Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
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Focused cardiac ultrasonography is performed by clinicians at the bedside and is used in time-sensitive scenarios to evaluate a patient's cardiovascular status when comprehensive echocardiography is not immediately available. This simplified cardiac ultrasonography is often performed by noncardiologists using small, portable devices to augment the physical examination, triage patients, and direct management in both critical care and outpatient settings. ⋯ In this review, we examine some of the challenges with rapid uptake of this technique and explore the benefits and potential risk of focused cardiac ultrasonography. We propose possible mechanisms for cross-specialty collaboration, quality improvement, and oversight.
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Case Reports
Usefulness of Ultrasound in Evaluating the Diaphragm in Neonates and Infants With Congenital Diaphragmatic Hernias.
This report describes the evaluations of 2 patients with congenital diaphragmatic hernias using ultrasound (US). Identifying the size of the diaphragmatic defect is important when determining the type of surgical repair required. ⋯ In case 2, (Morgagni-Larrey hernia), US revealed the left side of a retrosternal diaphragmatic hernia sac; therefore, thoracoscopic repair from the left thorax was performed. Ultrasound was useful for detecting the location and defect size of the diaphragmatic hernia and determining optimal surgical management.
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Comparative Study
Effect of Ultrasound-Guided Intercostal Nerve Block Versus Fluoroscopy-Guided Epidural Nerve Block in Patients With Thoracic Herpes Zoster: A Comparative Study.
To compare the efficacy of a conventional fluoroscopy-guided epidural nerve block and an ultrasound (US)-guided intercostal nerve block in patients with thoracic herpes zoster (HZ). ⋯ These findings showed that both the US-guided intercostal nerve block and the fluoroscopy-guided epidural nerve block were effective in patients with thoracic HZ. Compared data showed no significant differences in the pain reduction, duration of treatment, and frequency of injection. The US-guided intercostal nerve block, which is more accessible than the fluoroscopy-guided epidural nerve block, might be an alternative option for thoracic HZ.
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Randomized Controlled Trial Comparative Study
Comparison of Ultrasound-Guided and Landmark-Based Lumbar Punctures in Inexperienced Resident Physicians.
We sought to determine whether US-guided lumbar puncture reduced the rate of lumbar puncture failures for providers at an academic teaching hospital with variable lumbar puncture and US experience compared to the traditional landmark-based technique. ⋯ The use of US guidance to assist in lumbar punctures did not improve the procedural success rate over traditional landmark techniques in an academic setting with novice providers. Although using US for procedural guidance significantly decreased the number of attempts, it seemed to have no effect on postprocedural pain or the time to obtain CSF.
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Local anesthetic injection into the interspace between the popliteal artery and the posterior capsule of the knee (IPACK) has the potential to provide motor-sparing analgesia to the posterior knee after total knee arthroplasty. The primary objective of this cadaveric study was to evaluate injectate spread to relevant anatomic structures with IPACK injection. ⋯ This cadaver study of IPACK injection demonstrated spread throughout the popliteal fossa without proximal sciatic involvement. However, the potential for injectate to spread to the tibial or common peroneal nerve was demonstrated. Consistent surrounding of the middle genicular artery with injectate suggests a potential mechanism of analgesia for the IPACK block, due to the predictable relationship between articular sensory nerves and this artery. Further study is needed to determine the ideal site of IPACK injection.