Michael Murphy

Bio: Michael Murphy is an academic researcher from Brown University. The author has contributed to research in topics: Central venous pressure & Internal jugular vein. The author has an hindex of 5, co-authored 6 publications receiving 315 citations. Previous affiliations of Michael Murphy include Rhode Island Hospital.

Ultrasound detection of guidewire position during central venous catheterization.

Abstract: Introduction Ultrasound guidance decreases complications of central venous catheter (CVC) placement, but risks of arterial puncture and inadvertent arterial catheter placement exist. Ultrasound-assisted detection of guidewire position in the internal jugular vein could predict correct catheter position before dilation and catheter placement. Methods Ultrasound examinations were performed in an attempt to identify the guidewire before dilation and catheter insertion in 20 adult patients requiring CVC placement. Central venous pressures were measured after completion of the procedure. Results Guidewires were visible within the lumen of the internal jugular vein in all subjects. Central venous pressures confirmed venous placement of catheters. Ultrasound visualization of the guidewire predicted venous CVC placement with 100% sensitivity (95% confidence interval 80-100%) and 100% specificity (95% confidence interval 80%-100%). Conclusions Ultrasound reliably detects the guidewire during CVC placement and visualization of the wire before dilation and catheter insertion may provide an additional measure of safety during ultrasound-guided CVC placement.

Bedside ultrasound for the detection of diabetic myonecrosis.

Abstract: Diabetic myonecrosis is an uncommon complication of diabetes mellitus. There are fewer than 50 cases reported in the general medical literature. Patients classically complain of the abrupt onset of diffuse anterior thigh pain with no signs of overlying infection or signs of systemic toxicity.Because of the difficulty in diagnosis, most patients endure multiple medical visits until appropriate imaging modalities are obtained. Currently, magnetic resonance imaging (MRI) or tissue biopsy is considered the gold standard for diagnosis. This is the first case reported in the literature of diabetic myonecrosis detected in the ED by bedside ultrasound. We hope that with the continued use of bedside ultrasound, more physicians will be able to determine abnormal tissue architecture allowing for the early detection of diabetic myonecrosis.

Ultrasound diagnosis of traumatic partial triceps tendon tear in the emergency department.

Abstract: A 20-year-old man was a restrained front-seat passenger involved in a rollover motor vehicle accident that included a secondary impact with a tree. On arrival to the emergency department (ED), the patient was noted to be clinically intoxicated. He was complaining of pain in multiple areas including the face, neck, abdomen, and right upper extremity. The patient denied any past medical history, surgical history, illegal drugs, or current prescription medications. A full review of systems was negative for any significant findings.

International Evidence-Based Recommendations for Focused Cardiac Ultrasound

Abstract: Background Focused cardiac ultrasound (FoCUS) is a simplified, clinician-performed application of echocardiography that is rapidly expanding in use, especially in emergency and critical care medicine. Performed by appropriately trained clinicians, typically not cardiologists, FoCUS ascertains the essential information needed in critical scenarios for time-sensitive clinical decision making. A need exists for quality evidence-based review and clinical recommendations on its use. Methods The World Interactive Network Focused on Critical UltraSound conducted an international, multispecialty, evidence-based, methodologically rigorous consensus process on FoCUS. Thirty-three experts from 16 countries were involved. A systematic multiple-database, double-track literature search (January 1980 to September 2013) was performed. The Grading of Recommendation, Assessment, Development and Evaluation method was used to determine the quality of available evidence and subsequent development of the recommendations. Evidence-based panel judgment and consensus was collected and analyzed by means of the RAND appropriateness method. Results During four conferences (in New Delhi, Milan, Boston, and Barcelona), 108 statements were elaborated and discussed. Face-to-face debates were held in two rounds using the modified Delphi technique. Disagreement occurred for 10 statements. Weak or conditional recommendations were made for two statements and strong or very strong recommendations for 96. These recommendations delineate the nature, applications, technique, potential benefits, clinical integration, education, and certification principles for FoCUS, both for adults and pediatric patients. Conclusions This document presents the results of the first International Conference on FoCUS. For the first time, evidence-based clinical recommendations comprehensively address this branch of point-of-care ultrasound, providing a framework for FoCUS to standardize its application in different clinical settings around the world.

Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists

Abstract: Christopher A. Troianos, MD, Gregg S. Hartman, MD, Kathryn E. Glas, MD, MBA, FASE, Nikolaos J. Skubas, MD, FASE, Robert T. Eberhardt, MD, Jennifer D. Walker, MD, and Scott T. Reeves, MD,MBA, FASE, for the Councils on Intraoperative Echocardiography and Vascular Ultrasound of the American Society of Echocardiography, Pittsburgh, Pennsylvania; Lebanon, New Hampshire; Atlanta, Georgia; New York, New York; Boston, Massachusetts; and Charleston, South Carolina

Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use

Abstract: Introduction To investigate whether respiratory variation of inferior vena cava diameter (cIVC) predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure (ACF).

Special articles: guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society Of Cardiovascular Anesthesiologists.

Abstract: TABLE OF CONTENTS PAGEIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . .46Methodology and Evidence Review . . . . . . .46Ultrasound-Guided Vascular Cannulation . . . . . . . . . . . . . . . . . . . . . . . . . . . .47Ultrasound Principles for Needle-Guided Catheter Placement . . . .