Jason Filopei

Impact of pocket ultrasound use by internal medicine housestaff in the diagnosis of Dyspnea

BACKGROUND Recent reports demonstrate high diagnostic accuracy of lung ultrasound for evaluation of dyspnea. We assessed the feasibility of training internal medicine residents in lung ultrasound with a pocket ultrasound device. METHODS We performed a prospective, observational trial of residents performing lung ultrasound with a pocket ultrasound. Training consisted of two 90-minute sessions of didactics and supervised bedside performance. Two residents received an additional 2 weeks of training. Residents recorded a clinical diagnosis based on admission data. Following lung ultrasound performance, an ultrasound diagnosis was recorded integrating clinical and sonographic findings. Using receiver operating curve analysis, the area under the curve was calculated for both clinical diagnosis and ultrasound diagnosis using attending physicians final discharge diagnosis as the gold standard. RESULTS Five residents performed 69 exams. The AUC for ultrasound diagnosis was significantly higher than that for clinical diagnosis (0.87 vs 0.81, P < 0.01). AUCs increased using lung ultrasound for diagnoses as follows: chronic obstructive pulmonary disease (0.73-0.85, P = 0.06), acute pulmonary edema (0.85-0.89, P = 0.49), pneumonia (0.77-0.88, P = 0.01), and pleural effusions (0.76-0.96, P < 0.002). CONCLUSIONS Lung ultrasound performed by residents with a pocket ultrasound improved the diagnostic accuracy of dyspnea. Two residents undergoing extended training showed a total increase in diagnostic accuracy.

THE IMPLEMENTATION OF A MULTI-DISCIPLINARY PULMONARY EMBOLISM RESPONSE TEAM (PERT) IN A NEW YORK CITY TEACHING HOSPITAL CENTER

METHODS: A multi-disciplinary PERT was assembled to respond to PE in two sites of an academic hospital center, comprised of attending physicians in Pulmonary/Critical Care, Interventional Radiology, and Cardiothoracic Surgery. Critical care consultations for submassive or massive PE lead to activation of the PERT, available 24 hours a day. A secure encrypted messaging application is used to share information, including clips of the CT angiogram and transthoracic echocardiogram (TTE) images. This allows the involved specialties to review relevant information, ask questions and give input in real-time. Once a consensus is reached the PERT leader, assigned weekly, directly contacts the intensivist who activated the PERT (ultimately the decision belongs to this intensivist). Fellows are also included in this group for their education and involvement.