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      A comparison of handheld ultrasound versus traditional ultrasound for acquisition of RUSH views in healthy volunteers

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          Abstract

          Few studies evaluate the use of handheld ultrasound devices for point‐of‐care ultrasonography in the emergency department. We hypothesized that image acquisition time and image quality are similar between a handheld device and a traditional device. We compared these 2 types of devices in healthy, non‐pregnant adults with using a crossover non‐inferiority design while acquiring Rapid Ultrasound for Shock and Hypotension (RUSH) view. We excluded those with a history of surgical intervention or known abnormality to the lungs, abdomen, or pelvis. Images were compiled into a de‐identified video clip reviewed for image quality by 2 blinded reviewers. Cohen's Kappa was used to determine interrater agreement. Disagreements were adjudicated by an independent physician. Imaging time was compared using a paired Student's t test. Of 59 screened participants, 9 were excluded. Most subjects (N = 30, 60%) were female with a mean age of 39 (Range: 19–67) years. The median time to complete the RUSH exam did not differ (handheld 249.4, interquartile range 33.5 seconds); traditional 251.4, interquartile range 66.3 seconds); [ P = 0.81]). Agreement between ultrasound reviewers was good (agreement 83%; k = 0.69; 95% CI, 0.49–0.88). Images were determined to be of adequate quality for interpretation in 41/50 (82%) and 43/50 (86%) in the handheld and traditional devices, respectively ( P = 0.786). Neither time to image acquisition nor image quality differed between the handheld and traditional devices. The handheld device may be an alternative for use in RUSH exams.

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          The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll.

          The RUSH exam (Rapid Ultrasound in SHock examination), presented in this article, represents a comprehensive algorithm for the integration of bedside ultrasound into the care of the patient in shock. By focusing on a stepwise evaluation of the shock patient defined here as "Pump, Tank, and Pipes," clinicians will gain crucial anatomic and physiologic data to better care for these patients.
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            Ultrasonography in the emergency department

            Point-of-care ultrasonography (POCUS) is a useful imaging technique for the emergency medicine (EM) physician. Because of its growing use in EM, this article will summarize the historical development, the scope of practice, and some evidence supporting the current applications of POCUS in the adult emergency department. Bedside ultrasonography in the emergency department shares clinical applications with critical care ultrasonography, including goal-directed echocardiography, echocardiography during cardiac arrest, thoracic ultrasonography, evaluation for deep vein thrombosis and pulmonary embolism, screening abdominal ultrasonography, ultrasonography in trauma, and guidance of procedures with ultrasonography. Some applications of POCUS unique to the emergency department include abdominal ultrasonography of the right upper quadrant and appendix, obstetric, testicular, soft tissue/musculoskeletal, and ocular ultrasonography. Ultrasonography has become an integral part of EM over the past two decades, and it is an important skill which positively influences patient outcomes.
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              Evaluation of a new pocket echoscopic device for focused cardiac ultrasonography in an emergency setting

              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. Methods During 4 months, patients admitted to our emergency department and requiring transthoracic echocardiography (TTE) were included in this single-center, prospective and observational study. Patients underwent TTE using a PUD and a conventional echocardiography system. Each examination was performed independently by a physician experienced in echocardiography, unaware of the results found by the alternative device. During the focused cardiac echocardiography, the following parameters were assessed: global cardiac systolic function, identification of ventricular enlargement or hypertrophy, assessment for pericardial effusion and estimation of the size and the respiratory changes of the inferior vena cava (IVC) diameter. Results One hundred fifty-one (151) patients were analyzed. With the tested PUD, the image quality was sufficient to perform focused cardiac ultrasonography in all patients. Examination using PUD adequately qualified with a very good agreement global left ventricular systolic dysfunction (κ = 0.87; 95%CI: 0.76-0.97), severe right ventricular dilation (κ = 0.87; 95%CI: 0.71-1.00), inferior vena cava dilation (κ = 0.90; 95%CI: 0.80-1.00), respiratory-induced variations in inferior vena cava size in spontaneous breathing (κ = 0.84; 95%CI: 0.71-0.98), pericardial effusion (κ = 0.75; 95%CI: 0.55-0.95) and compressive pericardial effusion (κ = 1.00; 95%CI: 1.00-1.00). Conclusions In an emergency setting, this new ultraportable echoscope (PUD) was reliable for the real-time detection of focused cardiac abnormalities.
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                Author and article information

                Contributors
                zachary.dewar@guthrie.org
                Journal
                J Am Coll Emerg Physicians Open
                J Am Coll Emerg Physicians Open
                10.1002/(ISSN)2688-1152
                EMP2
                Journal of the American College of Emergency Physicians Open
                John Wiley and Sons Inc. (Hoboken )
                2688-1152
                21 November 2020
                December 2020
                : 1
                : 6 ( doiID: 10.1002/emp2.v1.6 )
                : 1320-1325
                Affiliations
                [ 1 ] Guthrie Robert Packer Hospital–Department of Emergency Medicine Emergency Medicine Residency Sayre Pennsylvania USA
                [ 2 ] Lake Erie College of Osteopathic Medicine–Bradenton Campus Bradenton Florida USA
                [ 3 ] Geisinger Commonwealth School of Medicine Sayre Pennsylvania USA
                Author notes
                [*] [* ] Correspondence

                Dr. Zachary E. Dewar, MD, Emergency Medicine Residency, Guthrie/Robert Packer Hospital, 1 Guthrie Square, Sayre, PA 18840, USA.

                Email: zachary.dewar@ 123456guthrie.org

                Article
                EMP212322
                10.1002/emp2.12322
                7771775
                33392539
                bb0305af-a108-40df-b513-910ac4847670
                © 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 28 August 2020
                : 20 October 2020
                : 27 October 2020
                Page count
                Figures: 3, Tables: 0, Pages: 6, Words: 3214
                Categories
                Brief Research Report
                Imaging
                Custom metadata
                2.0
                December 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.6 mode:remove_FC converted:29.12.2020

                emergency ultrasound,image quality,rush exam,pocus,handheld ultrasound

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