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The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients

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World Journal of emergency Medicine 2019年第4期10卷 232-238页

作者： Ali Pourmand Matthew Pyle David Yamane Kazi Sumon sarah e.frasure Department of emergency Medicine George Washington University School of Medicine and Health Sciences

BACKGROUND:Volume resuscitation has only been demonstrated to be effective in approximately fifty percent of patients.The remaining patients do not respond to volume resuscitation and may even develop adverse outcomes(such as acute pulmonary edema necessitating endotracheal intubation).We believe that point-of-care ultrasound is an excellent modality by which to adequately predict which patients may benefi t from volume resuscitation.DATA ReSOURCeS:We performed a search using PubMed,Scopus,and MeDLINe.The following search terms were used:fluid responsiveness,ultrasound,non-invasive,hemodynamic,fluid challenge,and passive leg raise.Preference was given to clinical trials and review articles that were most relevant to the topic of assessing a patient’s cardiovascular ability to respond to intravenous fl uid administration using ultrasound.ReSULTS:Point-of-care ultrasound can be easily employed to measure the diameter and collapsibility of various large vessels including the inferior vena cava,common carotid artery,subclavian vein,internal jugular vein,and femoral vein.Such parameters are closely related to dynamic measures of fluid responsiveness and can be used by providers to help guide fluid resuscitation in critically ill patients.CONCLUSION:Ultrasound in combination with passive leg raise is a non-invasive,costand time-effective modality that can be employed to assess volume status and response to fluid resuscitation.Traditionally sonographic studies have focused on the evaluation of large veins such as the inferior vena cava,and internal jugular vein.A number of recently published studies also demonstrate the usefulness of evaluating large arteries to predict volume status.

关键词： Stroke volume Fluid responsiveness Ultrasound Non-invasive Hemodynamic

Hypertensive emergency versus preeclampsia in a patient with sickle cell disease:a case report

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World Journal of emergency Medicine 2023年第4期14卷 329-331页

作者： Jigar Patel Juan A Reyes Ivan Berezowski Quincy K Tran sarah e.frasure Ali Pourmand Division of Hospital Medicine Department of Medicinethe George Washington UniversityWashington DC 20037USA Department of emergency Medicine University of Maryland School of MedicineBaltimore 21201-1544USA Program in Trauma the R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA Department of emergency Medicine the George Washington University School of Medicine and Health SciencesWashington DC 20037USA

Sickle cell disease(SCD)is strongly associated with severe preeclampsia and has also been linked to poor pregnancy-related outcomes.Moreover,sickle cell nephropathy(SCN)is a common complication of SCD and results in chronic proteinuria.Pregnant patients with SCD who present to the emergency department(eD)with pulmonary edema,hypertension,and proteinuria may suffer from a hypertensive emergency with or without preeclampsia.Without prior lab work to determine whether a patient’s proteinuria or kidney dysfunction is new or at baseline,it may be impossible for the emergency physician to determine which diagnosis is more likely.Thus,amultidisciplinary approach which involves cardiology,nephrology,medicine and obstetrics consultations should be utilized to help direct treatment.We present the case of a 39-yearold patient with SCD,who was also 26 weeks pregnant,and presented to the eD with markedly elevated blood pressure and dyspnea.Although she was initially admitted to the obstetrics ward for blood pressure management given concern for preeclampsia,she was ultimately diagnosed with hypertensive emergency and sickle cell nephropathy.

关键词： hypertensive admitted markedly

Detection of adrenal mass during an educational point-of-care ultrasound in the emergency department

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World Journal of emergency Medicine 2021年第2期12卷 154-156页

作者： Kay Negishi Jorge Short Apellaniz Daniel Ratanski sarah e.frasure Andrew S.Liteplo Hamid Shokoohi Department of emergency Medicine Massachusetts General HospitalHarvard Medical SchoolBoston 02115USA Department of emergency Medicine George Washington University School of Medicine and Health SciencesWashington 20037USA

Dear editor,Incidental adrenal mass is a common radiological finding that is mostly detected in abdominal computed tomography (CT) scans.^([1]) Though pheochromocytomas are a relatively rare chromaffin cell tumor,they... 详细信息

关键词： adrenal diagnosis editor

Vulvar infl ammation as a manifestation of Crohn＇s disease

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World Journal of emergency Medicine 2017年第4期8卷 305-307页

作者： Michael e. Abboud sarah e. frasure Department of emergency Medicine Brigham and Women's Hospital Boston MA 02115 USA

Crohn＇s disease is a chronic inflammatory boweldisease that is also associated with extra-intestinal complications, such as arthritis, erythema nodosum,deep venous thrombosis, and uveitis. Involvement of thevulva, however, is a rare fi nding in female patients withCrohn＇s disease. We present a case of vulvar Crohn＇sdisease and discuss the disease process and treatmentoptions for affected patients.

关键词：小学英文教学辅导教材

Accuracy of abdominal ultrasound for the diagnosis of small bowel obstruction in the emergency department

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World Journal of emergency Medicine 2018年第4期9卷 267-271页

作者： sarah e. frasure Amy F. Hildrcth Raghu Seethala Heidi H. Kimberly George Washington University Hospital Washington DC 20037 USA NavalMedical Center San Diego San Diego CA 92134 USA Department of emergency Medicine Brigham and Women 's Hospital Boston MA 02115 USA

BACKGROUND: emergency physicians frequently encounter patients with acute small bowel obstructions(SBO). Although computed tomography(CT) imaging is the current gold standard in the assessment of patients with suspected SBO in the emergency department, a few studies have examined the use of ultrasound as an alternative imaging technique. MeTHODS: We evaluated the accuracy of ultrasound performed in the eD by a variety of providers(physicians with various levels of training, physician assistants) compared to CT imaging in 47 patients with suspected SBOs. ReSULTS: Our data demonstrated a sensitivity of 93.8% and a specificity of 93.3% when compared to abdominal CT, and a sensitivity of 94.3% and specificity of 95.2% using a composite endpoint of abdominal CT and discharge diagnosis. CONCLUSION: Ultrasound can play an important role in the identification of small bowel obstructions in eD patients.

关键词：小学英语课外阅读阅读材料

Comparison of fungal vs bacterial infections in the medical intensive liver unit:Cause or corollary for high mortality?

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World Journal of Hepatology 2024年第3期16卷 379-392页

作者： sarah Khan Hanna Hong Stephanie Bass Yifan Wang Xiao-Feng Wang Omar T Sims Christine e Koval Aanchal Kapoor Christina C Lindenmeyer Department of Internal Medicine Cleveland ClinicClevelandOH 44195United States Cleveland Clinic Lerner College of Medicine Cleveland ClinicClevelandOH 44195United States Department of Pharmacy Cleveland ClinicClevelandOH 44195United States Department of Quantitative Health Sciences/Biostatistics Section Cleveland ClinicClevelandOH 44195United States Department of Gastroenterology Hepatology and NutritionCleveland ClinicClevelandOH 44195United States Department of Infectious Disease Cleveland ClinicClevelandOH 44195United States Department of Critical Care Medicine Cleveland ClinicClevelandOH 44195United States

BACKGROUND Due to development of an immune-dysregulated phenotype,advanced liver disease in all forms predisposes patients to sepsis acquisition,including by opportunistic pathogens such as fungi.Little data exists on fungal infection within a medical intensive liver unit(MILU),particularly in relation to acute on chronic liver failure.AIM To investigate the impact of fungal infections among critically ill patients with advanced liver disease,and compare outcomes to those of patients with bacterial infections.MeTHODS From our prospective registry of MILU patients from 2018-2022,we included 27 patients with culture-positive fungal infections and 183 with bacterial infections.We compared outcomes between patients admitted to the MILU with fungal infections to bacterial counterparts.Data was extracted through chart review.ReSULTS All fungal infections were due to Candida species,and were most frequently blood isolates.Mortality among patients with fungal infections was significantly worse relative to the bacterial cohort(93%vs 52%,Pe majority of the fungal cohort developed grade 2 or 3 acute on chronic liver failure(ACLF)(90%vs 64%,P=0.02).Patients in the fungal cohort had increased use of vasopressors(96%vs 70%,P=0.04),mechanical ventilation(96%vs 65%,Pe to acute kidney injury(78%vs 52%,P=0.014).On MILU admission,the fungal cohort had significantly higher Acute Physiology and Chronic Health evaluation(108 vs 91,P=0.003),Acute Physiology Score(86 vs 65,P=0.003),and Model for end-Stage Liver Disease-Sodium scores(86 vs 65,P=0.041).There was no significant difference in the rate of central line use preceding culture(52%vs 40%,P=0.2).Patients with fungal infection had higher rate of transplant hold placement,and lower rates of transplant;however,differences did not achieve statistical significance.CONCLUSION Mortality was worse among patients with fungal infections,likely attributable to severe ACLF development.Prospective studies examining empiric antifungals in severe ACLF and associa

关键词： Fungal Infection Sepsis Acute on chronic liver failure Intensive care

emergency department patients with small bowel obstruction： What is the anticipated clinical course？

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World Journal of emergency Medicine 2016年第1期7卷 35-39页

作者： sarah e.frasure Amy Hildreth Sukhjit Takhar Michael B Stone emergency Department Harvard University45 Francis St Neville House-236ABostonMassachusetts 02115USA

BACKGROUND:emergency physicians(ePs)often care for patients with acute small bowel obstruction.While some patients require exploratory laparotomy,others are managed successfully with supportive care.We aimed to determine features that predict the need for operative management in emergency department(eD)patients with small bowel obstruction(SBO).MeTHODS:We performed a retrospective chart review of 370 consecutive patients admitted to a large urban academic teaching hospital with a diagnosis of SBO over a two-year period.We evaluated demographic characters(prior SBO,prior abdominal surgery,active malignancy)and clinical findings(leukocytosis and lactic acid)to determine features associated with the need for urgent operative intervention.ReSULTS:Patients with a prior SBO were less likely to undergo operative intervention[20.3%(42/207)]compared to those without a prior SBO[35.2%(57/162)].Abnormal bloodwork was not associated with need for operative intervention.68%of patients with CT scan findings of both an SBO and a hernia,however,were operatively managed.CONCLUSIONS:Patients with a history of SBO were less likely to require operative intervention at any point during their hospitalization.Abnormal bloodwork was not associated with operative intervention.The CT finding of a hernia,however,predicted the need for operative intervention,while other findings(ascites,duodenal thickening)did not.Further research would be helpful to construct a prediction rule,which could help community ePs determine which patients may benefit from expedited transfer for operative management,and which patients could be safely managed conservatively as an initial treatment strategy.

关键词： Small bowel obstruction Computed tomography Hernia

Ultrasound diagnosis of diverticulitis

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World Journal of emergency Medicine 2016年第1期7卷 74-76页

作者： Michael e. Abboud sarah e. frasure Michael B. Stone emergency Department Harvard University 45 Francis St Neville House - 236A Boston Massachusetts 02115 USA

INTRODUCTION Diverticular disease accounts for approximately312 000 hospital admissions in the United States annually,and costs nearly 2.6 billion dollars.[1,2]Approximately20%of Americans with diverticular disease will experience at least one episode of acute diverticulitis,necessitating a visit to their physician's office or the emergency department(eD)for treatment.[3]As the risk of developing diverticulitis rises with age(nearly 50%of people aged over 60 years have colonic diverticula),

关键词： will oral

Surgical intervention combined with weight-bearing walking training promotes recovery in patients with chronic spinal cord injury:a randomized controlled study

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Neural Regeneration Research 2024年第12期19卷 2773-2784页

作者： Hui Zhu James D.Guest sarah Dunlop Jia-Xin Xie Sujuan Gao Zhuojing Luo Joe e.Springer Wutian Wu Wise Young Wai Sang Poon Song Liu Hongkun Gao Tao Yu Dianchun Wang Libing Zhou Shengping Wu Lei Zhong Fang Niu Xiaomei Wang Yansheng Liu Kwok-Fai So Xiao-Ming Xu Kunming Tongren Hospital KunmingYunnan ProvinceChina Neurological Surgery and the Miami Project to Cure ParalysisMiller School of MedicineUniversity of MiamiMiamiFLUSA School of Biological Sciences The University of Western AustraliaPerthWAAustralia Minderoo Foundation PerthWAAustralia Clinical Center for Spinal Cord Injury Kunming General Hospital of Chengdu Military CommandKunmingYunnan ProvinceChina Department of Biostatistics and Health Data Science Indiana University School of MedicineIndianapolisINUSA Department of Orthopedic Spinal Surgery Xijing HospitalFourth Military Medical UniversityXi’anShaanxi ProvinceChina Spinal Cord and Brain Injury Research Center Department of Physical Medicine and RehabilitationUniversity of Kentucky College of MedicineLexingtonKYUSA Guangdong-HongKong-Macao Institute of CNS Regeneration Jinan UniversityGuangzhouGuangdong ProvinceChina W.M.Keck Center for Collaborative Neuroscience Rutgers UniversityPiscatawayNJUSA Neurosurgery Department Chinese University of Hong KongPrince of Wales HospitalHong Kong Special Administration RegionChina Spinal Cord and Brain Injury Research Group Stark Neurosciences Research InstituteDepartment of Neurological SurgeryIndiana University School of MedicineIndianapolisINUSA

For patients with chronic spinal cord injury,the co nventional treatment is rehabilitation and treatment of spinal cord injury complications such as urinary tract infection,pressure sores,osteoporosis,and deep vein thrombosis.Surgery is rarely perfo rmed on spinal co rd injury in the chronic phase,and few treatments have been proven effective in chronic spinal cord injury patients.Development of effective therapies fo r chronic spinal co rd injury patients is needed.We conducted a randomized controlled clinical trial in patients with chronic complete thoracic spinal co rd injury to compare intensive rehabilitation(weight-bearing walking training)alone with surgical intervention plus intensive rehabilitation.This clinical trial was registered at ClinicalTrials.gov(NCT02663310).The goal of surgical intervention was spinal cord detethering,restoration of cerebrospinal fluid flow,and elimination of residual spinal cord compression.We found that surgical intervention plus weight-bearing walking training was associated with a higher incidence of American Spinal Injury Association Impairment Scale improvement,reduced spasticity,and more rapid bowel and bladder functional recovery than weight-bearing walking training alone.Overall,the surgical procedures and intensive rehabilitation were safe.American Spinal Injury Association Impairment Scale improvement was more common in T7-T11 injuries than in T2-T6 injuries.Surgery combined with rehabilitation appears to have a role in treatment of chronic spinal cord injury patients.

关键词： chronic spinal cord injury intensive rehabilitation locomotor training neurological recovery surgical intervention weightbearing walking training