point of care

Ultrasound for Lumbar Punctures – An Invaluable tool for the Acute Physician

The traditional procedure of identifying anatomical landmarks when performing lumbar punctures can lead to a failure rate of 19%.
The Society of Hospital Medicine have published a statement, recommending use of ultrasound (US) guidance for all adult lumbar punctures (LP).
A recent meta-analysis found several advantages of point of care US guided LP: higher success rate and diminished pain.
US assisted LP is easy to learn, integrating ultrasound guided LP into Acute Medicine curriculum, could lead to better patient outcome.

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Gaps in point of care ultrasound provision and the cost of ultrasound equipment provision: results of a nationwide audit of acute medical units

Introduction: Advances in ultrasound technology have allowed an investigation previously restricted to the radiology department to be used more liberally in clinical decision making. Point-of-Care-Ultrasound (PoCUS) has superior diagnostic performance to traditional clinical examination across a range of pathologies in the hands of a suitably experienced practitioner. The utilisation of PoCUS has the potential to greatly influence the delivery of acute care, but little is known about the current level of resource provision within the acute medical setting.

Methods: To establish the availability of ultrasound equipment and appropriately trained clinicians within Acute Medical Units (AMUs) in the United Kingdom (UK) we asked specific questions with an annual day of care survey, undertaken by the Society for Acute Medicine. We compared data across two years to assess interval changes.

Results: 58.1% (75/129) of AMUs had access to dedicated ultrasound equipment in SAMBA’19. This represents a small increase from SAMBA’18. Ultrasound expertise is concentrated across a small number of AMUs. Growth in the number of ultrasound trained clinicians is greatest units with established expertise.

Conclusion: The equipment to provide PoCUS is not present on all AMUs and appropriately trained clinicians are not distributed evenly across units. This is likely to affect individual AMUs ability to deliver bedside ultrasound to appropriate patients who may benefit. Bridging the gap to ensure all AMUs have the option to use PoCUS will require planning and investment.

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Training Requirements for Point of Care Ultrasound in Acute Medicine

Abstract

The aim of the study was to explore the ultrasound training requirements in acute medicine by comparing the ultrasound skill of an acute medicine trainee (AMT) with that of the radiology department following short ultrasound training.

Results: 43 participants (34 males and 9 females).The mean age was 58 (range 20-93 years). Liver: AMT reported 15/17 as normal (Specificity 88%) and diagnosed ascites in 100% (NPV 93%). Gallbladder: There was 100% sensitivity and NPV for excluding gallstone. CBD: Sensitivity and specificity of 83 and 95% for dilated CBD (NPV 95%). Kidneys: AMT identified 100% of normal kidneys. Spleen: Splenomegaly diagnosed with 95% specifity and NPV.

Conclusion: The AMT achieved a high level of accuracy in diagnosing and excluding gallstone, dilated CBD, ascites and splenomegaly.

CBD = Common Bile Duct, NPV=Negative Predictive Value.

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