Resa and Mike team up to discuss important happening at SCUF 2019 Annual conference. Guest stars Nova Panebianco and Sara Damewood!

We use ultrasound a lot. Sometimes we find things that are not clearly related to the reason the patient came in. The prevalence of these incidental findings relates to the usefulness of the diagnostic test. These authors take the bull by the horns, randomly whole-body-POCUS scanning emergency department patients to see what sort of findings might pop up. But should disease prevalence change our use of the tool?

https://www.ncbi.nlm.nih.gov/pubmed/30587153

Fractures of the distal radius are pretty common among people who choose not to break their fall with their face. Sure - it's not hard to see these on xray, but is there a better way? Ultrasound is great for finding fractures, but what about being able to guide the reduction? This has been shown to be useful in a pediatric population, but this study looks at a population of adult patients in the emergency department to see just how accurate ultrasound is for determining if the pieces have been put back together.

https://www.ncbi.nlm.nih.gov/pubmed/30191190

TEE has been heralded as the latest and greatest way to monitor a cardiac arrest resuscitation. The advantages include continuous monitoring of cardiac activity, ability to evaluate efficacy of chest compressions, and better evaluation of etiologies of the arrest. Although many places are using it currently, there is not much evidence to support these theoretical benefits. What we do know is that a few studies have shown that transthoracic ultrasound leads to prolonged pauses in cardiac arrest. This study aims to see if TEE is the solution.

https://www.ncbi.nlm.nih.gov/pubmed/30773413

Many ultrasound enthusiasts have been using point of care ultrasound to assist in the diagnosis of acute decompensated heart failure, but it has not been widely adopted. It has been shown by many studies that ultrasound can visualize pulmonary edema easily so that treatment can be started quickly. However, some still cling to their chest xrays and their natriuretic peptides, just hoping it won't lead them astray. Well this trial aims to prove the superior accuracy of lung ultrasound combined with clinical assessment over chest xray and pro-BNP (also combined with clinical assessment). Hold onto your hats, because there is a lot we can learn from this well done randomized controlled trial of over 500 patients!

https://www.ncbi.nlm.nih.gov/pubmed/30690825

Point of care ultrasound can be used for a great many things, but I don't think many people grab for the probe when a patient comes in with suspected pre-eclampsia. However, we know that pre-eclampsia can lead to pathophysiology that is readily identified on ultrasound - things like interstitial edema, cardiac dysfunction, and increased intracranial pressure. This study takes the first step by examining patients in pre-eclampsia and determining how often you might find something if you go a lookin.

https://www.ncbi.nlm.nih.gov/pubmed/30211771

The gallbladder loves to be scanned - a fluid filled sac nestled against a wonderful acoustic window? Are you kidding me? In any case, here is what we know: ultrasound is good for diagnosing cholecystitis, point of care ultrasound in the emergency department is good for diagnosing cholecystitis, BUT many surgeons still prefer a comprehensive RUQ ultrasound prior to cuttin' anyone. This article takes a look to see if these positive findings in the ED lead to people requiring cholecystectomy. Also - does it actually save time?

https://www.ncbi.nlm.nih.gov/pubmed/30109274

Chest pain is fun, right? Maybe add in some shortness of breath? It can be hard to sort through the potentially sick from the okay to go home. We know that point of care ultrasound (POCUS) can be helpful in making or excluding many cardiothoracic pathologies, but we don't even know if it really makes a difference! This article takes the first step by asking, "when you use POCUS, does it help lower the diagnostic uncertainty about that patient?" Secondly, it takes on an old rivalry by comparing POCUS to chest xray in these patients.

https://www.ncbi.nlm.nih.gov/pubmed/30413369

Fluid responsiveness has been all the rage in emergency and critical care medicine. Trying to determine which patients will benefit from fluids or how much fluids is a daily struggle for providers. However, every new measurement or technique to quantify a patients possible responsiveness to fluids has been riddled with problems. Is carotid flow time, the holy grail that we have been waiting for? This study dives into the use of carotid flow time in an ICU patient population and attempts to answer if flow time can predict fluid responsiveness.

The FAST exam is tried and true for trauma, but in the past it hasn't been super useful for patients with isolated pelvic fractures. This study teases out a very sick subset of this population - patient who have significant hemorrhage associated with their fracture. The question is how well can the FAST identify intraabdominal hemorrhage in these people. The authors' idea is that if the FAST can find intraperitoneal blood, it might help determine who would benefit from REBOA instead of laparotomy.