The Medical clinics of North America
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Ultrasound guidance for bedside procedures improves rates of success while reducing complications. It is the standard of care for most bedside procedures and has ever-increasing utility for peri-procedural assessment. Herein, we provide a concise description with associated images and videos detailing the proper technique for ultrasound image acquisition and interpretation, along with common pitfalls to be avoided.
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Point-of-care ultrasound (POCUS) infrastructure is the underpinning of a well integrated POCUS program. In order to achieve its full potential and fully integrate into the health care system, a POCUS program requires a robust and resilient infrastructure. The essential components of POCUS infrastructure are hardware, software, and an informed, well-integrated governance structure. This infrastructure can be leveraged for clinical decision-making, education, research, credentialing, documentation, health record integration as well as quality assurance and improvement.
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The use of point-of-care ultrasound (POCUS) of the vasculature has expanded beyond procedural guidance and is utilized by multiple specialties in varied clinical settings. Evidence supports the use of POCUS for diagnosing deep venous thrombosis in the lower extremities, while for thrombosis in the upper extremities or abdominal aortic aneurysm screening, the evidence is still nascent. Here, we review POCUS of the extremity veins and abdominal aorta with a summary of the pertinent literature, review of the relevant anatomy, description of the appropriate acquisition technique, introduction to associated pathology, and discussion of pitfalls one could encounter.
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Med. Clin. North Am. · Jan 2025
ReviewSafety, Ergonomics and Patient Centered Point-of-Care Ultrasound.
Ultrasound imaging is a safe diagnostic tool that has become ubiquitous, in part due to its portability, effectiveness, and safety record. The latter is aided be adherence to regulatory limits, safety guidelines, and the "as low as reasonably achievable" principle. Operators receive feedback on potential tissue heating and mechanical effects through output display standard that shows the thermal index and mechanical index. ⋯ Ergonomic sonography practices are emphasized to prevent work-related musculoskeletal disorders (WRMSD), with professional organizations encouraging the use of ergonomically designed equipment and proper body positioning during scans. Operators should understand and properly apply ergonomic practices. Administrators play a key role by providing ergonomic equipment, education on WRMSD prevention, and creating workplace policies.
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Med. Clin. North Am. · Jan 2025
ReviewVolume Status: A Preload Assessment by Ultrasound of the Inferior Vena Cava and Jugular Venous Pulsation.
An accurate assessment of intracardiac pressure and etiology of its pathologic change is crucial in assessing volume status and cardiac hemodynamics. The assessment for abnormal central venous pressure in heart failure has driven the development of noninvasive assessment of the central veins: the inferior vena cava and, more recently, ultrasound assessment of the jugular venous pressure. This article discusses the evidence, techniques, and limitations of estimating central venous pressure by ultrasound assessment of the inferior vena cava and internal jugular vein.