Evaluation of a new pocket echoscopic device for focused cardiac ultrasonography in an emergency setting.
TL;DR: In an emergency setting, this new ultraportable echoscope (PUD) was reliable for the real-time detection of focused cardiac abnormalities.
Abstract: Introduction
In the emergency setting, focused cardiac ultrasound has become a fundamental tool for diagnostic, initial emergency treatment and triage decisions. A new ultra-miniaturized pocket ultrasound device (PUD) may be suited to this specific setting. Therefore, we aimed to compare the diagnostic ability of an ultra-miniaturized ultrasound device (Vscan™, GE Healthcare, Wauwatosa, WI) and of a conventional high-quality echocardiography system (Vivid S5™, GE Healthcare) for a cardiac focused ultrasonography in patients admitted to the emergency department.
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01 Jan 2015
TL;DR: This chapter will review technical considerations, imaging acquisition and interpretation, and pitfalls in the critical care ultrasound assessment of pericardial effusion and tamponade.
Abstract: Pericardial effusion with tamponade physiology is an underrecognized and life-threatening but treatable cause of hemodynamic impairment in the critical care setting. As fluid accumulates in the pericardial space, the pericardial pressure exceeds the intracardiac pressure and diminishes cardiac output. Goal-directed critical care echocardiography performed at the bedside can promptly detect a pericardial effusion, which is visualized as an echo-free space surrounding the heart. In the proper clinical context, echocardiographic signs of tamponade, such as diastolic collapse of the right-sided chambers and plethora of the inferior vena cava, can help to establish the diagnosis of cardiac tamponade. This chapter will review technical considerations, imaging acquisition and interpretation, and pitfalls in the critical care ultrasound assessment of pericardial effusion and tamponade.
17 Jul 2014
TL;DR: In this paper, a tamponnade péricardique suite à une plaie de l’apex ventriculaire gauche is shown to have a pneumothorax compressif.
Abstract: Fig. 1. Aspect échocardiographique de tamponnade péricardique suite à une plaie de l’apex ventriculaire gauche. En médecine préhospitalière, la précision de l’examen clinique est limitée et toute erreur diagnostique peut aboutir à un retard ou à un mauvais choix thérapeutique dommageable pour le patient. Pour pallier ces limites, l’échographie d’urgence intègre les ultrasons dans la suite logique de l’examen physique afin d’obtenir en temps réel des informations directement liées à la symptomatologie clinique [1]. Bien que les conséquences cliniques en termes d’amélioration de pronostic soient difficiles à démontrer, l’échographie préhospitalière peut permettre d’identifier ou infirmer précocement une détresse vitale et modifier l’orientation et la prise en charge initiale de patients instables [2]. Ainsi nous rapportons le cas d’un patient de 35 ans pris en charge par le Smur suite à un traumatisme pénétrant du thorax. L’examen clinique initial retrouvait un patient conscient mais très algique, polypnéique, tachycarde à 120 b/min et hypotendu (95/ 55 mmHg). L’auscultation révélait un murmure vésiculaire bilatéral. On ne notait aucune turgescence jugulaire. Un examen échocardiographique ciblé par un urgentiste ayant bénéficié d’une formation courte mettait en évidence un aspect typique de tamponnade péricardique (Fig. 1). La visualisation d’un glissement pleural bilatéral infirmait la présence d’un pneumothorax compressif. Dans ce contexte, le patient était maintenu en respiration spontanée sous oxygénothérapie. La défaillance circulatoire était contrôlée par un remplissage vasculaire itératif sous réserve d’une hypotension permissive. Le drainage péricardique était non réalisé en préhospitalier devant l’absence de signes cliniques de désamorçage. Un transport héliporté était organisé directement vers le bloc opératoire de chirurgie cardiaque pour suture de l’apex ventriculaire gauche et drainage péricardique. L’évolution postopératoire favorable permettait le retrait du drainage péricardique et la sortie du patient vers le service d’hospitalisation.
Cites background from "Evaluation of a new pocket echoscop..."
...[1] Biais M, Carrié C, Delaunay F, Morel N, Revel P, Janvier G....
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...Pour pallier ces limites, l’échographie d’urgence intègre les ultrasons dans la suite logique de l’examen physique afin d’obtenir en temps réel des informations directement liées à la symptomatologie clinique [1]....
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TL;DR: Pulmonary ultrasound has become a "standard of care" when caring for a patient with dyspnea -a practice that has become widespread during the COVID epidemic as mentioned in this paper , which is a good indication for the use of ultrasound due to the air contained in the thorax.
Abstract: Technological advances over the past two decades have paved the way for the prehospital use of ultrasound. This practice was first developed in traumatology and then in a multitude of other indications, including cardiology. The development of pulmonary ultrasound is certainly the most visible illustration of this. Firstly, because it is an extra-cardiac examination that provides the answer to a cardiac question. Secondly because from a theoretical point of view this ultrasound indication was a bad indication for the use of ultrasound due to the air contained in the thorax. Thirdly, because this indication has become a 'standard of care' when caring for a patient with dyspnea - a practice that has become widespread during the COVID epidemic. In patients with heart failure, ultrasound has a high diagnostic power (including for alternative diagnoses) which is all the more precise since the technique is non-invasive, the response is obtained quickly, the examination can be repeated at desire to follow the evolution of the patient. The main other indications for prehospital ultrasound are cardiac arrest to search for a curable cause, identification of residual mechanical cardiac activity, monitoring of cerebral perfusion; chest pain, for both positive and negative diagnoses; shock for the search for an etiology and therapeutic follow-up or even pulmonary embolism or ultrasound for the search for dilation of the right ventricle which is now at the forefront of the recommendation algorithm.
TL;DR: A variety of hand-held ultrasound (HHU) machines have recently become available and offer different capabilities and features as mentioned in this paper and significant potential for the growth of HHU as a tool to facilitate patient care exists when performed by well-trained and competent providers.
References
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TL;DR: A general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies is presented and tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interob server agreement are developed as generalized kappa-type statistics.
Abstract: This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
64,109 citations
TL;DR: An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.
43,884 citations
"Evaluation of a new pocket echoscop..." refers methods in this paper
...LVEFs obtained with the two devices were compared by using linear correlation and Bland and Altman analysis [25]....
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TL;DR: In this article, the authors present a procedure for having two or more judges independently categorize a sample of units and determine the degree, significance, and significance of the units. But they do not discuss the extent to which these judgments are reproducible, i.e., reliable.
Abstract: CONSIDER Table 1. It represents in its formal characteristics a situation which arises in the clinical-social-personality areas of psychology, where it frequently occurs that the only useful level of measurement obtainable is nominal scaling (Stevens, 1951, pp. 2526), i.e. placement in a set of k unordered categories. Because the categorizing of the units is a consequence of some complex judgment process performed by a &dquo;two-legged meter&dquo; (Stevens, 1958), it becomes important to determine the extent to which these judgments are reproducible, i.e., reliable. The procedure which suggests itself is that of having two (or more) judges independently categorize a sample of units and determine the degree, significance, and
34,965 citations
"Evaluation of a new pocket echoscop..." refers methods in this paper
...The ability of the PUD to discriminate the severity of the global LV systolic dysfunction (normal was greater than 50%, moderately depressed was 30% to 50%, and severely depressed was less than 30%) was tested by using Cohen’s coefficient, and 95% confidence intervals (CIs) were calculated [26]....
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...The agreement between the clinical responses provided by the two devices was assessed by using Cohen’s coefficient, and 95% CIs were calculated [26]....
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TL;DR: This document reviews the technical aspects on how to perform quantitative chamber measurements of morphology and function, which is a component of every complete echocardiographic examination.
Abstract: Quantification of cardiac chamber size, ventricular mass and function ranks among the most clinically important and most frequently requested tasks of echocardiography. Over the last decades, echocardiographic methods and techniques have improved and expanded dramatically, due to the introduction of higher frequency transducers, harmonic imaging, fully digital machines, left-sided contrast agents, and other technological advancements. Furthermore, echocardiography due to its portability and versatility is now used in emergency rooms, operating rooms, and intensive care units. Standardization of measurements in echocardiography has been inconsistent and less successful, compared to other imaging techniques and consequently, echocardiographic measurements are sometimes perceived as less reliable. Therefore, the American Society of Echocardiography, working together with the European Association of Echocardiography, a branch of the European Society of Cardiology, has critically reviewed the literature and updated the recommendations for quantifying cardiac chambers using echocardiography. This document reviews the technical aspects on how to perform quantitative chamber measurements of morphology and function, which is a component of every complete echocardiographic examination.
4,014 citations
"Evaluation of a new pocket echoscop..." refers methods in this paper
...For the purpose of this study, the systematic examination using conventional TTE was considered the reference diagnostic method to measure each variable, as recommended by the European Association of Echocardiography [21]....
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...Echocardiography 2003, 20:455-461....
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...Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, Porter TR, Spencer KT, Tayal VS, Wei K: Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians....
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...Recently, a consensus statement by the American Society of Echocardiography/American College of Emergency Physicians emphasized the complementary role of focused cardiac US to that of a more comprehensive echocardiography [9]....
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...A report from the Echocardiography Task Force on New Technology of the Nomenclature and Standards Committee of the American Society of Echocardiography....
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TL;DR: This review includes videos demonstrating the use of ultrasonography to guide central venous access, detect pneumothorax, detect evidence of hemorrhage after trauma, and screen for abdominal aortic aneurysm.
Abstract: Compact ultrasound technology has facilitated growth in point-of-care uses in many specialties. This review includes videos demonstrating the use of ultrasonography to guide central venous access, detect pneumothorax, detect evidence of hemorrhage after trauma, and screen for abdominal aortic aneurysm.
1,267 citations
"Evaluation of a new pocket echoscop..." refers background in this paper
...Because standard echocardiographic equipment may be heavy and difficult to handle, hand-carried ultrasound (US) devices have been developed for bedside use, facilitating the growth of point-of-care ultrasonography [5]....
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