Search

A young woman presented to the emergency department with lethargy, hemodynamic instability, and diffuse abdominal tenderness. On point-of-care ultrasound (PoCUS), she was found to have intraperitoneal free fluid and a large pelvic mass, which were discovered intraoperatively to be hemoperitoneum due to ruptured vessels of a uterine leiomyoma. Although rare, a life-threatening, ruptured leiomyoma may be treated surgically if recognized in an expedient fashion. A PoCUS can aid the emergency clinician in prompt diagnosis.

In the Emergency Department (ED), ultrasound-guided nerve blocks (UGNBs) have become a cornerstone of multimodal pain regimens. We investigated current national practices of UGNBs across academic medical center EDs, and how these trends have changed over time. We conducted a cross-sectional electronic survey of academic EDs with ultrasound fellowships across the United States. Twenty-item questionnaires exploring UGNB practice patterns, training, and complications were distributed between November 2021–June 2022. Data was manually curated, and descriptive statistics were performed. The survey results were then compared to results from Amini et al. 2016 UGNB survey to identify trends. The response rate was 80.5% (87 of 108 programs). One hundred percent of responding programs perform UGNB at their institutions, with 29% (95% confidence interval (CI), 20%–39%) performing at least 5 blocks monthly. Forearm UGNB are most commonly performed (96% of programs (95% CI, 93%–100%)). Pain control for fractures is the most common indication (84%; 95% CI, 76%–91%). Eighty-five percent (95% CI, 77%–92%) of programs report at least 80% of UGNB performed are effective. Eighty-five percent (95% CI, 66%–85%) of programs have had no reported complications from UGNB performed by emergency providers at their institution. The remaining 15% (95% CI, 8%–23%) report an average of 1 complication annually. All programs participating in our study report performing UGNB in their ED, which is a 16% increase over the last 5 years. UGNB's are currently performed safely and effectively in the ED, however practice improvements can still be made. Creating multi-disciplinary committees at local and national levels can standardize guidelines and practice policies to optimize patient safety and outcomes. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Point-of-care ultrasound (POCUS) is a low-cost, low-mass imaging modality that will facilitate healthcare for human spaceflight. However, POCUS skills have been shown to degrade over time, presenting a barrier to effective use during missions. While some astronauts are clinically trained, many only receive limited training on POCUS, making acquisition and diagnostic skills less robust to degradation with time. Artificial intelligence (AI) tool integration may minimize skill degradation for novice, technically competent users, but this has not been experimentally investigated. This is the first study investigating whether AI assistance prevents POCUS skill degradation over time in a subject pool that mimics astronaut candidates. METHODS: 30 subjects, (15 male/15 female) were recruited in an IRB-approved human subjects study. Subjects possessed or were working towards a STEM university degree and had no medical training. Subjects were evenly grouped into 2 cohorts: conventional POCUS and POCUS with AI-assistance. During the first data collection session, subjects underwent didactic and hands-on training and performed their first experimental trial. 2 additional trials took place 2 weeks and 8 weeks after the initial session. In each trial, subjects performed 5 renal scans, 5 bladder scans, and 5 bladder volume estimations and completed the System Usability Scale and a self-confidence survey. Images were independently graded by 2 physicians and scored based on target organ acquisition rates. Dependent variables were analyzed via chisquare tests, Levene's tests, and linear mixed effects models. RESULTS: The AI-assisted group correctly imaged the bladder more often than the conventional group (p<0.0005) and exhibited improved diagnostic accuracy in bladder scans at 2 weeks (p=0.0416) but not at 0 or 8 weeks. AI-assistance did not significantly affect skill degradation in renal scans throughout the study. AI-assistance improved perceived system usability over time (p=0.0407) but not user confi- dence. DISCUSSION: POCUS AI-assistance improves novice, technically competent user ability to correctly image the bladder and accurately perform bladder diagnostics while increasing perceived system usability with time. These effects augment the applicability of POCUS in spaceflight contexts where astronauts may not have advanced sonography training. Future work includes study replication in more realistic operational scenarios or with upgraded AI algorithms. Learning Objectives 1. The audience will be able to understand the utility of point-of-care ultrasound in human spaceflight healthcare and recognize that point-of-care ultrasound skills have been shown to degrade over time, necessitating a study that investigates methods of skill degradation prevention for subject pools that mimic that of astronaut candidates. 2. The audience will learn that the integration of artificial intelligence tools into point-of-care ultrasound scanning modalities improved subject ability to correctly capture the bladder and accurately perform bladder diagnostics. [ABSTRACT FROM AUTHOR]

The article focuses on spinal immobilization or spinal motion restriction after blunt trauma is a routine practice and standard care in most settings due to fear of movement causing or worsening spinal cord injury. Topics include the aim of these interventions is to restrict mobility to prevent secondary spinal cord injury during extrication and transport, and the cervical collars have been shown to have several deleterious effects.

The article offers information on Proton Pump Inhibitors for Acute Upper Gastrointestinal Bleeding (UGB). Topics include create optimal conditions for clotting over arteries at ulcer bases, as neutralization of gastric acid leads to stabilization of blood clots; and patients who had been admitted to the hospital for other reasons and subsequently developed UGIB.

Background: The value of routine bedside lung ultrasound (LUS) for predicting patient disposition during visits to the Emergency Department (ED) is difficult to quantify. We hypothesized that a simplified scoring of bedside-acquired LUS images for the triage of acute respiratory symptoms in the ED would be associated with patient disposition., Methods: For this observational pragmatic study, we reviewed prospectively-collected bedside LUS images from patients presenting to the ED with acute respiratory symptoms. We agreed on a simplified LUS scoring approach (0-3). At least three reviewers blindly assessed the available LUS images for each patient and determined the worst score for each patient and the presence of individual LUS findings. The worst LUS score was used to classify patients' LUS-suggested hospital admission risk. We evaluated the agreement between reviewers and the predictive value of LUS findings for patient disposition., Results: 204 patients were eligible, and 126 sets of images were available and scored. The most common LUS finding were isolated B-lines (63.5 % of LUS images), pleural thickening/irregularity (48.4 %), and diffuse B-lines (43.7 %). The patients' worst LUS score were 2 (43.5 %), 3 (26.1 %), 1 (20.7 %), and 0 (9.8 %). There was good agreement among reviewers on the worst LUS score (intra-class correlation coefficient 0.830, 95 % confidence interval (0.772-0.875)) and the LUS-suggested disposition (ICC 0.882, 95 % CI (0.846, 0.911))., Conclusion: A simplified scoring of bedside-acquired LUS images from patients with acute respiratory symptoms at the emergency department reliably predicts patient disposition., Competing Interests: Declaration of competing interest JK serves on the Butterfly Network, Inc. Advisory Board. AFB reports additional research funding from the US National Institutes of Health, the US Department of Defense, the Merck Investigator-initiated Studies Program and the Institute for Healthcare Quality, Safety and Efficiency for projects unrelated to the discussed work. Other remaining authors has no competing to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)