Part 1: Why are physicians beginning to use ultrasound increasingly at the bedside?

by James Mateer MD RDMS

The initial interest in point of care ultrasound (POC US) exams has been driven by the rapid advancements in ultrasound technology over the past 15-20 years.  These advancements have largely paralleled the development of advances in computer technology.

The 80’s advanced portable real-time imaging options.

The 90’s brought improvements in image quality and more compact portable console units.

This is an example of a hand-carried ultrasound unit. (provided by GE)
This is an example of a hand-carried ultrasound unit.
(provided by GE)

After 2000, a number of compact, hand-carried units were introduced.

Today, the improved image quality, price point and portability for both compact console and hand- carried units have focused the attention of clinicians on utilization of bedside ultrasound.

During this period of technological advancement, physicians have published numerous studies demonstrating conclusively that POC- US improves diagnostic efficiency and patient outcome.

This has led many specialties to incorporate POC US training into their residency or fellowship programs.   We now have a growing number of clinicians who realize the value of the POC US exam for improved diagnosis and treatment.

Currently, several medical schools have initiated POC US training for medical students as they progress through their clinical rotations. These physicians of the future will determine how extensively POC US is utilized for physical diagnosis, disease screening and therapeutic intervention.

As ultrasound advances, there will be continued improvements in portability, image resolution, ease of use and digital interface with the electronic medical record systems.

All of these past and continued technological developments will be a driving force for further utilization of point of care ultrasonography.

Coming up…

Part 2: How a renewed emphasis on the cost effective practice of medicine and patient safety issues will influence the future of POC US.

Learn more from Dr. Mateer at Introduction and Advanced Emergency Medicine and Critical Care Ultrasound Training Courses at Gulfcoast Ultrasound Institute.

Ultrasound-Guided Vascular Access: In-Plane Approach

 

Ultrasound-Guided Vascular Access: In-Plane Approach

Needle Placement In-Plane
Figure 1: Needle placement in-plane with beam

The transducer is held stationary with the non-dominant hand while advancing the needle using the dominant hand.

The in-plane or long access approach is the technique used to allow visualization of the entire needle when performing ultrasound-guided vascular access.

In-Plane Approach
Figure 2: In-plane approach

The transducer is positioned in a long axis over the selected vein.  The vessel is visualized straight across the screen.  The needle is placed at the center of the transducer in-line with the ultrasound beam and the trajectory of the vessel with the bevel up.

Ultrasound Image of the Needle
Figure 3: Ultrasound Image demonstrating needle (yellow arrow)

To learn more about ultrasound-guided procedures, check out ultrasound-guided training courses from Gulfcoast Ultrasound Institute.

References:
Figure 2: Adapted from Chapter 19, Emergency Ultrasound Ed. 2, James Mateer MD, editor”

 

Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children

Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children.

Rabiner JE, Khine H, Avner JR, Friedman LM, Tsung JW.

Source

Department of Pediatrics, Division of Pediatric Emergency Medicine, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA. jrabiner@montefiore.org

Abstract

STUDY OBJECTIVE:

We determine the test performance characteristics for point-of-care ultrasonography performed by pediatric emergency physicians compared with radiographic diagnosis of elbow fractures and compare interobserver agreement between enrolling physicians and an experienced pediatric emergency medicine sonologist.

METHODS:

This was a prospective study of children aged up to 21 years and presenting to the emergency department (ED) with elbow injuries requiring radiographs. Before obtaining radiographs, pediatric emergency physicians performed focused elbow ultrasonography. An ultrasonographic result positive for fracture at the elbow was defined as the pediatric emergency physician’s determination of an elevated posterior fat pad or lipohemarthrosis of the posterior fat pad. All patients received an elbow radiograph in the ED and clinical follow-up. The criterion standard for fracture was fracture on initial or follow-up radiographs.

RESULTS:

One hundred thirty patients with a mean age of 7.5 years were enrolled by 26 sonologists. Forty-three (33%) patients had a radiograph result positive for fracture. A positive elbow ultrasonographic result had a sensitivity of 98% (95% confidence interval [CI] 88% to 100%), specificity of 70% (95% CI 60% to 79%), positive likelihood ratio of 3.3 (95% CI 2.4 to 4.5), and negative likelihood ratio of 0.03 (95% CI 0.01 to 0.23) for fracture. The interobserver agreement (κ) was 0.77. The use of elbow ultrasonography would reduce radiographs in 48% of patients but would miss 1 fracture.

CONCLUSION:

Point-of-care ultrasonography is highly sensitive for elbow fractures, and a negative ultrasonographic result may reduce the need for radiographs in children with elbow injuries. Elbow ultrasonography may be useful in settings in which radiography is not readily accessible or is time consuming to obtain.

Copyright © 2012. Published by Mosby, Inc

Reference:  http://www.ncbi.nlm.nih.gov/pubmed/23142008