ABSTRACT
Many ocular emergencies are difficult to diagnose in the emergency setting with conventional physical examination tools. Additionally, persistent efforts to re-examine the eye may be deleterious to a patient's overall condition. Ultrasound is an important tool because it affords physicians a rapid, portable, accurate, and dynamic tool for evaluation of a variety of ocular and orbital diseases. The importance of understanding orbital anatomy, with attention to the firm attachment points of the various layers of the eye, cannot be understated. This article describes the relevant eye anatomy, delves into the ultrasound technique, and illustrates a variety of orbital pathologies detectable by bedside ultrasound.
Subject(s)
Emergencies , Eye Diseases/diagnostic imaging , Eye Injuries/diagnostic imaging , Ultrasonography/methods , Humans , Point-of-Care Systems , Ultrasonography/instrumentationABSTRACT
Use of bedside ultrasound to guide simple procedures increases safety by allowing real-time visualization of patient anatomy. This article discusses ultrasound guidance for basic procedures including peripheral and central intravenous access, arterial access, suprapubic aspiration, abscess incision and drainage, foreign body identification, and joint arthrocentesis. It reviews the indications and complications of the procedure, advantages of ultrasound guidance, anatomy, and procedural technique.
Subject(s)
Point-of-Care Systems , Ultrasonography, Interventional/methods , Abscess/diagnostic imaging , Abscess/surgery , Catheterization, Central Venous , Foreign Bodies/diagnostic imaging , Foreign Bodies/surgery , Humans , Joint Diseases/diagnostic imaging , Joint Diseases/surgery , Ultrasonography, Interventional/instrumentation , Vascular Surgical ProceduresABSTRACT
Ultrasound guidance has become the standard of care for many bedside procedures, owing to its portability, ease of use, and significant reduction in complications. This article serves as an introduction to the use of ultrasonography in several advanced procedures, including pericardiocentesis, thoracentesis, paracentesis, lumbar puncture, regional anesthesia, and peritonsillar abscess drainage.
Subject(s)
Point-of-Care Systems , Ultrasonography, Interventional/methods , Anesthesia, Conduction , Drainage , Humans , Paracentesis , Pericardiocentesis , Peritonsillar Abscess/diagnostic imaging , Peritonsillar Abscess/surgery , Spinal Puncture , Thoracostomy , Ultrasonography, Interventional/instrumentationABSTRACT
OBJECTIVE: The primary purpose of this study was to investigate the overall accuracy of bedside extremity tendon ultrasound performed by emergency physicians in the emergency department. We also sought to investigate whether or not bedside tendon ultrasonography can be used to expedite the diagnosis and discharge planning in patients with suspected tendon injuries. METHODS: This was a prospective study conducted at 2 academic level 1 trauma centers. Thirty-four patients were enrolled and underwent a comprehensive physical examination of the injured extremity, followed by a bedside ultrasound evaluation to look for tendon disruption. Results of the tendon ultrasound were compared against the findings seen during wound exploration in the emergency department, wound exploration in the operating room, or results from an extremity magnetic resonance imaging (MRI). RESULTS: There were 6 finger injuries, 11 hand injuries, 6 arm injuries, 6 forearm injuries, and 5 lower extremity injuries. Of the 34 total patients, 4 patients had partial tendon injuries, 9 suffered from 100% tendon laceration or rupture, and 21 had no tendon injury noted on exploration or MRI. Bedside ultrasound had a sensitivity, specificity, and accuracy of 100%, 95%, and 97%, respectively. Physical examination had a sensitivity, specificity, and accuracy of 100%, 76%, and 85%, respectively. Average time to bedside ultrasound was 46.3 minutes compared with 138.6 minutes for wound irrigation and exploration, MRI, or surgery consultation. CONCLUSION: Bedside ultrasound is more sensitive and specific than physical examination for detecting tendon lacerations, and takes less time to perform than traditional wound exploration techniques or MRI.
Subject(s)
Point-of-Care Systems , Tendon Injuries/diagnostic imaging , Arm Injuries/diagnosis , Arm Injuries/diagnostic imaging , Hand Injuries/diagnosis , Hand Injuries/diagnostic imaging , Humans , Leg Injuries/diagnosis , Leg Injuries/diagnostic imaging , Magnetic Resonance Imaging , Physical Examination , Prospective Studies , Sensitivity and Specificity , Tendon Injuries/diagnosis , Time Factors , Trauma Centers/statistics & numerical data , UltrasonographyABSTRACT
PURPOSE: We sought to determine whether dilation of the optic nerve sheath diameter (ONSD), as detected at the bedside by emergency ultrasound (US), could reliably correlate with patient blood pressure and whether there was a blood pressure cutoff point where you would start to see abnormal dilation in the ONSD. METHODS: This was a single-blinded, prospective, observational trial from September 2010 to April 2011. One hundred fifty patients presenting to the emergency department were enrolled. There were 3 arms to the study with 50 patients in each arm: (1) ONSD in normotensive/asymptomatic patients; (2) ONSD in hypertensive/asymptomatic patients; and (3) ONSD in hypertensive/symptomatic patients. Ocular US was conducted on all subjects. RESULTS: Neither the number of symptoms nor the type of symptom present in the hypertensive/symptomatic group was able to significantly predict the average ONSD before treatment (P = .818 and .288, respectively). There was a significant correlation between both systolic blood pressure (SBP) and diastolic blood pressure (DBP) with the ONSD in all hypertensive patients. The best SBP and DBP cutoff point for abnormal ONSD was 166/82 mm Hg. Decrease in ONSD observed after blood pressure treatment was not statistically significant (P = .073). CONCLUSIONS: In conclusion, our study shows that practitioners can use bedside ocular US and a blood pressure cutoff point to help predict whether patients require more aggressive management of their symptomatic hypertension. Knowing the SBP and DBP readings that lead to increased ONSD and increased intracranial pressure can help guide management and treatment decisions at the bedside.
Subject(s)
Hypertension/diagnostic imaging , Intracranial Hypertension/diagnostic imaging , Optic Nerve/diagnostic imaging , Aged , Blood Pressure , Emergency Service, Hospital , Female , Humans , Male , Point-of-Care Systems , Prospective Studies , Single-Blind Method , UltrasonographyABSTRACT
Between 1972 and 1999, the Orthopedic Oncology Service treated 150 patients with resection and allograft transplantation of the proximal femur. Of the group, 121 patients had malignant tumors of the proximal femur and 29 had benign disorders. Four types of allografts were used: osteoarticular (46 patients), allograft-prosthesis (73), intercalary (20), and allograft-arthrodesis (5). Only 16% of the patients died of disease and 3% required amputation. The overall success rate for the series was 77% with the best results for the allograft prosthetic (82%) and intercalary procedures (87%). Graft infection (15 patients), allograft fracture (26 patients), and local recurrence (11 patients) most markedly affected outcome. With the exception of deaths of disease, no significant outcome difference occurred between the patients with malignant and benign disorders. In conclusion, allograft implantation especially for aggressive or malignant tumors of the proximal femur appears to be a competent system for therapy.
