The Medical clinics of North America
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Med. Clin. North Am. · Jan 2025
ReviewIntestinal Ultrasound in Common Gastrointestinal Disorders: An Evidence-Based Approach.
Patients with abdominal symptoms are among the most common to present both urgently and non-urgently for medical evaluation. While intestinal ultrasound (IUS) is useful to aid management of these patients, it is not routinely taught, performed, or included as part of the core set of point-of-care ultrasound competencies. The authors present an approach to performing a systematic, but focused, IUS at the bedside and diagnostic accuracies for small bowel obstruction inflammatory bowel disease, appendicitis, and diverticulitis. An approach on how to integrate IUS findings and common pitfalls will also be discussed.
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Med. Clin. North Am. · Jan 2025
ReviewAdvanced Cardiac Point-of-Care Ultrasound: A Systematic Review of Select Cardiac Diseases.
Basic cardiac point-of-care ultrasound (POCUS)/focused cardiac ultrasound (FoCUS) often reveals incidental findings. Consider a patient with dyspnea in whom FoCUS reveals left ventricular (LV) hypertrophy, calcified valves, and pericardial effusion but "normal" LV systolic function. ⋯ This systematic review identified studies suggesting that a sufficiently trained practitioner can leverage advanced techniques to evaluate conditions such as hypertrophic cardiomyopathy (4), LV diastolic dysfunction (6), severe valvular heart disease (6), and tamponade (8). This article discusses the use of advanced cardiac POCUS in these conditions.
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Abdominal point-of-care ultrasound is an essential diagnostic tool for internal medicine physicians. It can identify intraperitoneal free fluid, evaluate the liver for size, presence of steatosis, and assessment for possible cirrhosis. ⋯ In such cases, sonographic measurements may provide a more definitive diagnosis. With the proper training, these organs can be evaluated at the bedside and guide clinical decision making.
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Med. Clin. North Am. · Jan 2025
ReviewPrinciples and Practice of Internal Medicine Point-of-Care Ultrasound.
While point-of-care ultrasound (POCUS) use is expanding within Internal Medicine, basic yet important practices and key infrastructure are frequently underutilized. This is appropriately raising concerns that patients may be unintentionally harmed by POCUS. ⋯ It is also important to build infrastructure to allow for ongoing monitoring and quality assurance with an emphasis on transparency and objectivity of the clinician's POCUS findings. This will ensure the safe and effective integration of POCUS in Internal Medicine.
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Integrated multi-organ ultrasound is increasingly used across various medical specialties. It should be performed in conjunction with history, physical examination, and other investigations in the diagnostic process to enhance the detection of conditions in the lung, heart, and abdomen. Multi-organ ultrasound has been shown to improve diagnostic accuracy in a sizeable portion of patients, potentially altering treatment plans. Specifically, it aids in assessing shock, sepsis, dyspnea, delirium, and in the perioperative setting, contributing to a more comprehensive patient assessment process.