ultrasound

Point of care ultrasound: Current and future directions for Acute Medicine

Review Articles, Volume 22, Issue 2, Pages 57 – 108 (2023)

Point of care ultrasound (POCUS) represents an exciting tool for current and future acute care practitioners. POCUS has come a long way in a short space of time and its widespread implementation may well be one of the biggest changes seen in acute medicine across the next decade.

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

Correspondence, Volume 22, Issue 2, Pages 57 – 108 (2023)

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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Point of care ultrasound 3-point compression vs departmental scanning for lower limb DVT in ambulatory and internal medicine patients

Research Audit and Clinical Practice, Volume 20, Issue 4, Pages 249 – 308 (2021)

Point of care ultrasound scanning (POCUS) is safe and effective in positively identifying lower limb DVT in emergency departments globally. In the UK, the requisite knowledge and skills are integrated into the FAMUS and FUSIC curricula.
Five FAMUS practitioners of varying experience performed 3-point compression POCUS on medical ambulatory and inpatients. Accuracy and timing of POCUS was compared between practitioners and with subsequent departmental scans.
89% sensitivity and 97% specificity were observed, with little difference between supervisors and candidates. Additionally, a significantly higher proportion of POCUS vs departmental scans (69% vs 7%, p = 0.0001) occurred within 24 hours of request.
Minimal experience was required to produce accurate results within ambulatory and internal medicine settings, and significant time savings can be made.

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Focused Acute Medicine Ultrasound (FAMUS): uptake, completion and barriers to accreditation after two years

Original Articles, Volume 20, Issue 3, Pages 157-248 (2021)

The Society for Acute Medicine launched their ultrasound accreditation in September 2016, involving a practical course alongside completion of scanning competencies. Candidates require a registered supervisor to oversee their training.
We present here the results of a survey of attendees of practical courses approximately 2 years after launch. The majority of respondents were Consultants or trainees within AIM. Fourteen of 76 (18.4%) respondents had completed the whole accreditation process, whilst 51 (67.1%) had not completed any of the three individual modules. The biggest barriers to accreditation were seen to be lack of supervisors, and lack of dedicated training time. There was good uptake of available online learning resources with good feedback.
These results will be used to help develop the training pathway further and widen access to ultrasound training within the specialty and beyond.

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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

Original Articles, Volume 19, Issue 2, Pages 61 – 112 (2020)

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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Bedside Point-of-Care Ultrasound of an Adult with Diffuse Intermittent Abdominal Pain

Case Reports, Volume 19, Issue 1, Pages 1 - 60 (2020)

A 29-year-old woman with a history of obesity status post Roux-en-Y gastric bypass greater than five years prior presented to the emergency department with four hours of sudden-onset stabbing left-sided abdominal pain associated with nausea and non-bloody emesis. She denied melaena and hematochezia, but did report two weeks of diarrhoea that was unchanged with this new onset abdominal pain.

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Malignant renal obstruction without dilatation

Case Reports, Volume 18, Issue 2, Pages 61 – 136 (2019)

A 61 year old male presented with a one-week history of abdominal pain and loose stools. He had recently received treatment for cellulitis with flucloxacillin. He was anuric on presentation requiring haemodialysis. His ultrasound scan showed patent vessels with no signs of obstruction.

A kidney biopsy revealed tubulointerstitial nephritis, attributed to recent treatment with flucloxacillin. A week later he developed lower limb thromboembolic disease triggering further investigations. A FDG PET-CT scan revealed a large FDG-avid retroperitoneal mass causing non-dilated obstruction of both kidneys. Bilateral retrograde stents were inserted which resulted in a 1.6L diuresis and cessation of haemodialysis.

Non-dilated obstruction should be considered in anuric AKI, particularly in the context of malignancy, and may require a therapeutic trial of decompression.

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Focused Acute Medicine Ultrasound (FAMUS) – point of care ultrasound for the Acute Medical Unit

Research Audit and Clinical Practice, Volume 15, Issue 4, Pages 165 – 220 (2016)

Point of care ultrasound (POCU) is becoming increasingly popular as an extension to clinical examination techniques. Specific POCU training pathways have been developed in specialties such as Emergency and Intensive Care Medicine (CORE Emergency Ultrasound and Core UltraSound Intensive Care, for example), but until this time there has not been a curriculum for the acutely unwell medical patient outside of Critical Care. We describe the development of Focused Acute Medicine Ultrasound (FAMUS), a curriculum designed specifically for the Acute Physician to learn ultrasound techniques to aid in the management of the unwell adult patient. We detail both the outline of the curriculum and the process involved for a candidate to achieve FAMUS accreditation. It is anticipated this will appeal to both Acute Medical Unit (AMU) clinicians and general physicians who deal with the unwell or deteriorating medical or surgical patient. In time, the aspiration is for FAMUS to become a core part of the AIM curriculum.

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A UK wide survey on attitudes to point of care ultrasound training amongst clinicians working on the Acute Medical Unit

Research Audit and Clinical Practice, Volume 14, Issue 4, Pages 145 - 196 (2015)

Abstract

The use of point of care ultrasound (POCU) is increasing across a number of specialties, becoming mandatory within some specialist training programmes (for example respiratory and emergency medicine). Despite this, there are few data looking at the prevalence of use or the training clinicians have undertaken; this survey sought to address this. It shows that the majority of POCU undertaken on the Acute Medical Unit (AMU) is without formal accreditation, with significant barriers to training highlighted including a lack of supervision, time and equipment. For those who undertook POCU, it was shown to regularly speed up clinical decision making, while 76.3% respondents believed a lack of access to POCU out of hours may affect patient safety. The data provide support to the concept of developing AMU specific POCU accreditation, to ensure robust and safe use of this modality on the AMU.

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