Joaquin Valle Alonso; John Turpie; Islam Farhad; Gabrielle Ruffino
Volume 7, Issue 1 , January 2019, , Pages 67-71
Abstract
Sepsis and septic shock remain a major cause of morbidity and mortality globally. In septic patient’s bedside physical examination can often be unhelpful in helping to identify the source of infection and, therefore, decide upon appropriate management. Protocols for point-of-care-ultrasound ...
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Sepsis and septic shock remain a major cause of morbidity and mortality globally. In septic patient’s bedside physical examination can often be unhelpful in helping to identify the source of infection and, therefore, decide upon appropriate management. Protocols for point-of-care-ultrasound (POCUS) in critically-ill patients who present with shock or trauma have been described elsewhere including rapid ultrasound in shock (RUSH), focused assessment with sonography for trauma (FAST), and focused cardiac ultrasound (FOCUS). Although the use of POCUS in sepsis has been reported in existing literature, there is not an algorithm for when POCUS is indicated in septic patients. We describe the case of a 70-year-old woman who presented to the emergency department (ED) with a 1-week history of diarrhoea and vomiting. The initial diagnosis in ED was viral gastroenteritis with prerenal acute kidney injury and she was initially referred to the medial team. However, the patient remained hypotensive and oliguric after 2 litters of IV fluids. A point-of-case-ultrasound (POCUS) showed a right kidney with moderate hydronephrosis. Urology team was immediately contacted with a CT that confirmed an obstructive stone causing moderate kidney hydronephrosis. Emergency nephrostomy was performed and the patient was discharged and has remained asymptomatic.
Parisa Javidi Parsijani; Nima Pourhabibi Zarandi; Shahram Paydar; Hamidreza Abbasi; Shahram Bolandparvaz
Volume 1, Issue 4 , October 2013, , Pages 158-163
Abstract
Objectives: To evaluate the accuracy of sonography in diagnosing acute appendicitis in patients with Alvarado score 4–7.Methods: This is a retrospective cross-sectional study being performed in Namazee hospital affiliated with Shiraz University of Medical sciences during a one year period from 9/2007 ...
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Objectives: To evaluate the accuracy of sonography in diagnosing acute appendicitis in patients with Alvarado score 4–7.Methods: This is a retrospective cross-sectional study being performed in Namazee hospital affiliated with Shiraz University of Medical sciences during a one year period from 9/2007 to 9/2008. We evaluated all patients with Alvarado score 4-7 and divided them in two groups: those with Ultrasound study prior to surgery and those without any imaging modalities for diagnosis of AA. The demographic information, histopathology, physical examination, laboratory data, sonography report and histopathological reports of patients were gathered. Results: A total of 238 patients had Alvarado scores 4-7 including 160 males and 78 females. 110 patients did not have any imaging and 128 had undergone sonography before operation. Ultrasound had overall sensitivity of 75 %, specificity 69.2 %, PPV 88 %, NPV 46.1% and accuracy of 73.6 %. Negative appendectomy rate was20.9 % and 23.4 % in those without sonography and inpatients with sonography respectively, with a higher rate in females.Conclusion: Ultrasound is more useful when the patient is female and the result of sonography is positive; however, it is not reliable when the result is negative and maybe other diagnostic modalities such as CT scan can help us in better diagnosis of Acute Appendicitis.
