BACKGROUND:Point-of-care ultrasound(POCUS)has become increasingly integrated into the practice of emergency medicine.A common application is the extended focused assessment with sonography in trauma(eFAST)exam.The Ame...BACKGROUND:Point-of-care ultrasound(POCUS)has become increasingly integrated into the practice of emergency medicine.A common application is the extended focused assessment with sonography in trauma(eFAST)exam.The American College of Emergency Physicians has guidelines regarding the scope of ultrasound in the emergency department and the appropriate documentation.The objective of this study was to conduct a review of performed,documented and billed eFAST ultrasounds on trauma activation patients.METHODS:This was a retrospective review of all trauma activation patients during a 10-month period at an academic level-one trauma center.A list comparing all trauma activations was crossreferenced with a list of all billed eFAST scans.Medical records were reviewed to determine whether an eFAST was indicated,performed,and appropriately documented.RESULTS:We found that 1,507 of 1,597 trauma patients had indications for eFAST,but 396(27%)of these patients did not have a billed eFAST.Of these 396 patients,87(22%)had documentation in the provider note that an eFAST was performed but there was no separate procedure note.The remaining 309(78%)did not have any documentation of the eFAST in the patient’s chart although an eFAST was recorded and reviewed during ultrasound quality assurance.CONCLUSION:A significant proportion of trauma patients had eFAST exams performed but were not documented or billed.Lack of documentation was multifactorial.Emergency ultrasound programs require appropriate reimbursement to support training,credentialing,equipment,quality assurance,and device maintenance.Our study demonstrates a significant absence of adequate documentation leading to potential revenue loss for an emergency ultrasound program.展开更多
A biloma is a rare disease characterized by an abnormal intra-or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system.Laboratory findings are nonspecific.The diagnosis is usuall...A biloma is a rare disease characterized by an abnormal intra-or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system.Laboratory findings are nonspecific.The diagnosis is usually suspected on the basis of a typical history(right upper quadrant abdominal pain,chills,fever and recent abdominal trauma or surgery) and is confirmed by detection of typical radiologic features.We report the case of a patient with a history of previous cholecystectomy for lithiasis who presented with clinical symptoms and laboratory data suggestive of acute pancreatitis.Imaging studies also revealed the presence of a chronic and asymptomatic biloma,which could be mistaken for a pseudocyst.The atypical location and ultrasound findings suggested an alternative diagnosis.We therefore reviewed the known literature for bilomas,focusing on the role of ultrasonography,which can reveal some typical aspects,such as location and imaging features.Weconclude that ultrasound plays a key role in the assessment of a suspected biloma in patients with appropriate history and clinical features and provides valuable diagnostic clues even in the absence of these.展开更多
Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal inju...Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal injury,each with their usefulness and limitations.Currently,plain radiographs and intravenous urography have no role in the evaluation of patients with suspected renal injury.Ultrasonography(USG) has a limited role in evaluating patients with suspected retroperitoneal injury;however,it plays an important role during follow up in patients with urinoma formation.USG helps to monitor the size of a urinoma and also for the drainage procedure.The role of selective renal arteriography is mainly limited to an interventional purpose rather than for diagnostic utility.Retrograde pyelography is useful in assessing ureteral and renal pelvis integrity in suspected ureteropelvic junction injury and for an interventional purpose,like placing a stent across the site of ureteric injury.Magnetic resonance imaging has no role in acute renal injuries.Multidetector computed tomography is the modality of choice in the evaluation of renal injuries.It is also useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help to define the extent of penetrating injuries in patients with stab wounds in the flank region.The combination of imaging findings along with clinical information is important in the management of the individual patient.This article will describe a spectrum of renal injuries encountered in a trauma setting.展开更多
Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments,including pre-hospital triage,emergency department,an...Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments,including pre-hospital triage,emergency department,and critical care settings.The increasing availability of lightweight,robust,user-friendly,and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident(MCI).Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid,focused protocols using hand-carried emergency ultrasonography could be developed.Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings,we propose a protocol for sonographic evaluation of the chest,abdomen,vena cava,and extremities for acute triage.The protocol is two-tiered,based on the urgency and technical difficulty of the sonographic examination.In addition to utilization of well-established bedside abdominal and thoracic sonography applications,this protocol incorporates extremity assessment for long-bone fractures.Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings.展开更多
目的探讨超声检测气胸作为扩大的创伤重点超声评估法(extended focused assessment with sonography for trauma,EFAST)的一部分在多发伤患者气胸中的临床诊断价值。方法 2012年9月至2014年3月收住本院重症三科的多发性创伤患者98例,均...目的探讨超声检测气胸作为扩大的创伤重点超声评估法(extended focused assessment with sonography for trauma,EFAST)的一部分在多发伤患者气胸中的临床诊断价值。方法 2012年9月至2014年3月收住本院重症三科的多发性创伤患者98例,均予EFAST检查(EFAST组),以"肺点"出现或"肺滑行"和"彗尾征"消失诊断气胸。在超声检查前后3小时内行胸部CT(CT组)和床旁X线检查或临床穿刺抽气检查(混合组)。结果 CT检查结果证实气胸32例36侧,其中EFAST诊断29例32侧,仰卧位胸片和临床穿刺抽出气体诊断气胸14例16侧。超声检查对气胸的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为:88.6%、98.5%、96.9%、94.4%和95.1%;而混合组的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为:45.7%、100%、100%、78.2%、81.6%。结论本研究结果表明,EFAST对外伤性气胸的诊断敏感性、阴性预测值和准确度比仰卧位X线胸片和临床诊断好,和CT检查结果基本一致。展开更多
目的探讨使用便携式超声仪应用创伤重点超声评估（focused assessment with sonography for trauma，FAST）检查法快速诊断海战腹部闭合伤方面的应用价值。方法模拟伤病员40名（随机抽取中方人员36名，马方人员4名），分别使用便携式彩...目的探讨使用便携式超声仪应用创伤重点超声评估（focused assessment with sonography for trauma，FAST）检查法快速诊断海战腹部闭合伤方面的应用价值。方法模拟伤病员40名（随机抽取中方人员36名，马方人员4名），分别使用便携式彩色超声仪应用FAST检查法判断伤病员腹腔各问隙是否存在游离液体和固定大型彩色超声诊断仪对腹腔各脏器进行常规超声检查判断是否存在腹腔脏器损伤，记录两种检查方法所用检查时间，并进行统计学分析。结果使用便携式超声仪FAST检查法检查伤病员均未发现腹腔游离液体，检查耗时15．6～58．6s，平均（32．21±11．74）s；固定式超声仪常规检查方法检查伤病员共发现肝囊肿5例，胆囊息肉4例，肾囊肿5例，前列腺钙化灶7例，均未发现腹腔脏器损伤，检查耗时97．7～149．5s，平均（118．21±18．29）s，两者检查耗时差异有统计学意义（P〈0．01）。结论便携式超声仪应用超声FAST检查法可快速评估腹部闭合损伤伤情，为下一步诊疗赢得宝贵时间，提高伤员的救治率，适合在作战舰艇部队医疗卫生部门积极推广普及。展开更多
文摘BACKGROUND:Point-of-care ultrasound(POCUS)has become increasingly integrated into the practice of emergency medicine.A common application is the extended focused assessment with sonography in trauma(eFAST)exam.The American College of Emergency Physicians has guidelines regarding the scope of ultrasound in the emergency department and the appropriate documentation.The objective of this study was to conduct a review of performed,documented and billed eFAST ultrasounds on trauma activation patients.METHODS:This was a retrospective review of all trauma activation patients during a 10-month period at an academic level-one trauma center.A list comparing all trauma activations was crossreferenced with a list of all billed eFAST scans.Medical records were reviewed to determine whether an eFAST was indicated,performed,and appropriately documented.RESULTS:We found that 1,507 of 1,597 trauma patients had indications for eFAST,but 396(27%)of these patients did not have a billed eFAST.Of these 396 patients,87(22%)had documentation in the provider note that an eFAST was performed but there was no separate procedure note.The remaining 309(78%)did not have any documentation of the eFAST in the patient’s chart although an eFAST was recorded and reviewed during ultrasound quality assurance.CONCLUSION:A significant proportion of trauma patients had eFAST exams performed but were not documented or billed.Lack of documentation was multifactorial.Emergency ultrasound programs require appropriate reimbursement to support training,credentialing,equipment,quality assurance,and device maintenance.Our study demonstrates a significant absence of adequate documentation leading to potential revenue loss for an emergency ultrasound program.
文摘A biloma is a rare disease characterized by an abnormal intra-or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system.Laboratory findings are nonspecific.The diagnosis is usually suspected on the basis of a typical history(right upper quadrant abdominal pain,chills,fever and recent abdominal trauma or surgery) and is confirmed by detection of typical radiologic features.We report the case of a patient with a history of previous cholecystectomy for lithiasis who presented with clinical symptoms and laboratory data suggestive of acute pancreatitis.Imaging studies also revealed the presence of a chronic and asymptomatic biloma,which could be mistaken for a pseudocyst.The atypical location and ultrasound findings suggested an alternative diagnosis.We therefore reviewed the known literature for bilomas,focusing on the role of ultrasonography,which can reveal some typical aspects,such as location and imaging features.Weconclude that ultrasound plays a key role in the assessment of a suspected biloma in patients with appropriate history and clinical features and provides valuable diagnostic clues even in the absence of these.
文摘Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal injury,each with their usefulness and limitations.Currently,plain radiographs and intravenous urography have no role in the evaluation of patients with suspected renal injury.Ultrasonography(USG) has a limited role in evaluating patients with suspected retroperitoneal injury;however,it plays an important role during follow up in patients with urinoma formation.USG helps to monitor the size of a urinoma and also for the drainage procedure.The role of selective renal arteriography is mainly limited to an interventional purpose rather than for diagnostic utility.Retrograde pyelography is useful in assessing ureteral and renal pelvis integrity in suspected ureteropelvic junction injury and for an interventional purpose,like placing a stent across the site of ureteric injury.Magnetic resonance imaging has no role in acute renal injuries.Multidetector computed tomography is the modality of choice in the evaluation of renal injuries.It is also useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help to define the extent of penetrating injuries in patients with stab wounds in the flank region.The combination of imaging findings along with clinical information is important in the management of the individual patient.This article will describe a spectrum of renal injuries encountered in a trauma setting.
文摘Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments,including pre-hospital triage,emergency department,and critical care settings.The increasing availability of lightweight,robust,user-friendly,and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident(MCI).Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid,focused protocols using hand-carried emergency ultrasonography could be developed.Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings,we propose a protocol for sonographic evaluation of the chest,abdomen,vena cava,and extremities for acute triage.The protocol is two-tiered,based on the urgency and technical difficulty of the sonographic examination.In addition to utilization of well-established bedside abdominal and thoracic sonography applications,this protocol incorporates extremity assessment for long-bone fractures.Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings.
文摘目的探讨超声检测气胸作为扩大的创伤重点超声评估法(extended focused assessment with sonography for trauma,EFAST)的一部分在多发伤患者气胸中的临床诊断价值。方法 2012年9月至2014年3月收住本院重症三科的多发性创伤患者98例,均予EFAST检查(EFAST组),以"肺点"出现或"肺滑行"和"彗尾征"消失诊断气胸。在超声检查前后3小时内行胸部CT(CT组)和床旁X线检查或临床穿刺抽气检查(混合组)。结果 CT检查结果证实气胸32例36侧,其中EFAST诊断29例32侧,仰卧位胸片和临床穿刺抽出气体诊断气胸14例16侧。超声检查对气胸的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为:88.6%、98.5%、96.9%、94.4%和95.1%;而混合组的敏感性、特异性、阳性预测值、阴性预测值和准确度分别为:45.7%、100%、100%、78.2%、81.6%。结论本研究结果表明,EFAST对外伤性气胸的诊断敏感性、阴性预测值和准确度比仰卧位X线胸片和临床诊断好,和CT检查结果基本一致。
文摘目的探讨使用便携式超声仪应用创伤重点超声评估（focused assessment with sonography for trauma，FAST）检查法快速诊断海战腹部闭合伤方面的应用价值。方法模拟伤病员40名（随机抽取中方人员36名，马方人员4名），分别使用便携式彩色超声仪应用FAST检查法判断伤病员腹腔各问隙是否存在游离液体和固定大型彩色超声诊断仪对腹腔各脏器进行常规超声检查判断是否存在腹腔脏器损伤，记录两种检查方法所用检查时间，并进行统计学分析。结果使用便携式超声仪FAST检查法检查伤病员均未发现腹腔游离液体，检查耗时15．6～58．6s，平均（32．21±11．74）s；固定式超声仪常规检查方法检查伤病员共发现肝囊肿5例，胆囊息肉4例，肾囊肿5例，前列腺钙化灶7例，均未发现腹腔脏器损伤，检查耗时97．7～149．5s，平均（118．21±18．29）s，两者检查耗时差异有统计学意义（P〈0．01）。结论便携式超声仪应用超声FAST检查法可快速评估腹部闭合损伤伤情，为下一步诊疗赢得宝贵时间，提高伤员的救治率，适合在作战舰艇部队医疗卫生部门积极推广普及。
