Early goal-directed therapy in the treatment of severe sepsis and septic shock

https://research.birmingham.ac.uk/portal/files/54164678/Gregory_et_al_Antithromotic_therapy_for_atrial_Chest_2018.pdf

Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report

The use of ultrasound has developed over the last 50 years into an indispensable first-line test for the cardiac evaluation of symptomatic patients. The technologic miniaturization and improvement in transducer technology, as well as the implementation of educational curriculum changes in residency training programs and specialty practice, have facilitated the integration of focused cardiac ultrasound into practice by specialties such as emergency medicine. In the emergency department, focused cardiac ultrasound has become a fundamental tool to expedite the diagnostic evaluation of the patient at the bedside and to initiate emergent treatment and triage decisions by the emergency physician.

Focused Cardiac Ultrasound in the Emergent Setting: A Consensus Statement of the American Society of Echocardiography and American College of Emergency Physicians

https://www.medschool.lsuhsc.edu/emergency_medicine/docs/RUSH%20protocol.pdf

The RUSH Exam: Rapid Ultrasound in SHock in the Evaluation of the Critically lll

2014 focused update of the Canadian Cardiovascular Society Guidelines for the management of atrial fibrillation.

Bedside echocardiography by emergency physicians.

Assessment of hemodynamic status in a shock state remains a challenging issue in Emergency Medicine and Critical Care. As the use of invasive hemodynamic monitoring declines, bedside-focused ultrasound has become a valuable tool in the evaluation and management of patients in shock. No longer a means to simply evaluate organ anatomy, ultrasound has expanded to become a rapid and noninvasive method for the assessment of patient physiology. Clinicians caring for critical patients should strongly consider integrating ultrasound into their resuscitation pathways.

/pdf/bedside-ultrasound-in-resuscitation-and-the-rapid-ultrasound-20wepano7u.pdf

Bedside Ultrasound in Resuscitation and the Rapid Ultrasound in Shock Protocol

OBJECTIVES Bedside ultrasound examination by emergency physicians (EPs) is being integrated into clinical emergency practice, yet minimum training requirements have not been well defined or evaluated. This study evaluated the accuracy of EP ultrasonography following a 16-hour introductory ultrasound course. METHODS In phase I of the study, a condensed 16-hour emergency ultrasound curriculum based on Society for Academic Emergency Medicine guidelines was administered to emergency medicine houseofficers, attending staff, medical students, and physician assistants over two days. Lectures with syllabus material were used to cover the following ultrasound topics in eight hours: basic physics, pelvis, right upper quadrant, renal, aorta, trauma, and echo-cardiography. In addition, each student received eight hours of hands-on ultrasound instruction over the two-day period. All participants in this curriculum received a standardized pretest and posttest that included 24 emergency ultrasound images for interpretation. These images included positive, negative, and nondiagnostic scans in each of the above clinical categories. In phase II of the study, ultrasound examinations performed by postgraduate-year-2 (PGY2) houseofficers over a ten-month period were examined and the standardized test was readministered. RESULTS In phase I, a total of 80 health professionals underwent standardized training and testing. The mean +/- SD pretest score was 15.6 +/- 4.2, 95% CI = 14. 7 to 16.5 (65% of a maximum score of 24), and the mean +/- SD posttest score was 20.2 +/- 1.6, 95% CI = 19.8 to 20.6 (84%) (p < 0. 05). In phase II, a total of 1,138 examinations were performed by 18 PGY2 houseofficers. Sensitivity was 92.4% (95% CI = 89% to 95%), specificity was 96.1% (95% CI = 94% to 98%), and overall accuracy was 94.6% (95% CI = 93% to 96%). The follow-up ultrasound written test showed continued good performance (20.7 +/- 1.2, 95% CI = 20.0 to 21.4). CONCLUSIONS Emergency physicians can be taught focused ultrasonography with a high degree of accuracy, and a 16-hour course serves as a good introductory foundation.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1553-2712.2000.tb02092.x

Ultrasound training for emergency physicians--a prospective study.

This report describes a novel sonographic protocol for the evaluation of the undifferentiated hypotensive patient. This protocol combines components of 3 sonographic applications: free fluid, cardiac, and abdominal aorta into a single protocol. We believe this protocol and its underlying principles should be a routine part of the empiric evaluation of the patient with undifferentiated hypotension or pulseless electrical activity.

Diku Mandavia

Papers

The RUSH Exam: Rapid Ultrasound in SHock in the Evaluation of the Critically lll

Bedside echocardiography by emergency physicians.

Bedside Ultrasound in Resuscitation and the Rapid Ultrasound in Shock Protocol

Ultrasound training for emergency physicians--a prospective study.

The UHP ultrasound protocol: a novel ultrasound approach to the empiric evaluation of the undifferentiated hypotensive patient.