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Dyspnea: What Can Ultrasound Tell Us?
S104
Ultrasound in Medicine and Biology
T8. Emergency and Critical Care Ultrasound Pre-Congress Workshop/Symposium T8-13-IN01 Clinically Integrated Ultrasound in the Differential Diagnosis of Acute Abdomen Young-Rock Ha Department of Emergency Medicine, Bundang Jesaeng Hospital, Korea Rapid and accurate diagnosis is vital for a proper management of acute abdomen. However acute abdomen in the emergency department (ED) is the wide spectrum of characteristics. Patients can visit ED at any point of each disease process. Some patients, especially elder ones, hardly describe their symptoms. Although most recommendations depict diagnostic policy based on the location of pain, the location itself is reported not to specify the disease. As a clinician, acute care physician (ACP) can use physical examination based on the knowledge of difference between not only the visceral and parietal pain, but also symptoms and signs. Fortunately possible surgical abdomen is a clinical diagnosis. They frequently shows rapid symptom evolution, severe pain, and associated with unstable vital signs, fever, and dehydration. Using the clinical feature and physical examinations, ACP should stabilize the unstable and/or potentially life threatening abdominal pain by either confirming or improving confidence with ultrasound. In addition, ACP can make differential diagnosis of stable acute abdomen with ultrasound. Even ultrasound might not reveal any reasonable pathology in some cases, which can be defined as sonographically non-specific abdominal pain. The second level imaging (including CT) can be reserved in selected patient negative or inconclusive ultrasound or in patients not responsive to standard pharmacological treatment. To accomplish all of these, ACP need to perform a ‘clinically integrated multi-focused ultrasound’. A multi-focused ultrasound is defined as systemic whole abdominal scanning regardless the location of abdominal pain. Here I’d like to introduce ‘SAFER (focused) Lasso (multi-organ sequentially systemic scanning) approach’; SAFER signifies Size, Air, Fluid, Echogenicity, and Regional lesion. Lasso, a loop of rope that is designed to capture the cows, directs the sequence of scan. T8-13-IN02 Dyspnea: What Can Ultrasound Tell Us? Francis Lee Acute & Emergency Care Centre, Khoo Teck Puat Hospital, Singapore Dyspnea is a common problem in emergency and critical care practice. The correct diagnosis of the underlying pathophysiologic process is imperative in guiding the correct therapeutic decisions. The traditional approach of physical examination, chest radiographs and laboratory studies form the basis of bedside assessment but has its limitations in diagnosis sensitivity and specificity. The advent of lung ultrasound changes the landscape for dyspnea assessment by providing ‘‘visual’’ clues to the problems at hand. The two key principles of lung ultrasound are: most acute lung problems start at the periphery of the lung and are therefore accessible for ultrasound examination; diagnosis of lung pathophysiology is based on the recognition of the loss or alteration of lung artefacts (such as lung sliding, curtain sign). After a comprehensive examination of the lung fields, one could piece the ultrasound information with the understanding of the pathophysiology of various lung conditions into a diagnostic lung matrix.
Volume 43, Number S1, 2017
T8-13-IN03 The Role of Ultrasound in Evaluating Patients with Acute Chest Pain Chien-Hua Huang National Taiwan University Hospital In acute cardiac care setting, echocardiography is a non-invasive exam with real time images. Echocardiography is an excellent tool to provide details of the cardiac structures information and functional abnormalities – vessels, valves, and muscle. Doppler color mapping is used to measure blood flow across valves, across septal defects (shunts), extent of regurgitations and extremely useful in the detection of abnormal operation of the valves and shunts. Patients with chest pain can carry life-threatening emergency situations. Using echocardiography brings a chance to do rapid and accurate diagnoses to differentiate the causes, including acute coronary syndrome with or without mechanical complications, pericardial disease, aortic diseases or trauma-related cardiac injuries. In addition to the chest pain, careful evaluation of associated symptoms, such as dyspnea, fever and shock status helps for searching the underlying diseases by echocardiography. T8-13-IN04 First International Guidelines on intestinal ultrasound (GIUS) Odd Helge Gilja, Prof., MD, PhD National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, and Institute of Medicine, University of Bergen, Norway EFSUMB has through the years released many guidelines and clinical recommendations. The world’s first ever guidelines on gastrointestinal ultrasound (GIUS) was released by EFSUMB in 2016 (1). The first subset of the GIUS guidelines on methodology and scanning techniques were published online in EJU September 2016 and will appear in print with an editorial by Seitz KH, Ødegaard S and Lutz H. An EFSUMB Task Force Group (TFG) with experts from all over Europe is continuously working to make more GIUS guidelines and the next topic will be ultrasound in IBD. Other GIUS guidelines are also in pipeline: Inflammatory conditions, transrectal/ perineal US, miscellaneous, Upper GI / functional ultrasound. Gastrointestinal ultrasound (GIUS) offers a unique possibility to examine non-invasively and in physiological condition the bowel including extra-intestinal features such as the splanchnic vessels, mesentery, oment and lymph nodes. For properly trained users, GIUS has been shown to have good accuracy and repeatability not only in a primary work-up, but also in the follow up of chronic diseases. When reporting findings in GIUS the most discriminatory parameters include bowel wall thickness, length and distribution of bowel wall thickening, an assessment of the preservation of layering and symmetry of any changes present. The presence of fat wrapping and fat creep is a highly specific finding in Crohn’s disease and should be included in the report when present. The presence of complications such as fistulae, strictures and collections, together with functional findings such as enteric content and the presence of bowel dilatation and peristalsis should also be noted in the examination report. All the EFSUMB guidelines and position statements can be downloaded from our website www.efsumb.org T8-13-IN05 Assessment of Acute Scrotum Sudheer Gokhale, MD, FICR, FICMU, FAIUM Sri Aurobindo Medical College & P G Institute, Indore, India Acute scrotal pain is a common clinical problem. Unfortunately symptoms are vague and clinical findings are non-specific. Immediate
Ultrasound in Medicine and Biology
T8. Emergency and Critical Care Ultrasound Pre-Congress Workshop/Symposium T8-13-IN01 Clinically Integrated Ultrasound in the Differential Diagnosis of Acute Abdomen Young-Rock Ha Department of Emergency Medicine, Bundang Jesaeng Hospital, Korea Rapid and accurate diagnosis is vital for a proper management of acute abdomen. However acute abdomen in the emergency department (ED) is the wide spectrum of characteristics. Patients can visit ED at any point of each disease process. Some patients, especially elder ones, hardly describe their symptoms. Although most recommendations depict diagnostic policy based on the location of pain, the location itself is reported not to specify the disease. As a clinician, acute care physician (ACP) can use physical examination based on the knowledge of difference between not only the visceral and parietal pain, but also symptoms and signs. Fortunately possible surgical abdomen is a clinical diagnosis. They frequently shows rapid symptom evolution, severe pain, and associated with unstable vital signs, fever, and dehydration. Using the clinical feature and physical examinations, ACP should stabilize the unstable and/or potentially life threatening abdominal pain by either confirming or improving confidence with ultrasound. In addition, ACP can make differential diagnosis of stable acute abdomen with ultrasound. Even ultrasound might not reveal any reasonable pathology in some cases, which can be defined as sonographically non-specific abdominal pain. The second level imaging (including CT) can be reserved in selected patient negative or inconclusive ultrasound or in patients not responsive to standard pharmacological treatment. To accomplish all of these, ACP need to perform a ‘clinically integrated multi-focused ultrasound’. A multi-focused ultrasound is defined as systemic whole abdominal scanning regardless the location of abdominal pain. Here I’d like to introduce ‘SAFER (focused) Lasso (multi-organ sequentially systemic scanning) approach’; SAFER signifies Size, Air, Fluid, Echogenicity, and Regional lesion. Lasso, a loop of rope that is designed to capture the cows, directs the sequence of scan. T8-13-IN02 Dyspnea: What Can Ultrasound Tell Us? Francis Lee Acute & Emergency Care Centre, Khoo Teck Puat Hospital, Singapore Dyspnea is a common problem in emergency and critical care practice. The correct diagnosis of the underlying pathophysiologic process is imperative in guiding the correct therapeutic decisions. The traditional approach of physical examination, chest radiographs and laboratory studies form the basis of bedside assessment but has its limitations in diagnosis sensitivity and specificity. The advent of lung ultrasound changes the landscape for dyspnea assessment by providing ‘‘visual’’ clues to the problems at hand. The two key principles of lung ultrasound are: most acute lung problems start at the periphery of the lung and are therefore accessible for ultrasound examination; diagnosis of lung pathophysiology is based on the recognition of the loss or alteration of lung artefacts (such as lung sliding, curtain sign). After a comprehensive examination of the lung fields, one could piece the ultrasound information with the understanding of the pathophysiology of various lung conditions into a diagnostic lung matrix.
Volume 43, Number S1, 2017
T8-13-IN03 The Role of Ultrasound in Evaluating Patients with Acute Chest Pain Chien-Hua Huang National Taiwan University Hospital In acute cardiac care setting, echocardiography is a non-invasive exam with real time images. Echocardiography is an excellent tool to provide details of the cardiac structures information and functional abnormalities – vessels, valves, and muscle. Doppler color mapping is used to measure blood flow across valves, across septal defects (shunts), extent of regurgitations and extremely useful in the detection of abnormal operation of the valves and shunts. Patients with chest pain can carry life-threatening emergency situations. Using echocardiography brings a chance to do rapid and accurate diagnoses to differentiate the causes, including acute coronary syndrome with or without mechanical complications, pericardial disease, aortic diseases or trauma-related cardiac injuries. In addition to the chest pain, careful evaluation of associated symptoms, such as dyspnea, fever and shock status helps for searching the underlying diseases by echocardiography. T8-13-IN04 First International Guidelines on intestinal ultrasound (GIUS) Odd Helge Gilja, Prof., MD, PhD National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, and Institute of Medicine, University of Bergen, Norway EFSUMB has through the years released many guidelines and clinical recommendations. The world’s first ever guidelines on gastrointestinal ultrasound (GIUS) was released by EFSUMB in 2016 (1). The first subset of the GIUS guidelines on methodology and scanning techniques were published online in EJU September 2016 and will appear in print with an editorial by Seitz KH, Ødegaard S and Lutz H. An EFSUMB Task Force Group (TFG) with experts from all over Europe is continuously working to make more GIUS guidelines and the next topic will be ultrasound in IBD. Other GIUS guidelines are also in pipeline: Inflammatory conditions, transrectal/ perineal US, miscellaneous, Upper GI / functional ultrasound. Gastrointestinal ultrasound (GIUS) offers a unique possibility to examine non-invasively and in physiological condition the bowel including extra-intestinal features such as the splanchnic vessels, mesentery, oment and lymph nodes. For properly trained users, GIUS has been shown to have good accuracy and repeatability not only in a primary work-up, but also in the follow up of chronic diseases. When reporting findings in GIUS the most discriminatory parameters include bowel wall thickness, length and distribution of bowel wall thickening, an assessment of the preservation of layering and symmetry of any changes present. The presence of fat wrapping and fat creep is a highly specific finding in Crohn’s disease and should be included in the report when present. The presence of complications such as fistulae, strictures and collections, together with functional findings such as enteric content and the presence of bowel dilatation and peristalsis should also be noted in the examination report. All the EFSUMB guidelines and position statements can be downloaded from our website www.efsumb.org T8-13-IN05 Assessment of Acute Scrotum Sudheer Gokhale, MD, FICR, FICMU, FAIUM Sri Aurobindo Medical College & P G Institute, Indore, India Acute scrotal pain is a common clinical problem. Unfortunately symptoms are vague and clinical findings are non-specific. Immediate