framework, the course aimed to provide theoretical and practical instruction in basic obstetric ultrasound, with intrapartum sonography and focused assessment with abdominal sonography for trauma (FAST) as key supplementary specialisations. The results demonstrated a significant increase in the students' overall knowledge and practical skills, as evidenced by the median post-course total score rising from 20 to 60 out of 75 (p < 0.001) in the objective structured clinical examination (OSCE) and from 9 to 19 out of 20 (p = 0.001) in the knowledge test. Additionally, students reported high satisfaction with the course and noted substantial personal benefits. Conclusion: The integration of basic obstetric ultrasound training within the midwifery curriculum is feasible and effective to teach fundamental knowledge and skills of obstetric ultrasound examinations to midwifery students. Expansion, standardisation and regulatory structures are critical components for a continued improvement and realistic integration into midwifery educational frameworks and thus the further development of the midwifery profession. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (POCUS) has increasingly been used by neonatal providers in neonatal intensive care units in the United States. However, there is a lack of literature addressing the complexities of POCUS coding and billing practices in the United States. This article describes the coding terminology and billing process especially those relevant to neonatal POCUS. We elucidate considerations for neonatal POCUS billing framework and workflow integration. Directions on image storage and supporting documentation to facilitate efficient reimbursement, compliance with billing regulations, and appeal to insurance claim denial are discussed. Key Points Code neonatal POCUS procedure precisely allows accurate reimbursement and reduced errors in billing. Document details to support medical necessity and reimbursement claims effectively. Adhere to regulations to avoid audits, denials, and ensure proper reimbursement. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (POCUS) is emerging as a valuable adjunct tool to medical history and physical examination, enhancing the diagnosis and management of diseases. Even though it was initially concentrated in intensive care units and emergency departments, its application has now expanded to various medical specialties, including nephrology. Point-ofcare ultrasound has become very useful in the assessment of native and graft kidneys, arteriovenous access assessment, procedural guidance, and the objective evaluation of volume status, which sometimes might be clinically difficult. Notably, it has been quite useful in volume assessment in patients with chronic liver disease and acute kidney injury. The incorporation of POCUS into nephrology education and practice has gained a momentum, and Portugal has set a good example. Despite its various challenges and limitations, as a group of young nephrologists, we believe that a structured training program for POCUS is needed, which will culminate in its wide adoption in daily practice. [ABSTRACT FROM AUTHOR]

While point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) is broadly perceived as having value in intravascular volume status assessment, this has not been borne out in large-scale meta-analyses containing heterogenous populations of acutely ill patients. While the limitations of IVC POCUS could be largely due to the complexity of the relationship between IVC appearance and volume status, another confounder not widely appreciated is the ease with which the aorta or right hepatic vein (RHV) can be mistaken for the IVC. While misidentification of the aorta as the IVC has been recognized elsewhere, misidentification of the RHV for the IVC has not and, in our experience, occurs frequently, even in the hands of experienced sonographers. We demonstrate how these errors occur and provide guidance on how to systematically avoid them. [ABSTRACT FROM AUTHOR]

Introduction: The emergence of handheld ultrasound devices capable of connecting to cell phones or tablets heralds a significant advancement in medical technology, particularly within the field of obstetrics. These devices offer the promise of immediate bedside ultrasound examinations, potentially revolutionizing patient care by enabling fetal assessments in diverse settings. Material and Methods: This prospective study aimed to validate the reliability of non‐piezo, chip‐based handheld ultrasound devices in clinical obstetric practice. Conducted in a university hospital obstetric ward, the study included 100 pregnant women between 17 and 41 weeks of gestation. Participants underwent ultrasound examinations using both conventional and portable point‐of‐care ultrasound (POCUS) devices to compare the accuracy in estimating fetal weight and other parameters, such as cardiac activity, fetal presentation, placental location, and amniotic fluid volume. The reliability and agreement between the devices were assessed using intraclass correlation coefficients, Bland–Altman plots, and Pearson correlation coefficients. Results: The results show a near‐perfect agreement (0.98) and correlation (r = 0.98, p < 0.001) for estimated fetal weight and most biometry measurements between the two types of ultrasound devices, with slight deviations in head circumference and amniotic fluid index measurements. Subgroup analysis revealed variations in agreement and correlation rates with higher BMI and advanced gestational age, indicating areas for further refinement. Conclusions: These findings affirm the high reliability of handheld ultrasound devices for basic obstetric ultrasound evaluations, supporting their integration into daily clinical practice. This technology improves the flexibility and immediacy of prenatal care, although further research is needed to optimize its application across patient populations and treatment settings. [ABSTRACT FROM AUTHOR]

Background: Cardiac point-of-care ultrasound (cPOCUS) can aid in the diagnosis and treatment of cardiac disorders. Such disorders can arise as complications of acute brain injury, but most neurologic intensive care unit (NICU) providers do not receive formal training in cPOCUS. Caption artificial intelligence (AI) uses a novel deep learning (DL) algorithm to guide novice cPOCUS users in obtaining diagnostic-quality cardiac images. The primary objective of this study was to determine how often NICU providers with minimal cPOCUS experience capture quality images using DL-guided cPOCUS as well as the association between DL-guided cPOCUS and change in management and time to formal echocardiograms in the NICU. Methods: From September 2020 to November 2021, neurology-trained physician assistants, residents, and fellows used DL software to perform clinically indicated cPOCUS scans in an academic tertiary NICU. Certified echocardiographers evaluated each scan independently to assess the quality of images and global interpretability of left ventricular function, right ventricular function, inferior vena cava size, and presence of pericardial effusion. Descriptive statistics with exact confidence intervals were used to calculate proportions of obtained images that were of adequate quality and that changed management. Time to first adequate cardiac images (either cPOCUS or formal echocardiography) was compared using a similar population from 2018. Results: In 153 patients, 184 scans were performed for a total of 943 image views. Three certified echocardiographers deemed 63.4% of scans as interpretable for a qualitative assessment of left ventricular size and function, 52.6% of scans as interpretable for right ventricular size and function, 34.8% of scans as interpretable for inferior vena cava size and variability, and 47.2% of scans as interpretable for the presence of pericardial effusion. Thirty-seven percent of screening scans changed management, most commonly adjusting fluid goals (81.2%). Time to first adequate cardiac images decreased significantly from 3.1 to 1.7 days (p < 0.001). Conclusions: With DL guidance, neurology providers with minimal to no cPOCUS training were often able to obtain diagnostic-quality cardiac images, which informed management changes and significantly decreased time to cardiac imaging. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) has emerged as an essential bedside tool for clinicians, but lack of access to ultrasound equipment has been a top barrier to POCUS use. Recently, several handheld ultrasound devices ("handhelds") have become available, and clinicians are seeking data to guide purchasing decisions. Few comparative studies of different handhelds have been done. We conducted a cross-sectional study comparing 6 handhelds readily available in the United States (Butterfly iQ + ™ by Butterfly Network Inc.; Clarius™ by Clarius Mobile Health; Kosmos™ by EchoNous; TE Air™ by Mindray; Vscan Air™ SL and CL by General Electric; and Lumify™ by Philips Healthcare). A multi-specialty group of physician POCUS experts (n = 35) acquired three standard ultrasound views (abdominal right upper quadrant, cardiac apical 4-chamber, and superficial neck and lung views) in random order on the same standardized patients and rated the image quality. Afterward, a final survey of the overall ease of use, image quality, and satisfaction of each handheld was completed. Results: Thirty-five POCUS experts specializing in internal medicine/hospital medicine, critical care, emergency medicine, and nephrology acquired and rated right upper quadrant, apical 4-chamber, and superficial neck and lung views with 6 different handhelds. For image quality, the highest-rated handhelds were Vscan Air™ for the right upper quadrant view, Mindray TE Air™ for the cardiac apical 4-chamber view, and Lumify™ for superficial views of the neck and lung. Overall satisfaction with image quality was highest with Vscan Air™, Lumify™, and Mindray, while overall satisfaction with ease of use was highest with Vscan Air™. The 5 most desirable characteristics of handhelds were image quality, ease of use, portability, probe size, and battery life. Ultimately, all 6 handhelds had notable advantages and disadvantages, with no single device having all desired qualities or features. Conclusions: The overall satisfaction with image quality was rated highest with Vscan Air™, Lumify™, and Mindray TE Air™when acquiring right upper quadrant, apical 4-chamber, and superficial neck and lung views. No single handheld was perceived to be superior in image quality for all views. Vscan Air™ was rated highest for overall ease of use and was the most preferred handheld for purchase by POCUS experts. [ABSTRACT FROM AUTHOR]

Shock is a life-threatening condition that requires prompt recognition and treatment to prevent organ failure. In the intensive care unit, shock is a common presentation, and its management is challenging. Critical care ultrasound has emerged as a reliable and reproducible tool in diagnosing and classifying shock. This comprehensive review proposes an ultrasound-based protocol for the hemodynamic assessment of shock to guide its management in the ICU. The protocol classifies shock as either low or high cardiac index and differentiates obstructive, hypovolemic, cardiogenic, and distributive etiologies. In distributive shock, the protocol proposes a hemodynamic-based approach that considers the presence of dynamic obstruction, fluid responsiveness, fluid tolerance, and ventriculo-arterial coupling. The protocol gives value to quantitative measures based on critical care ultrasound to guide hemodynamic management. Using critical care ultrasound for a comprehensive hemodynamic assessment can help clinicians diagnose the etiology of shock and define the appropriate treatment while monitoring the response. The protocol's use in the ICU can facilitate prompt recognition, diagnosis, and management of shock, ultimately improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Ultrasound can detect fluid in the alveolar and interstitial spaces of the lung using the presence of artifacts known as B-lines. The aim of this study was to determine whether a deep learning algorithm generated B-line severity score correlated with pulmonary congestion and disease severity based on clinical assessment (as identified by composite congestion score and Rothman index) and to evaluate changes in the score with treatment. Patients suspected of congestive heart failure underwent daily ultrasonography. Eight lung zones (right and left anterior/lateral and superior/inferior) were scanned using a tablet ultrasound system with a phased-array probe. Mixed effects modeling explored the association between average B-line score and the composite congestion score, and average B-line score and Rothman index, respectively. Covariates tested included patient and exam level data (sex, age, presence of selected comorbidities, baseline sodium and hemoglobin, creatinine, vital signs, oxygen delivery amount and delivery method, diuretic dose). Results: Analysis included 110 unique subjects (3379 clips). B-line severity score was significantly associated with the composite congestion score, with a coefficient of 0.7 (95% CI 0.1–1.2 p = 0.02), but was not significantly associated with the Rothman index. Conclusions: Use of this technology may allow clinicians with limited ultrasound experience to determine an objective measure of B-line burden. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound is rapidly gaining traction in clinical practice, including primary care. Yet, logistical challenges and geographical isolation hinder skill acquisition. Concurrently, an evidentiary gap exists concerning such guidance's effectiveness and optimal implementation in these settings. Methods: We developed a lung point-of-care ultrasound (POCUS) curriculum for primary care physicians in a rural, medically underserved region of the south of Israel. The course included recorded lectures, pre-course assessments, hands-on training, post-workshop lectures, and individual practice. To evaluate our course, we measured learning outcomes and physicians' proficiency in different lung POCUS domains using hands-on technique assessment and gathered feedback on the course with a multi-modal perception approach: an original written pre- and post-perception and usage questionnaire. Results: Fifty primary care physicians (PCPs) showed significant improvement in hands-on skills, increasing from 6 to 76% proficiency (p < 0.001), and in identifying normal versus abnormal views, improving from 54 to 74% accuracy (p < 0.001). Ten weeks after training, primary care physicians reported greater comfort using lung ultrasound, rising from 10 to 54% (p < 0.001), and improved grasp of its potential and limits, increasing from 27.5% to 84% (p < 0.001). Weekly usage increased from none to 50%, and the number of primary care physicians not using at all decreased from 72 to 26% (p < 0.001). Conclusions: A two-day focused in-person and remote self-learning lung-POCUS training significantly improved primary care physicians' lung ultrasound skills, comfort, and implementation. [ABSTRACT FROM AUTHOR]

Purpose: To undertake a global assessment of existing ultrasound practices, barriers to access, point-of-care ultrasound (POCUS) training pathways, and the perceived clinical utility of POCUS in Child Surgery. Methods: An electronic survey was disseminated via the GICS (Global Initiative of Children's Surgery) network. 247 anonymized responses from 48 countries were collated. 71.3% (176/247) worked in child surgery. Results: Ultrasound was critical to practice with 84% (147/176) of requesting one daily or multiple times per week. Only 10% (17/176) could access emergency ultrasound < 1 h from request. The main barrier was a lack of trained personnel. HIC surgeons were more likely to have ultrasound training (24/29; 82.8%) compared with LMICs (74/147; 50.3%) (p =.001319; CI 95%). Self-perceived POCUS competence was associated with regularity of POCUS use (p < 0.001; CI 95%). Those who already practice POCUS most commonly use it for trauma, intussusception, and ultrasound-guided procedures. Majority (90%; 159/176) of child surgeons would attend formal POCUS training if available. Conclusions: Ultrasound is critically important in children's surgery globally, however, many surgeons experience barriers to timely access. There is a strong interest in learning POCUS for relevant pediatric surgical applications. Further research is needed to evaluate the best methods of training, accreditation, and governance. [ABSTRACT FROM AUTHOR]

Background: Although the number of point-of-care ultrasound devices available in Hungarian primary care practices are increasing due to government funding, their use in day-to-day patient care is limited and unregulated. Our study aimed to evaluate the attitudes and needs of general practitioners (GPs) and patients in Hungary regarding the introduction of bedside ultrasonography in primary care practices. Methods: As a part of a cross-sectional study, an anonymous, self-administered questionnaire was distributed to GPs and patients on a social media platform. Data collection was carried out from August 2023 to October 2023. Chi-square test was used to determine the associations between categorical variables. Results: The survey was completed by 415 GPs (mean age 53.8 ± 11.1 years, 54.9% female, mean 19.5 ± 11.9 years of practice) and 693 patients (mean age 45.5 ± 12.3 years, 95.2% female). There was a statistically significant increase in interest in PoCUS among young and middle-aged GPs (age 28–59; p = 0.02). In addition, this population of GPs was also more likely to undertake training in PoCUS than their older colleagues (p < 0.0001). An inverse relationship was found between the duration of practice and training willingness (p = 0.0011). Even with the government's financial support, only 8.2% of GPs currently use PoCUS in a daily basis, and 59.5% of GPs are unfamiliar with the indications and the ways of using it. Patients would even pay to have the examination done in a primary care setting, even though only 45.9% of patients would pay a GP who is not certified in PoCUS, but the willingness to pay increased to 99.4% for those with formal training (p = 0.024). Conclusion: Our findings indicate a significant interest in adapting PoCUS in primary care from both GPs and patients. Based on the fact that a significant proportion of Hungarian GPs are unaware of PoCUS and its indications, it is particularly important to develop educational frameworks, and practical guidelines for the effective incorporation of PoCUS in Hungary. [ABSTRACT FROM AUTHOR]

Background: Clinicians from multiple professional backgrounds are increasingly using point-of-care ultrasound in clinical practice. Performing ultrasound is a complex skill, and training is required to ensure competency and patient safety. There is a lack of skilled trainers within health professions to meet this increasing educational demand. The role of sonographers in educating other health professionals in point-of-care ultrasound has not yet been well defined. Sonographers can provide ultrasound education interprofessionally, if equipped with appropriate clinical knowledge and educational skills. Methods: A Delphi consensus study was conducted to define the knowledge, skills and attributes required of sonographers teaching point-of-care ultrasound to other health professionals in Australia and New Zealand. Health professionals with subject matter expertise in the leadership, facilitation, and delivery of ultrasound education by sonographers were invited to participate. Results: There were 72 expert participants in survey round one, and 49 in round two. Participants included physicians, sonographers, and other health professionals. Consensus was reached on 31 competency items for sonographers teaching ultrasound interprofessionally, with agreement of greater than 94% reached by participants. Conclusions: This consensus study has defined the knowledge, skills and attitudes required for sonographer competence in point-of-care ultrasound education. This is an important step to developing a training pathway for sonographers engaging in this emerging area. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (POCUS) has emerged as a cost-effective diagnostic tool that significantly augments physical examinations. Positioned as an extension of traditional examination methods, particularly appealing to the upcoming generation of clinicians, it holds promise in potentially replacing the stethoscope in various medical assessments and procedures. The University of Rochester is deploying 2500 POCUS machines, enhancing compliance for image storage and documentation. Halfway through our 4-year deployment plan, we will discuss our governance structure, educational initiatives, and credentialing strategies. While POCUS adoption has seen organic growth over the past decade, our aim is to implement a comprehensive strategy ensuring adherence to established protocols for image storage and documentation. At present, we have successfully deployed 789 probes, with integration across 64 departments or divisions into our IT platform. Notably, this implementation has resulted in a remarkable 116% increase in hospital charges, underscoring the tangible impact of POCUS integration. However, achieving compliance and education among established providers has proven to be challenging. [ABSTRACT FROM AUTHOR]

Objective: Point-of-Care Ultrasound (POCUS) refers to the use of portable ultrasound machines to perform quick and focused ultrasound examinations at a patient's bedside or point-of-care. POCUS can be performed by all health workers with specific training to use POCUS. The aim of this study was to investigate the radiological performance and feasibility of POCUS using a handheld ultrasound device (HHUSD) in children for examining the thyroid gland. Methods: A pediatric endocrinologist performed thyroid imaging in children referred to our hospital with suspected thyroid disease using an HHUSD. The same children underwent ultrasonography (US) imaging using the same device by the first radiologist, and a second radiologist performed thyroid US using an advanced high-range ultrasound device (AHUSD) (defined as the gold-standard method) within two hours. The data obtained by the three researchers were compared with each other. Results: This study included 105 patients [68.6% girls (n=72)] with a mean age 12.8±3.6 years. When the thyroid volume was evaluated, a strong correlation was found between the measurements of the three researchers (AA vs. MG: r=0.963, AA vs. GT: r=0.969, MG vs. GT: r=0.963, p<0.001). According to the Bland-Altman analysis for total thyroid volume, AA measured 0.43 cc [95% confidence interval (CI): -0.89-0.03] smaller than MG, and 0.11 cc (95% CI: -0.30-0.52) larger than GT, whereas MG measured 0.52 cc (95% CI: 0.09-0.94) larger than GT. When evaluated for the presence of goiter and nodules, a near-perfect agreement was found between the results of the three researchers (AA vs. GT; κ=0.863, MG vs. GT; κ=0.887, p<0.001, and AA vs. GT; κ=1.000, MG vs. GT; κ=0.972, p<0.001, respectively). When evaluated in terms of the longest axis of nodules, a high correlation was found between the measurements of the three researchers (AA vs. MG; r=0.993, AA vs. GT; r=0.996, MG vs. GT; r=0.996, p<0.001). When evaluated in terms of the final diagnosis, the evaluations of the three researchers showed excellent agreement with each other (AA vs. GT; κ=0.893, MG vs. GT; κ=0.863, p<0.001, accuracy rate AA vs. GT: 93.3%; MG vs. GT: 91.4%). Conclusion: A pediatric endocrinologist, equipped with sufficient training in thyroid US evaluation, incorporated HHUSD examination as a routine clinical tool in an outpatient setting. It was shown that, they could effectively assess normal thyroid tissue in pediatric patients. Moreover, the HHUSD proved to be useful in detecting thyroid pathologies. However, it is important to note that for a more comprehensive evaluation of thyroid nodules, including detailed assessment and Thyroid Imaging Reporting and Data System (TIRADS) classification, patients should be referred to radiology departments equipped with AHUSD systems. These specialized devices, along with the expertise of radiologists, are essential for in-depth evaluations and accurate classification of thyroid nodules. [ABSTRACT FROM AUTHOR]

Immunoglobulin A vasculitis, historically known as Henoch-Schönlein purpura, is a rare form of autoimmune-induced vasculitis most common in children. This disease is characterized by a purpuric rash, arthritis, digestive tract complication, and renal inflammation (Hopkins). We present the case of a 78-year-old man in the emergency department with findings of weakness, abdominal pain, and bloody diarrhea for 3 days and a new-onset bilateral lower extremity rash. Diagnostic imaging and labs diagnosed this patient with immunoglobulin A vasculitis (IgAV) with associated acute kidney injury and abdominal mesenteric edema. Why Should an Emergency Physician be Aware of This? Recognition of IgAV by emergency physicians and assessment of multiple organ involvement is critical to expedite treatment and minimize complications. Particularly, physicians should consider and recognize the increased severity and different presentation of IgAV in adults in comparison with the more widely known manifestation in children. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility of lung ultrasonography (LUS) performed by novice users' general practitioners (GPs) in diagnosing lower respiratory tract infections (LRTIs) in primary health care settings. Design: A prospective interventional multicenter study (December 2019–March 2020). Settings and subjects: Patients aged >3 months, suspected of having LRTI consulting in three different general practices (GPs) (rural, semirural and urban) in France. Main outcome measures: Feasibility of LUS by GPs was assessed by (1) the proportion of patients where LUS was not performed, (2) technical breakdowns, (3) interpretability of images by GPs, (4) examination duration and (5) patient perception and acceptability. Results: A total of 151 patients were recruited, and GPs performed LUS for 111 (73.5%) patients (LUS group). In 99.1% (n = 110) of cases, GPs indicated that they were able to interpret images. The median [IQR] exam duration was 4 [3–5] minutes. LRTI was diagnosed in 70.3% and 60% of patients in the LUS and no-LUS groups, respectively (p =.43). After LUS, GPs changed their diagnosis from 'other' to 'LRTI' in six cases (+5.4%, p <.001), prescribed antibiotics for five patients (+4.5%, p =.164) and complementary chest imaging for 10 patients (+9%, p <.001). Patient stress was reported in 1.8% of cases, 81.7% of patients declared that they better understood the diagnosis, and 82% of patients thought that the GP diagnosis was more reliable after LUS. Conclusions: LUS by GPs using handheld devices is a feasible diagnostic tool in primary health care for LRTI symptoms, demonstrating both effectiveness and positive patient reception. Trial Registration Number: Clinicaltrial.gov: NCT04602234, 20/10/2020. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (POCUS) is a valuable adjunct to traditional imaging and physical exam. Adult-Gerontology Acute Care Nurse Practitioners (AGACNPs) serve as primary providers for acutely ill patients across the country, yet there is limited literature to describe the AGACNP experience with POCUS training and clinical application. This integrative review was to describe barriers to learning and performing POCUS that AGACNP's experience, identify necessary components of a successful POCUS curriculum, and synthesize evidence to propose solutions. CINAHL, PubMed, and Ovid databases were systematically searched for publications. Two reviewers completed the quality appraisal of the 12 articles identified during the literature search. Common barriers include: formal training; access to ultrasound machines; quality assurance; time to perform exams; inability to use findings in documentation/decision making. Low confidence may be an underrepresented barrier. Successful training programs include an introductory class with mixed didactic and hands-on training, training with live models, direct supervision and image review by experts, and longitudinal training. Adult-Gerontology Acute Care Nurse Practitioners are capable of learning and incorporating POCUS use into clinical practice. Broad solutions can be instituted to remove barriers, but more research is needed to describe necessary components of a successful POCUS training program. • Point-of-care ultrasound is an essential bedside tool to answer clinical questions • Several barriers limit point-of-care ultrasound use, particularly training • Nurse practitioners can become proficient with proper training and mentorship • Graduate program curricula do not require point-of-care ultrasound competency. [ABSTRACT FROM AUTHOR]

Introduction: Evaluating outpatient cases in internal medicine consultations presents a significant diagnostic challenge. Ultrasound can be a highly useful tool in assessment and decision‐making. Patients and Methods: A prospective observational study was conducted on a cohort of patients attending an internal medicine rapid assessment clinic. Eighty patients were prospectively recruited. A medical consultation was conducted as per usual clinical practice, followed by a POCUS evaluation; collecting pulmonary, cardiac, and abdominal data. All findings were analyzed and recorded, particularly those that were significant or altered the initial diagnosis, subsequent tests, or treatment. Results: Significant ultrasound findings were found in 37.5% of the patients. Of all ultrasound scans, the most clinically relevant were in the heart region (31.9%), followed by the abdomen (26%). These findings led to a change in overall management in 27.5% of patients. Using logistic regression, a model was developed to estimate the presence of clinically relevant findings with an area under the curve (AUC) of 0.78 (95% CI 0.66–0.89; p < 0.001) with 80% Sensitivity and 66% Specificity. Conclusion: The systematic and standardized incorporation of clinical ultrasound in internal medicine consultations contributes to decision‐making, can provide significant findings that allow for modifications in clinical suspicion and therapeutic management. [ABSTRACT FROM AUTHOR]

Aims In acute decompensated heart failure (HF), systemic venous congestion contributes to patients' symptoms and hospital admissions. The purpose of our study is to determine if venous congestion, examined using the venous excess ultrasound (VExUS) score, predicts HF-related hospitalization and mortality in patients admitted to the emergency department (ED) with acute decompensated HF. Methods and results Fifty patients admitted for acute HF in ED underwent ultrasound (US) assessment according to the VExUS score within the first 24 and 72 h. All patients were followed up with a telephone call at 30 and 60 days after hospital discharge. On admission, 56% had a VExUS score of 3. After 72 h, 32% had no more signs of congestion at the Doppler VExUS examination (inferior vena cava < 2 cm, VExUS score of 0); a similar percentage still exhibited a VExUS score of 3 despite therapy. Eighty per cent of patients were hospitalized after admission to the ED, while six (15%) died in-hospital; all exhibited a first-assessment VExUS score of 3. No patient with a VExUS score < 3 died during the study. During short-term follow-up, 18 patients were readmitted to the ED for acute decompensated HF. Ninety-four per cent of the readmitted patients had a VExUS score of 3 at the Doppler assessment at the first ED admission. Conclusion Severe venous congestion, defined as a VExUS score of 3 at the initial assessment of patients with acute decompensated HF, predicts inpatient mortality, HF-related death, and early readmission. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (POCUS) is an important tool for clinical diagnosis and decision-making in critical and non-critical scenarios. Dyspnea, chest pain, and shock are conditions susceptible to evaluation with ultrasound considering diagnostic accuracy and clinical impact already proven. There is scarce evidence in diagnosis agreement using ultrasound as an extension of physical examination. We aimed to evaluate ED patients in whom POCUS was performed, to analyze agreement between clinical initial diagnosis using ultrasound images and final diagnosis. Furthermore, we analyze failed diagnosis, inconclusive POCUS exams, and discuss details. A cross-sectional analytical study was conducted on adults who visited the emergency department with any of these three chief complaints: dyspnea, chest pain, and shock. All were evaluated with ultrasound at admission. Agreement between initial diagnosis using POCUS and final definite diagnosis was calculated. Failed diagnosis and inconclusive exams were analyzed. A total of 209 patients were analyzed. Populations: mostly males, mean age 64 years old, hypertensive. Agreement on patients with dyspnea and suspicion of acute decompensated heart failure was 0.98; agreement on chest pain suspicion of non-ST acute coronary syndrome was 0.96; agreement on type of shock was 0.90. Among the population, 12 patients had an inconclusive POCUS exam, and 16 patients had a failed diagnosis. The use of POCUS in the emergency department shows almost perfect agreement when compared with the final diagnosis in individuals experiencing acutely decompensated heart failure, acute coronary syndrome, and shock. Prospective studies are needed to evaluate the impact of this tool on mortality and prognosis when there are diagnostic errors. [ABSTRACT FROM AUTHOR]

Abstract 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 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

Abstract Background Point-of-care ultrasound (POCUS) has gained popularity as a bedside diagnostic imaging modality. In obstetrical populations, particularly in acute care settings, POCUS serves as a valuable complement to clinical assessment. Despite its many applications, only a few have been defined and validated in the obstetric population. This scoping review aims to delineate literature on the diagnostic applications of POCUS in obstetric anesthesia and critical care. Methods This review will adhere to the Joanna Briggs Institute methodology for scoping reviews, as updated by Arksey and O’Malley and in stages elaborated by Levac et al. Relevant literature will be identified using Medical Subject Headings (MeSH), keyword, and proximity searches and combined using Boolean operators in PubMed, Embase, and Web of Science from January 1, 2000, to the present. Two independent reviewers will screen literature against predefined eligibility criteria in abstract and full-text forms. A third reviewer will be consulted if consensus cannot be reached. Data extraction will be systematic, focusing on pre-specified variables aligned with the review’s aims. Descriptive statistical and thematic analysis will follow data extraction, with findings presented in graphical and tabular forms. The reporting will follow Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Conclusion This review will present the scope of the current literature on diagnostic POCUS in obstetric anesthesia and critical care, highlighting both strengths and gaps in existing knowledge. The insights gained will support future research, knowledge synthesis, and development of educational programs. The findings will be disseminated through peer-reviewed journal publications, conferences, and social media platforms. Systematic review registration Not applicable.

Abstract Background Ultrasound technology is indispensable in perinatal care due to its non-invasive and painless nature, offering vital insights into foetal development and childbirth. With the academisation of midwifery in Germany, there is a growing necessity to incorporate ultrasound training into midwifery education. This paper discusses the development and implementation of an introductory obstetric ultrasound curriculum tailored for midwifery students, focusing on fundamental ultrasound techniques in obstetrics. Materials and methods We used Kern’s six-step approach of curricular development comprising [1] problem identification and general needs assessment [2], needs assessment of the targeted learners [3], goals and objectives [4], educational strategies [5], implementation, and [6] evaluation and feedback. The individual components of the curriculum were meticulously designed based on comprehensive literature reviews, thorough consultations with experienced ultrasound experts and evaluated needs of participants prior to the course instruction. Results Twenty-seven ultrasound-naive midwifery students participated in the newly developed obstetric ultrasound course. Structured as a modular and integrated framework, the course aimed to provide theoretical and practical instruction in basic obstetric ultrasound, with intrapartum sonography and focused assessment with abdominal sonography for trauma (FAST) as key supplementary specialisations. The results demonstrated a significant increase in the students’ overall knowledge and practical skills, as evidenced by the median post-course total score rising from 20 to 60 out of 75 (p

Abstract Background Point-of-care ultrasound (POCUS) has emerged as an essential bedside tool for clinicians, but lack of access to ultrasound equipment has been a top barrier to POCUS use. Recently, several handheld ultrasound devices (“handhelds”) have become available, and clinicians are seeking data to guide purchasing decisions. Few comparative studies of different handhelds have been done. We conducted a cross-sectional study comparing 6 handhelds readily available in the United States (Butterfly iQ + ™ by Butterfly Network Inc.; Clarius™ by Clarius Mobile Health; Kosmos™ by EchoNous; TE Air™ by Mindray; Vscan Air™ SL and CL by General Electric; and Lumify™ by Philips Healthcare). A multi-specialty group of physician POCUS experts (n = 35) acquired three standard ultrasound views (abdominal right upper quadrant, cardiac apical 4-chamber, and superficial neck and lung views) in random order on the same standardized patients and rated the image quality. Afterward, a final survey of the overall ease of use, image quality, and satisfaction of each handheld was completed. Results Thirty-five POCUS experts specializing in internal medicine/hospital medicine, critical care, emergency medicine, and nephrology acquired and rated right upper quadrant, apical 4-chamber, and superficial neck and lung views with 6 different handhelds. For image quality, the highest-rated handhelds were Vscan Air™ for the right upper quadrant view, Mindray TE Air™ for the cardiac apical 4-chamber view, and Lumify™ for superficial views of the neck and lung. Overall satisfaction with image quality was highest with Vscan Air™, Lumify™, and Mindray, while overall satisfaction with ease of use was highest with Vscan Air™. The 5 most desirable characteristics of handhelds were image quality, ease of use, portability, probe size, and battery life. Ultimately, all 6 handhelds had notable advantages and disadvantages, with no single device having all desired qualities or features. Conclusions The overall satisfaction with image quality was rated highest with Vscan Air™, Lumify™, and Mindray TE Air™when acquiring right upper quadrant, apical 4-chamber, and superficial neck and lung views. No single handheld was perceived to be superior in image quality for all views. Vscan Air™ was rated highest for overall ease of use and was the most preferred handheld for purchase by POCUS experts.

Abstract Background Ultrasound can detect fluid in the alveolar and interstitial spaces of the lung using the presence of artifacts known as B-lines. The aim of this study was to determine whether a deep learning algorithm generated B-line severity score correlated with pulmonary congestion and disease severity based on clinical assessment (as identified by composite congestion score and Rothman index) and to evaluate changes in the score with treatment. Patients suspected of congestive heart failure underwent daily ultrasonography. Eight lung zones (right and left anterior/lateral and superior/inferior) were scanned using a tablet ultrasound system with a phased-array probe. Mixed effects modeling explored the association between average B-line score and the composite congestion score, and average B-line score and Rothman index, respectively. Covariates tested included patient and exam level data (sex, age, presence of selected comorbidities, baseline sodium and hemoglobin, creatinine, vital signs, oxygen delivery amount and delivery method, diuretic dose). Results Analysis included 110 unique subjects (3379 clips). B-line severity score was significantly associated with the composite congestion score, with a coefficient of 0.7 (95% CI 0.1–1.2 p = 0.02), but was not significantly associated with the Rothman index. Conclusions Use of this technology may allow clinicians with limited ultrasound experience to determine an objective measure of B-line burden.

This review explores the impact of telemedicine, mobile health (mHealth) applications, and point-of-care ultrasound in disaster scenarios. A comprehensive literature review was conducted using databases such as PubMed, MEDLINE, and Google Scholar to identify relevant studies on technology in disaster medicine. The findings indicate that telemedicine significantly enhances communication and coordination among emergency teams, mHealth applications improve patient tracking and triage, and point-of-care ultrasound provides rapid and accurate diagnostics in disaster settings. These technological advancements have contributed to efficient and effective disaster response efforts, highlighting the critical role of technology in modern disaster medicine.

Abstract Background Point-of-care ultrasound is rapidly gaining traction in clinical practice, including primary care. Yet, logistical challenges and geographical isolation hinder skill acquisition. Concurrently, an evidentiary gap exists concerning such guidance's effectiveness and optimal implementation in these settings. Methods We developed a lung point-of-care ultrasound (POCUS) curriculum for primary care physicians in a rural, medically underserved region of the south of Israel. The course included recorded lectures, pre-course assessments, hands-on training, post-workshop lectures, and individual practice. To evaluate our course, we measured learning outcomes and physicians’ proficiency in different lung POCUS domains using hands-on technique assessment and gathered feedback on the course with a multi-modal perception approach: an original written pre- and post-perception and usage questionnaire. Results Fifty primary care physicians (PCPs) showed significant improvement in hands-on skills, increasing from 6 to 76% proficiency (p

INTRODUCTION: Point-of-Care Ultrasound (POCUS) refers to the use of portable ultrasound machines to perform quick and focused ultrasound examinations at a patient’s bedside or point-of-care. POCUS can be performed by all health workers with specific training to use POCUS. The aim of this study was to investigate the radiological performance and feasibility of POCUS using a handheld ultrasound device (HHUSD) in children for examining the thyroid gland. METHODS: A pediatric endocrinologist performed thyroid imaging in children referred to our hospital with suspected thyroid disease using an HHUSD. The same children underwent ultrasonography (US) imaging using the same device by the first radiologist, and a second radiologist performed thyroid US using an advanced high-range ultrasound device (AHUSD) (defined as the gold-standard method) within two hours. The data obtained by the three researchers were compared with each other. RESULTS: This study included 105 patients [68.6% girls (n=72)] with a mean age 12.8±3.6 years. When the thyroid volume was evaluated, a strong correlation was found between the measurements of the three researchers (AA vs. MG: r=0.963, AA vs. GT: r=0.969, MG vs. GT: r=0.963, p

Abstract Background Clinicians from multiple professional backgrounds are increasingly using point-of-care ultrasound in clinical practice. Performing ultrasound is a complex skill, and training is required to ensure competency and patient safety. There is a lack of skilled trainers within health professions to meet this increasing educational demand. The role of sonographers in educating other health professionals in point-of-care ultrasound has not yet been well defined. Sonographers can provide ultrasound education interprofessionally, if equipped with appropriate clinical knowledge and educational skills. Methods A Delphi consensus study was conducted to define the knowledge, skills and attributes required of sonographers teaching point-of-care ultrasound to other health professionals in Australia and New Zealand. Health professionals with subject matter expertise in the leadership, facilitation, and delivery of ultrasound education by sonographers were invited to participate. Results There were 72 expert participants in survey round one, and 49 in round two. Participants included physicians, sonographers, and other health professionals. Consensus was reached on 31 competency items for sonographers teaching ultrasound interprofessionally, with agreement of greater than 94% reached by participants. Conclusions This consensus study has defined the knowledge, skills and attitudes required for sonographer competence in point-of-care ultrasound education. This is an important step to developing a training pathway for sonographers engaging in this emerging area.

Abstract Background Although the number of point-of-care ultrasound devices available in Hungarian primary care practices are increasing due to government funding, their use in day-to-day patient care is limited and unregulated. Our study aimed to evaluate the attitudes and needs of general practitioners (GPs) and patients in Hungary regarding the introduction of bedside ultrasonography in primary care practices. Methods As a part of a cross-sectional study, an anonymous, self-administered questionnaire was distributed to GPs and patients on a social media platform. Data collection was carried out from August 2023 to October 2023. Chi-square test was used to determine the associations between categorical variables. Results The survey was completed by 415 GPs (mean age 53.8 ± 11.1 years, 54.9% female, mean 19.5 ± 11.9 years of practice) and 693 patients (mean age 45.5 ± 12.3 years, 95.2% female). There was a statistically significant increase in interest in PoCUS among young and middle-aged GPs (age 28–59; p = 0.02). In addition, this population of GPs was also more likely to undertake training in PoCUS than their older colleagues (p

Abstract Lemierre's syndrome is a fatal condition characterized by septic thrombophlebitis of the internal jugular vein (IJV). Early diagnosis of Lemierre's syndrome in primary care remains challenging because of its rarity and common initial symptoms like fever and sore throat. The COVID‐19 pandemic has increased the difficulty of diagnosis, along with many diagnostic delays. Herein, we report a case in which an IJV thrombus was detected using point‐of‐care ultrasound (POCUS), leading to the diagnosis of Lemierre's syndrome. During the COVID‐19 pandemic, POCUS was a simple and noninvasive technique for screening Lemierre's syndrome without radiation and low droplet exposure.