January 09, 2020

How accurate is point-of-care-ultrasound (POCUS) at diagnosing acute appendicitis?

Written by: Mark Swanson RDMS, RVT

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Appendicitis is a surgical emergency and is commonly encountered in the emergency department. In a patient with indistinct right lower quadrant pain, appendicitis is often at the top of the differential diagnosis. Ultrasonography has emerged as a primary tool to aid in the diagnosis of appendicitis while also reducing radiation exposure, especially in children.

Using a “graded compression” technique will displace gas and bowel in the area and bring the appendix closer to the abdominal wall, making it easier to visualize.  Placing the probe over the point of maximal tenderness in the RLQ or just asking the patient to point to the most painful site are good first steps. Frequently, the clinician will have a difficult time locating the appendix. Additional techniques utilizing the ascending colon, cecum, psoas muscle, iliac vessels, and altering patient position are reviewed during the Introduction and Advanced Emergency Medicine Course.

Sensitivity for the point-of-care ultrasound was 65% and specificity was 90%, with a PPV of 84% and a NPV of 76%. Since point-of-care ultrasound has a low sensitivity, it should only be utilized as a “rule in” modality (Doniger, S. J. (2015). Pediatric emergency and critical care ultrasound. Cambridge: Cambridge University Press.)

Introduction and Advanced Emergency Medicine & Critical Care Ultrasound

Introduction and Advanced Emergency Medicine & Critical Care Ultrasound Live Training Course provides participants a strong foundation to perform and/or interpret the core ultrasound applications in an emergency setting as outlined in the ACEP ultrasound practice guidelines. These courses are taught by leading emergency medicine and critical care ultrasound experts that incorporates comprehensive lectures and interactive case presentations featuring a 3:1 faculty to participant hands-on scan ratio with live models and phantoms, and is specifically designed for physicians, sonographers and other medical professionals who need comprehensive emergency medicine ultrasound training. The course is held at multiple dates throughout the year, making it the perfect course for both local participants and participants traveling to our facility in St. Petersburg, Florida. In this five (5) day program, participants will learn ultrasound techniques for the entire emergency medicine & critical care specialty. Case Log Provided Documenting 85+ Exams.

• Imaging Fundamentals
• OB-GYN Anatomy/Exam
• Ectopic Pregnancy
• OB Cases & Abortion
• Fundamentals of Needle Guidance
• Ultrasound-Guided Vascular Access
• Abdominal Scanning Fundamentals
• FAST & E-FAST Exam
• Focused 2D Cardiac Exam (FATE)
• Biliary & Renal Colic
• Abdominal Aortic Aneurysm
• Evaluation of DVT
• Evaluation of Cardiac Arrest and Shock & Hypotension
• Ultrasound Guided Procedures: Pericardiocentesis, Paracentesis, Hemothorax, Lumbar Puncture, ET
• Training and Credentialing Sonography in Shock & Source of Sepsis (Gallbladder, Biliary Tree, Appendix, Bowel Obstruction, Peritonitis & Abscess, Pylonephritis)
• Fluid Responsiveness in the Critically Ill
• Advanced Non-Cardiac Chest (Sinuses, Larynx, Trachea, Lung & Pleura)
• Ultrasound Guided Peripheral Vascular Access
• Interactive Case Studies

• Critical Care Track:
• 1. Cardiac Doppler & Focused Calculations
• 2. Echo Assessment of Cardiomyopathies & Heart Failure
• 3. Mitral Insufficiency & Complications
• 4. Guidelines for Appropriate Use of Ultrasonography by the Intensivist

• Emergency Track:
• 1. Sonography of the Acute Scrotum
• 2. Advanced EM Applications (Evaluation of Soft Tissue for Abscess, Foreign Body Detection, MSK Applications, Evaluation of Bony Cortices, Ocular Emergencies)
• 3. Nerve Blocks in the ED (Forearm, Femoral, and Ankle Blocks)

• Increase participant’s knowledge to better perform and/or interpret Emergency ultrasound examinations.
• State the basic fundamentals of ultrasound physics and demonstrate appropriate optimization of system controls.
• Perform ultrasound evaluation of the trauma patient (E-FAST exam) and pneumothorax.
• Demonstrate scan protocols for focused evaluation of the abdomen, aorta, female pelvis and adult heart.
• State an algorithm for uses of bedside ultrasound during cardiac arrest, shock & hypotension.
• Demonstrate image orientation, transducer preparation, and scan protocols for performing use of ultrasound guidance for vascular access, pericardiocentesis, paracentesis, hemothorax, lumbar puncture, ET placement.
• Demonstrate protocol for focused evaluation of DVT.
• Differentiate normal/abnormal image characteristics of the abdomen, female pelvis, first trimester OB, and ectopic pregnancy.
Increase competence to incorporate protocols, scan techniques, and interpretation criteria into clinical practice.

   Point-of-Care Ultrasound Courses


About the Author

Mark Swanson RDMS, RVT

Mark is the Senior Clinical Instructor and Product Specialist at Gulfcoast Ultrasound Institute, Inc.

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