Ultrasound GEL

PEA Arrest

This is the second study from the REASON group - one of the most rigorously performed studies of ultrasound in cardiac arrest. In this article, they are looking at the population in pulseless electrical activity (PEA) with cardiac motion on ultrasound. From this group, they differentiate those with organized rhythms. The idea is that perhaps this population would have a different survival or respond to treatments differently. By reanalyzing their previous data, they are able to answer these questions.

POCUS in Sepsis

We know that POCUS can be used to diagnose many different types of infection. We also know that these infections can lead to serious systemic illness in the form of sepsis. Whenever we see a patient with sepsis, we want to know the source infection as quickly as possible so that we can treat it appropriately with antibiotics and/or a procedural intervention. Therefore, this paper takes a look to see if using ultrasound in the diagnostic work up of these undifferentiated infected patients can help diagnose the source and lead to better treatment.

A Few Abstracts from WCUME 2017

Members of the GEL team recently traveled to beautiful Montreal, Canada for the World Congress on Ultrasound in Medical Education 2017. Amidst the great speakers, great friends, and wonderful education - we picked out a few interesting research abstracts that we thought would be interesting to discuss.

Variability in Interpretation of Cardiac Standstill

Ultrasound is used in cardiac arrest frequently. We know that it can provide some prognostic information regarding a patient's chance of survival. But before we go calling everybody dead based on our ultrasounds, we should make sure everyone agrees what constitutes "no cardiac activity". This articles takes a look to see the level of agreement among a group of physicians classifying point of care cardiac ultrasound clips as cardiac standstill or not.

Ultrasound in Skin and Soft Tissue Infection

Have you ever stabbed into an abscess only to have nothing come out? Have you missed an abscess because you thought it was just cellulitis? In theory, ultrasound should be able to help us here by finding that magical pocket beneath the skin that is just asking to be drained. Does the literature support this? Is ultrasound superior to the exam alone? This metaanalysis takes a look at the studies that have been done to find out.

Lung and Cardiac Ultrasound Protocol for Acute Heart Failure

Ultrasound can be helpful for diagnosing acute heart failure - mainly by looking for signs of pulmonary edema and poor systolic heart function. Previous results have shown that ultrasound is accurate for the diagnosis, but maybe you're worried that it takes too long. This article tries to test a simple and fast ultrasound protocol that can maintain accuracy in making the diagnosis.

TAPSE to Diagnose Pulmonary Embolism

Alright, we all know that TAPSE (tricuspid annular plane systolic excursion) is a fun word to say, but the question is whether or not it can be used in the emergency department to help diagnose someone with a pulmonary embolism. The TAPSE is a marker of right heart strain, and we know that PEs can cause right heart strain - so...it seems like a reasonable idea, right? Well this article takes a look to see if this is something that can be done in the ED and whether or not it is accurate for the diagnosis.

Ultrasound Associated with Delays in Chest Compressions

Ultrasound is commonly used in the resuscitations of patients in cardiac arrest. It can help to determine cardiac activity and etiologies of the arrest. Usually the ultrasound evaluation is performed during a pulse check. We know that we need to minimize pulse checks to maintain good perfusion - so is it possible that ultrasound causes further delays between chest compressions? This article says yes.

Inferior Vena Cava Collapsibility for Fluid Responsiveness

Ultrasound of the IVC is the people's volume responsiveness test. The idea is that you can non-invasively tell if a patient will benefit from getting more IV fluids. Everybody wants this to work so we can have a simple test to help us in critical situations. It is more reliable in mechanically ventilated patients with a fixed tidal volume but how about the non-intubated patient? Can we trust it?

FAST exam in Stable Pediatrics

The FAST exam is one of the founding fathers of point of care ultrasound. As ultrasound creeps into the pediatric world, it is being used in trauma patients to assess for intraabdominal injury. This article looks at what happens when you apply the FAST exam to a stable pediatric patient with blunt torso trauma. Spoiler Alert! - nothing happens. We discuss what this study shows us, how FAST can be used in pediatrics, and further directions of this modality.