Diagnosis of necrotizing faciitis with bedside ultrasound: the STAFF Exam.
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ABSTRACT:
SUBMITTER: Castleberg E
PROVIDER: S-EPMC3935782 | biostudies-other | 2014 Feb
REPOSITORIES: biostudies-other
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Project description:Infective endocarditis is a challenging diagnosis that is rarely made in the emergency department. As the use of focused emergency ultrasound expands into more applications, including advanced echocardiography, the diagnosis of infective endocarditis may be made earlier, potentially leading to more timely treatment. We report a case of an ill-appearing patient presenting to the emergency department with an indwelling central venous catheter, a cardiac murmur, and necrotic toes, who was diagnosed with a large tricuspid vegetation and prominent tricuspid regurgitation on bedside emergency ultrasound. A cardiologist-performed echocardiogram confirmed these findings during the patient's hospital admission.
| S-EPMC3740785 | biostudies-literature
Project description:RationaleCentral venous catheter (CVC) placement is commonly performed in intensive care unit. And CVC placement is associated with risks including CVC malposition, pneumothorax. Many of the previously reported cases are about catheter misplacement detected by bedside ultrasound, chest x-ray (CXR) and computed tomography. In this case, malposition was detected by bedside ultrasound incidentally particularly with no clinical manifestation.Patient concernsAn 88-year-old male with severe diabetic peripheral neuropathy secondary to type 2 diabetes mellitus was admitted for further treatment.DiagnosesWe cannulated a single-lumen CVC via the right subclavian vein, and the tip ended up in the internal jugular vein on the same side. With bedside ultrasound, we discovered the malposition though it was mistaken by aspiration of venous blood. Later, CXR revealed malposition of the tip once again.InterventionsSince the patient was asymptomatic and the catheter was functioning normally, the catheter was used for the following 20 days without complications. Ultimately, we carefully performed the catheter removal.OutcomesAfter the inserted catheter was removed, we attempted a new CVC through the left internal jugular vein. After the procedure, bedside ultrasound and CXR confirmed the correct position of CVC. Following successful replacement of the central catheter, no further complications were observed.LessonsBedside ultrasound offers safety and effectiveness during insertion of CVC. It also exhibits promptness and accuracy compared to post-intervention radiological imaging.
| S-EPMC5908571 | biostudies-literature
Project description:(1) Background: Neutropenic enterocolitis (NEC) is a life-threatening complication following chemotherapy with high mortality rates. Early diagnosis is crucial to improve outcomes. We designed a large prospective study employing bedside ultrasonography (US) as a novel approach to allow early diagnosis and prompt treatment to reduce mortality. (2) Methods: NEC was defined as US or computed tomography (CT)-proven bowel wall thickness ≥ 4 mm at the onset of at least one of the following symptoms: fever and/or abdominal pain and/or diarrhea during neutropenia. From 2007 to 2018, 1754 consecutive patients underwent baseline bedside US that was invariably repeated within 12 h from the onset of symptom(s) suggestive of NEC. (3) Results: Overall, 117 episodes of NEC were observed, and overall mortality was 9.4%. Bowel wall thickening was invariably absent in the negative control group. Abdominal pain associated with one or more symptoms correlated with the highest relative risk (17.33), sensitivity (89.7%), specificity (100%), and accuracy (96.2%) for diagnosis. The combination of abdominal pain and fever at onset significantly correlated with worse survival (p < 0.0001, OR 13.85). BWT (p = 0.046), type of therapy (p = 0.049) and blood culture positivity (p = 0.003) correlated with worse survival. (4) Conclusions: Bedside ultrasound is a non-invasive and radiation free imaging technique for early diagnosis of NEC and its prompt treatment significantly reduced mortality.
| S-EPMC8468879 | biostudies-literature
Project description:BACKGROUND:Cardiac syncope can result from an atrial myxoma due to outflow obstruction. Myxoma is the most common primary cardiac tumor that may cause sudden death and the nonspecific symptoms may make early diagnosis difficult. CASE PRESENTATION:A 27-year-old man presented to our emergency department after two episodes of syncope and severe fatigue. He had no complaint of fever, weight loss, sweating, chest pain or dyspnea. Vital signs were within normal limits. A loud heart S1 was detected and normal neck veins. Other systemic examinations including neurological assessment were normal. Electrocardiography showed normal sinus rhythm. An obvious variability in heart rate was noticed on cardiac monitor changing by the patient's position. Point-of-care ultrasonography (PoCUS) showed a large hyperechoic lesion with a well-defined stalk originating from the left atrium (LA). Thus, the patient was transferred to a cardiac surgery center for surgical intervention. Histopathology reported an LA mass compatible with myxoma. CONCLUSIONS:Emergency physicians should be familiar with the vague presentations of cardiac tumors to improve patient outcomes. It is beneficial to take advantage of bedside ultrasound for prompt diagnosis and subsequent treatment.
| S-EPMC7246266 | biostudies-literature
Project description:IntroductionOur goal was to determine if heated gel for emergency department (ED) bedside ultrasonography improves patient satisfaction compared to room-temperature gel.MethodsWe randomized a convenience sample of ED patients determined by their treating physician to require a bedside ultrasound (US) study to either heated gel (102.0° F) or room-temperature gel (82.3° F). Investigators performed all US examinations. We informed all subjects that the study entailed investigation into various measures to improve patient satisfaction with ED US examinations but did not inform them of our specific focus on gel temperature. Investigators wore heat-resistant gloves while performing the examinations to blind themselves to the gel temperature. After completion of the US, subjects completed a survey including the primary outcome measure of patient satisfaction as measured on a 100-mm visual analogue scale (VAS). A secondary outcome was patient perceptions of sonographer professionalism measured by an ordinal scale (1-5).ResultsWe enrolled 124 subjects; 120 completed all outcome measures. Of these, 59 underwent randomization to US studies with room-temperature gel and 61 underwent randomization to heated US gel. Patient 100-mm VAS satisfaction scores were 83.9 among patients undergoing studies with room-temperature gel versus 87.6 among subjects undergoing studies with heated gel (effect size 3.7, 95% confidence interval -1.3-8.6). There were similarly no differences between the two arms with regard to patient perceptions of sonographer professionalism.ConclusionThe use of heated ultrasound gel appears to have no material impact on the satisfaction of ED patients undergoing bedside ultrasound studies.
| S-EPMC5654875 | biostudies-literature
Project description:ObjectiveAlthough there are training guidelines to credential emergency physicians in bedside ultrasound, many faculty groups have members who completed residency without a mandatory curriculum. These physicians are therefore required to learn bedside ultrasound while out in practice. The objective of this descriptive report is to illustrate a single academic facility's experience with acquiring credentials for emergency physicians in bedside ultrasound and the faculty's impressions on the motivators of and barriers to completion of the requirements.DesignCross-sectional survey.SettingTwo urban teaching hospitals with a combined volume of 170 000 visits a year.Participants41 emergency medicine attending physicians.InterventionEmergency medicine attending physicians underwent training and credentialing in the applications of aorta and pelvic ultrasound over a 9-month period.Outcome measureAfter the credentialing period, we conducted a survey to evaluate the physicians' perceptions of this process.ResultsThere were 41 faculty members during the credentialing survey period. 11 of the faculty members were exempt from ultrasound training. We asked attending physicians (N=41 exempt and non-exempt) to complete a web-based survey after the completion of the credentialing period. Questions about the potential barriers and incentives were listed and responders were asked to rank answers on a five-point Likert scale. Of the 31 respondents, 21 (67.7%) completed the credentialing requirements by the 9-month deadline. 19 of 26 emergency medicine residency trained physicians completed the requirements compared with 2/5 of those that were not emergency medicine residency trained. Our pilot study data suggest an association between fewer years in practice and completion of the requirements.ConclusionsThis is a report on a single academic institution's experience with a faculty credentialing programme in bedside ultrasound for physicians with a diversity of prior experience in bedside ultrasonography. We describe the success of the credentialing process and identify survey-based faculty characteristics associated with fulfilling the requirements.
| S-EPMC3758970 | biostudies-literature
Project description:Lung ultrasound can be routinely performed at the bedside by intensive care unit physicians and may provide accurate information on lung status with diagnostic and therapeutic relevance. This article reviews the performance of bedside lung ultrasound for diagnosing pleural effusion, pneumothorax, alveolar-interstitial syndrome, lung consolidation, pulmonary abscess and lung recruitment/derecruitment in critically ill patients with acute lung injury.
| S-EPMC2151891 | biostudies-literature
Project description:Dysphagia is associated with aspiration, pneumonia, and malnutrition, but remains challenging to identify at the bedside. A variety of exam protocols and maneuvers are commonly used, but the efficacy of these maneuvers is highly variable. We conducted a comprehensive search of 7 databases, including MEDLINE, Embase, and Scopus, from each database's earliest inception through June 9, 2014. Studies reporting diagnostic performance of a bedside examination maneuver compared to a reference gold standard (videofluoroscopic swallow study or flexible endoscopic evaluation of swallowing with sensory testing) were included for analysis. From each study, data were abstracted based on the type of diagnostic method and reference standard study population and inclusion/exclusion characteristics, design, and prediction of aspiration. The search strategy identified 38 articles meeting inclusion criteria. Overall, most bedside examinations lacked sufficient sensitivity to be used for screening purposes across all patient populations examined. Individual studies found dysphonia assessments, abnormal pharyngeal sensation assessments, dual axis accelerometry, and 1 description of water swallow testing to be sensitive tools, but none were reported as consistently sensitive. A preponderance of identified studies was in poststroke adults, limiting the generalizability of results. No bedside screening protocol has been shown to provide adequate predictive value for presence of aspiration. Several individual exam maneuvers demonstrated reasonable sensitivity, but reproducibility and consistency of these protocols was not established. More research is needed to design an optimal protocol for dysphagia detection.
| S-EPMC4607509 | biostudies-literature
Project description:Subcutaneous abscesses occur frequently in the pediatric population, yet there is great variability in the approach to diagnosis and management, partly due to opposing recommendations in the current literature and the lack of a standardized protocol for diagnosis and management among pediatric medical centers. This has led to inconsistencies by the providers, as well as the hospital clinical pathways, with regards to the appropriate management of subcutaneous abscesses. We hypothesize that the current variability in diagnostic work-up and management contributes to the wide use of unnecessary imaging and therapeutics without altering the overall outcomes. We performed a retrospective chart review that compared 200 encounters for patients < 18 years of age with a diagnosis of subcutaneous abscess at a single large tertiary pediatric institution. Our results showed that only 13.6% of wound cultures obtained led to a change in the antibiotic regimen and that blood cultures were positive in only 2.1% of cases. There was no difference in the incision and drainage performed based on ultrasound findings in the presence of fluctuance on physical exam. Patients presenting with fever were more likely to be admitted to the hospital for further care than those without fever. Our results showed no difference in outcome after incision and drainage for abscesses packed with gauze versus those left to drain via a vessel loop drain. There was no difference in recurrence in patients discharged with oral antibiotics versus without oral antibiotic treatment. Our data indicate that many of the diagnostic studies used for the management of a subcutaneous abscess have little to no effect on the outcome. Subcutaneous abscesses are a common pediatric complaint, and this study could help healthcare providers utilize more effective and efficient management strategies for skin and soft tissue infections.
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Project description:Over the past decade technological advances in the realm of ultrasound have allowed what was once a cumbersome and large machine to become essentially hand-held. This coupled with a greater understanding of lung sonography has revolutionized our bedside assessment of patients. Using ultrasound not as a diagnostic test, but instead as a component of the physical exam, may allow it to become the stethoscope of the 21st century.
| S-EPMC3352312 | biostudies-literature