Early Systolic Notching for Pulmonary Embolism

A New Doppler Sign of Massive and Submassive PE

By Michael Prats on 11/11/19 06:00 AM

A focused echo can go a long way in a patient with a suspected pulmonary embolus (PE). It can be especially valuable in those that are so sick and unstable that you need answers right away. In this way, point-of-care echo has been shown to help to diagnose submassive and massive pulmonary emboli by identifying signs of right heart strain. Echo parameters such as right ventricle diameter and right ventricular function (such as in TAPSE) are often part of the evaluation, but these are not as accurate as we would like. These authors propose a new doppler marker of a submassive or massive PE- enter the Early Systolic Notching pattern. https://www.ncbi.nlm.nih.gov/pubmed/31056367

Anterior vs Lateral Lung Fields in Heart Failure

Do we need both?

By Michael Prats on 10/28/19 06:00 AM

Suspected acute heart failure is a great reason to use point-of-care ultrasound. It can tell you in seconds if this patient is up to their neck in pulmonary edema. Knowing that interstitial edema is more common in dependent areas of the lung, one would think that the lateral areas of the lung fields would be most sensitive for the diagnosis. Likewise, if there is enough pulmonary edema to fill up the anterior lung fields, this theoretically should be pretty specific. But is this actually true?! These authors investigate the issue. https://www.ncbi.nlm.nih.gov/pubmed/30665807

Small Bowel Obstruction (#2)

Revisiting The Accuracy of POCUS

By Michael Prats on 10/15/19 06:00 AM

POCUS can be used to visualize small bowel obstruction (SBO) fairly easily. It has proven itself superior to xrays and has some advantages over CT, which for most people is the standard for diagnosis. Although initial work was quite promising, there were no large studies done confirming the accuracy of ultrasound for this purpose. In this podcast we examine the latest study (plus discuss a bonus similar one) that reveals maybe this is not as good as we thought! https://www.ncbi.nlm.nih.gov/pubmed/30762916

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