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'Bedside Ultrasonography Deep Vein Thrombosis' (123)


Jan
2018

Compression ultrasonography is the most effective diagnostic tool in the emergency department (ED) for the diagnosis of deep vein thrombosis (DVT). It has been demonstrated to be highly accurate and cost-effective.
The objective of this study was to determine the accuracy of emergency physicians who performed three-point compression ultrasound (US) for suspected above-knee DVT within the context of using Wells score and D-dimer.

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Nov
2017

Mesenteric Ischemia: A Deadly Miss.

Emerg Med Clin North Am 2017 Nov;35(4):879-888
Manpreet Singh, Brit Long, Alex Koyfman
Mesenteric ischemia has 4 etiologies: arterial embolus, arterial thrombosis, venous thrombosis, and nonocclusive. No history or physical examination finding can definitively diagnose the condition. A wide variety of presentations occur.

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Mar
2017

Lung and venous ultrasound are bedside diagnostic tools increasingly used in the early diagnostic approach of suspected pulmonary embolism (PE). However, the possibility of improving the conventional prediction rule for PE by integrating ultrasound has never been investigated.
We performed lung and venous ultrasound in consecutive patients suspected of PE in four emergency departments.

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Dec
2016

Point-of-care ultrasonography (POCUS) is a widely used tool in emergency and critical care settings, useful in the decision-making process as well as in interventional guidance. While having an impressive diagnostic accuracy in the hands of highly skilled operators, inexperienced practitioners must be aware of some common misinterpretations that may lead to wrong decisions at the bedside.
This article provides a revision list of common POCUS misdiagnoses usually found in practice and offers useful tips to recognize and avoid them.

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Feb
2017

IVCFs are usually placed under fluoroscopic guidance in dedicated angiography suites. Bedside placement of inferior vena cava filters (IVCF) is possible in patients not suitable for transportation, but data regarding their use are limited. The objective of this study is to compare utilization, procedural outcomes, complications, and long-term patient outcomes associated with bedside placement of IVCFs using intravascular ultrasound (IVUS) and fluoroscopic placement of IVCF.

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Dec
1969

Ultrasonography in the emergency department.

Crit Care 2016 08 15;20(1):227. Epub 2016 Aug 15.
Micah R Whitson, Paul H Mayo
Point-of-care ultrasonography (POCUS) is a useful imaging technique for the emergency medicine (EM) physician. Because of its growing use in EM, this article will summarize the historical development, the scope of practice, and some evidence supporting the current applications of POCUS in the adult emergency department. Bedside ultrasonography in the emergency department shares clinical applications with critical care ultrasonography, including goal-directed echocardiography, echocardiography during cardiac arrest, thoracic ultrasonography, evaluation for deep vein thrombosis and pulmonary embolism, screening abdominal ultrasonography, ultrasonography in trauma, and guidance of procedures with ultrasonography.

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Jul
2016

This is a single-center, descriptive report of the management and complications of venous catheter use in 19 severely burned passengers from a bus fire that occurred on July 5, 2014, in Hangzhou.
We recorded the parameters of the catheters insertion and indwelling. Sampling of each removed catheter was conducted to monitor for catheter-related infections.

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Jul
2016

Acute thoracic symptoms are common among adults visiting emergency departments in the United States. Adults with these symptoms constitute a large burden on the overall resources used in the emergency department. The wide range of possible causes can make a definitive diagnosis challenging, even after clinical evaluation and initial laboratory testing.

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Mar
2016

Using bedside ultrasound in the emergency room includes point of care sonography (echoscopy) and several protocols (RUSH, FATE, etc.). The aim of these protocols is to evaluate the life threatening emergency care situation without interrupting the clinical work flow.

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Jul
2016

To assess the interrater reliability and test characteristics of lower limb sonographic examination for the diagnosis of deep venous and proximal great saphenous vein thrombosis when performed by Emergency Physicians (EPs) as compared to that by the Department of Radiology (Radiology). The secondary objective was to assess the effects of patient body mass index and EP satisfaction with bedside ultrasound on sensitivity and specificity.
A prospective study was conducted for patients with clinical suspicion for lower extremity thrombus.

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Dec
1969

Because the clinical diagnosis of deep-vein thrombosis and pulmonary embolism is nonspecific, integrated diagnostic approaches for patients with suspected venous thromboembolism have been developed over the years, involving both non-invasive bedside tools (clinical decision rules and D-dimer blood tests) for patients with low pretest probability and diagnostic techniques (compression ultrasound for deep-vein thrombosis and computed tomography pulmonary angiography for pulmonary embolism) for those with a high pretest probability. This combination has led to standardized diagnostic algorithms with proven safety for excluding venous thrombotic disease. At the same time, it has become apparent that, as a result of the natural history of venous thrombosis, there are special patient populations in which the current standard diagnostic algorithms are not sufficient.

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Nov
2015

Because the clinical diagnosis of deep-vein thrombosis and pulmonary embolism is nonspecific, integrated diagnostic approaches for patients with suspected venous thromboembolism have been developed over the years, involving both non-invasive bedside tools (clinical decision rules and D-dimer blood tests) for patients with low pretest probability and diagnostic techniques (compression ultrasound for deep-vein thrombosis and computed tomography pulmonary angiography for pulmonary embolism) for those with a high pretest probability. This combination has led to standardized diagnostic algorithms with proven safety for excluding venous thrombotic disease. At the same time, it has become apparent that, as a result of the natural history of venous thrombosis, there are special patient populations in which the current standard diagnostic algorithms are not sufficient.

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Dec
1969

The use of ultrasound has gained its place in critical care as part of our day-to-day monitoring tools. A better understanding of ultrasound techniques and recent publications including protocols for the lungs, the abdomen and the blood vessels has introduced ultrasound to the bedside of our ICU patients. However, we will prove in this paper that early machines, dating back more than 25 years, were perfectly able to do the job as compared to modern laptop machines with more features but few additional advantages.

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Nov
2015

To establish evidence-based guidelines for the use of bedside ultrasound by intensivists and specialists in the ICU and equivalent care sites for diagnostic and therapeutic purposes for organs of the chest, abdomen, pelvis, neck, and extremities.
The Grading of Recommendations, Assessment, Development and Evaluation system was used to determine the strength of recommendations as either strong or conditional/weak and to rank the "levels" of quality of evidence into high (A), moderate (B), or low (C) and thus generating six "grades" of recommendation (1A-1B-1C-2A-2B-2C). Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for all questions with clinically relevant outcomes.

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Aug
2015

Portal vein thrombosis (PVT) may occur in liver cirrhosis patients. Malignant PVT is a common complication in cirrhotic patients with concomitant hepatocellular carcinoma (HCC) and, in some cases, it may be even the initial sign of an undetected HCC. Detection of malignant PVT in a patient with liver cirrhosis heavily affects the therapeutic strategy.

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Aug
2015

Bedside ultrasound is an important tool in modern palliative care practice. It can be utilized for rapid diagnostic evaluation or as an image guidance to perform invasive therapeutic procedures. With advent of portable ultrasound machines, it can also be used in community or home care settings, apart from palliative care wards.

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Sep
2015

McConnell's sign (right ventricular [RV] free wall hypokinesis with apical sparing on echocardiography) is often described as very specific for the diagnosis of pulmonary embolism (PE). We present the case of a patient who, despite manifesting a classic McConnell's sign, was not found to have a PE.
A 58-year-old woman presented to the emergency department with a cough, dyspnea, and leg swelling.

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Jun
2015

Venous thromboembolism (VTE) is a prevalent and life-threatening condition that requires an accurate and timely diagnosis. The current diagnostic approach to this condition, entailing an efficient integration of clinical judgment, diagnostic imaging, and laboratory testing, is the result of decades of scientific and medical research. This article aims to present and discuss the major breakthroughs that have occurred in the diagnostic imaging of both deep vein thrombosis and pulmonary embolism, along with the various biological markers that have emerged from the laboratory bench and which have only marginally migrated to the bedside.

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Jun
2015

Deep vein thrombosis (DVT) is commonly encountered in the emergency department. Clinical models, such as the Wells criteria, allow physicians to estimate the probability of DVT in a patient. Current literature suggests a low pretest probability combined with a negative D-dimer laboratory study rules out DVT approximately 99% of the time.

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Apr
2015

Inferior vena cava filters (IVCFs) have been used clinically for approximately 45 y, but only a few studies of these devices have involved intensive care unit (ICU) patients who were critically ill and had multiple-organ dysfunction or were otherwise too unstable for transport. The purpose of this research was to assess the tolerability and efficacy of bedside ultrasound-guided IVCF placement in ICU patients. A retrospective analysis of both bedside ultrasound-guided and X-ray-guided ICVF placement was performed from November of 2011 to August of 2013.

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Nov
2014

A short cut review was carried out to establish the diagnostic utility of Emergency Physician performed ultrasound in confirming or refuting the diagnosis of deep vein thrombosis compared with a radiology scan. A systematic review incorporating 16 studies and two studies published subsequently were found to be relevant to the question. The clinical bottom line was that some studies demonstrated high sensitivity and specificity compared with the reference standard but this finding was not universal.

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Sep
2014

Deep vein thrombosis (DVT) is both common and serious, yet the desire to never miss the diagnosis, coupled with the low specificity of D-dimer testing, results in high imaging rates, return visits, and empirical anticoagulation. The objective of this study was to evaluate a new approach incorporating bedside limited-compression ultrasound (LC US) by emergency physicians (EPs) into the workup strategy for DVT.
This was a cross-sectional observational study of emergency department (ED) patients with suspected DVT.

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Jul
2014

Since its initial introduction into the bedside assessment of the trauma patient via the Focused Assessment with Sonography for Trauma (FAST) exam, the use of point-of-care ultrasound has expanded rapidly. A growing body of literature demonstrates ultrasound can be used by nonradiologists as an extension of the physical exam to accurately diagnose or exclude a variety of conditions. These conditions include, but are not limited to, hemoperitoneum, pneumothorax, pulmonary edema, long-bone fracture, deep vein thrombosis, and elevated intracranial pressure.

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Jun
2014

Point of care ultrasonography, performed by acute care physicians, has developed into an invaluable bedside tool providing important clinical information with a major impact on patient care. In Part II of this narrative review, we describe ultrasound guided central venous cannulation, which has become standard of care with internal jugular vein cannulation. Besides improving success rates, real-time guidance also significantly reduces the incidence of complications.

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Apr
2014

Over the past decade, emergency and critical care physicians have been empowered with the ability to use bedside ultrasonography to assist in the evaluation and management of a variety of emergent conditions. Today a single health care provider at the bedside with Duplex ultrasound technology can evaluate peripheral vascular calamities that once required significant time and a variety of health care personnel for the diagnosis. This article highlights peripheral thromboembolic disease, aneurysm, pseudoaneurysm, and arterial occlusion in the acute care setting.

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May
2014

Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors.

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Mar
2014

Lemierre syndrome is a rare and life-threatening illness. Often referred to as "the forgotten disease," its incidence is reported to be as low as 1 in a million. The microorganism responsible for Lemierre syndrome is typically Fusobacterium necrophorum.

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Oct
2013

Vascular access used in the treatment of patients involves central and peripheral vein accesses and arterial accesses. Catheterization of central veins is widely used in clinical practice; it is a necessary part of the treatment of patients in various settings. The most commonly involved vessels are the internal jugular, subclavian, and femoral veins.

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Oct
2013

A 28-year-old policeman presented with left lower limb deep vein thrombus, pulmonary embolism and a highly mobile right atrial clot. Thrombolytic therapy with IV Tenecteplase was administered. Within a few minutes after the Tenecteplase bolus, the patient's condition worsened dramatically with severe hypotension and hypoxemia.

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Mar
2013

To analyze the diagnostic, monitoring, and procedural applications of ultrasound (US) imaging in neurocritical care (NCC) patients.
US imaging has been extensively validated in various subset of critically ill patients, but not specifically in the NCC population. We reviewed the clinical applications of US imaging for heart, vascular, brain, and lung evaluation and for possible procedural uses in NCC patients.

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Apr
2013

Dyspnea is a common symptom among emergency department (ED) patients. The differential diagnosis of dyspnea in ED patients is broad, and pulmonary embolism (PE) is a crucial consideration among these. Recognition of right ventricular (RV) dysfunction is critical in patients with PE.

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Jul
2013

Paget-Schroetter syndrome, or an upper-extremity deep venous thrombosis (UEDVT), occurs in young people after strenuous repetitive activity involving the upper extremity. The long-term morbidity and mortality of this condition is similar to the effects of lower-extremity DVT and therefore, its early diagnosis and treatment are essential.
This case report describes Paget-Schroetter syndrome (effort thrombosis) diagnosed at the bedside by Emergency Physician performed ultrasound.

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Jul
2013

In many intracranial disease states, monitoring of intracranial pressure (ICP) is essential to evaluate response to the therapeutic measures as well as estimation of prognosis. Although, direct estimation of ICP is reliable, it is invasive and not possible in all patients. Transcranial Doppler (TCD) ultrasonography is a bedside and noninvasive technique that provides reliable and real-time information about cerebral hemodynamics.

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Nov
2012

Ruling out a deep vein thrombosis (DVT) is difficult in general practice because the clinical manifestations of DVT are nonspecific and more often due to other diseases. The aim of diagnostic screening in primary care must be to rule out a DVT with high accuracy in most patients, so that only those who are likely to have a DVT will undergo further testing. In this study, we tested the accuracy of exclusion of DVT by the combination of a clinical score (the Wells score) with either a bedside D-dimer test or selective compression sonography.

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Dec
2012

Deep vein thrombosis and pulmonary embolism are major causes of morbidity and mortality in trauma patients. Anticoagulation therapy is often contraindicated in these patient populations. The retrievable inferior vena cava (IVC) filter provides a good option for preventing pulmonary embolism in the immediate injury and postoperative periods.

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Jan
2013

Duplex ultrasound is the first-line diagnostic test for detecting lower limb deep-vein thrombosis (DVT) but it is time consuming, requires patient transport, and cannot be interpreted by most physicians. The accuracy of emergency physician-performed ultrasound (EPPU) for the diagnosis of DVT, when performed at the bedside, is unclear. We did a systematic review and meta-analysis of the literature, aiming to provide reliable data on the accuracy of EPPU in the diagnosis of DVT.

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Apr
2012

Deep vein thrombosis (DVT) is highly elusive in the sense, that being so common among acutely ill hospitalised patients with multiple risk factors yet remain mostly unrecognised particularly at the early stage. Pulmonary thrombo-embolism (PTE), the most sinister acute complication of DVT carries a high mortality on one hand and involves expensive medicare and investigations on the other hand. Many studies that have been undertaken in recent past on this important clinical issue have produced a wealth of published data to show that in the absence of prophylaxis for DVT in such a setting the mortality rates were significantly high.

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Oct
2012

Bedside focused echocardiography diagnosis of massive pulmonary embolism during cardiac arrest is mainly based on the detection of a dilated right ventricle, while the lack of compressibility of a deep vein of the lower limbs confirms diagnosis in doubtful cases. We describe a case of unusual sonographic signs in a young woman with cardiac arrest due to massive pulmonary embolism showing spontaneous blood echogenicity in the inferior vena cava ("sludge sign") and nonmodulated ("flat") Doppler waveform in the left lower limb veins, suggesting isolated iliac vein thrombosis.

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Apr
2012

A 27-year-old man presents to the emergency department with a 1-day history of severe right upper extremity pain and swelling. The patient's status is post open reduction internal fixation for a left tibial plateau fracture, which was complicated by methicillin-sensitive Staphylococcus aureus osteomyelitis. A peripherally inserted central catheter (PICC) line was subsequently placed for intravenous antibiotic therapy.

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Nov
2012

Emergency physician-performed ultrasonography holds promise as a rapid and accurate method to diagnose multiple diseases in the emergency department (ED). Our objective was to assess the initial diagnostic accuracy (first 55 explorations) of emergency physician-performed ultrasonography for multiple categories of ultrasound use after a short training period.
This was a prospective observational study conducted at an urban ED from June 2010 to March 2011 in patients with suspected cholecystitis, hydronephrosis, deep vein thrombosis, and different cardiovascular problems.

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May
2012

To determine sensitivity, specificity and other operating characteristics of bedside three-point compression ultrasonography performed in emergency department by emergency physicians in comparison with duplex ultrasonography.
The cross-sectional study at Rasoul-e-Akram Hospital in Tehran, Iran, prospectively evaluated 81 suspected patients of lower extremity deep vein thrombosis between March 2006 and March 2007. A trained second-year resident and one attending physician of emergency medicine evaluated the veins of all the patients with through compression ultrasonography.

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May
2012

To evaluate the results of peripherally inserted central catheters (PICC) inserted by nurses using an ultrasound-guided technique at bed-side.
An observational and prospective study was conducted on all the PICC inserted at bed-side by an ultrasound-guided technique at the Araba University Hospital. The technique was introduced in June 2010, and the data collection period ended in November 2011.

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May
2012

To compare the accuracy of inferior vena cava (IVC) filter placement using a bedside technique guided by intravascular ultrasound (IVUS) with a concurrent experience of filter deployment with fluoroscopic venogram imaging.
From November 2006 to December 2009, 195 consecutive IVC filters were placed to prevent pulmonary embolism in 120 high-risk patients without lower limb deep vein thrombosis (DVT) and 75 patients with DVT and anticoagulation contraindications. Filter insertion techniques included bedside IVUS-guided (n = 97) and fluoroscopic-guided (n = 98) procedures.

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Dec
1969

Deep vein thrombosis is a common condition that is often difficult to diagnose and may be lethal when allowed to progress. However, early implementation of treatment substantially improves the disease prognosis. Therefore, care must be taken to both acquire an accurate differential diagnosis for patients with symptoms as well as to screen at-risk asymptomatic individuals.

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Dec
2010

The diagnosis of venous thromboembolism (VTE) cannot be confirmed or excluded by the medical history and physical examination alone. Objective testing is required in all cases of clinically suspected VTE; for most patients, this includes imaging modalities such as compression ultrasonography, ventilation-perfusion lung scintigraphy, or computed tomography pulmonary angiography (CTPA). Conventional pulmonary arteriography remains useful when CTPA is nondiagnostic or when an intervention such as catheter embolectomy is planned.

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Mar
2011

DVT is common among critically ill patients. A rapid and accurate diagnosis is essential for patient care. We assessed the accuracy and timeliness of intensivist-performed compression ultrasonography studies (IP-CUS) for proximal lower extremity DVT (PLEDVT) by comparing results with the formal vascular study (FVS) performed by ultrasonography technicians and interpreted by radiologists.

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Dec
2010

Compression ultrasonography of the lower extremity is an established method of detecting proximal lower extremity deep venous thrombosis when performed by a certified operator in a vascular laboratory. Our objective is to determine the sensitivity and specificity of bedside 2-point compression ultrasonography performed in the emergency department (ED) with portable vascular ultrasonography for the detection of proximal lower extremity deep venous thrombosis. We did this by directly comparing emergency physician-performed ultrasonography to lower extremity duplex ultrasonography performed by the Department of Radiology.

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Jul
2010

To prospectively evaluate outcomes associated with use of a triple-lumen (TL) peripherally inserted central catheter (PICC) in the intensive care unit (ICU) setting.
Patients were prospectively enrolled in this HIPAA-compliant, institutional review board-approved study. Informed consent was obtained.

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Feb
2010

Guidelines on cardiac arrest (CA) recommend the prompt beginning of cardio-pulmonary resuscitation (CPR) and the identification and correction of reversible causes. This article deals with the application of clinical ultrasonography (US) in resuscitation, presenting a simple codified US protocol usable during CPR to recognize reversible causes of CA. EVIDENCE ON US IN CA AND STATE OF THE ART: Emergency US is a bedside, point-of-care, focused diagnostic procedure with aim to complete the physical examination.

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