Review Article
Point-of-Care Ultrasound in Established Settings
Abstract
The original and most widely accepted applications for point-of-care ultrasound (POCUS) are in the settings of trauma, shock, and bedside procedures. Trauma was the original setting for the introduction of POCUS and has been standardized under the four-plus view examination called the Focused Assessment with Sonography in Trauma (FAST). This examination was found to be especially practice changing for achieving rapid diagnoses in critically ill patients who are too unstable for the delays and transportation inherent in more advanced imaging with computed tomography. This application was broadened from the critically ill trauma patient to any critically ill patient, particularly the patient in undifferentiated shock. Although the Focused Assessment with Sonography in Trauma examination originally focused on sources of hemorrhage causing hypovolemic shock, POCUS also can quickly differentiate cardiogenic, obstructive, and distributive shock and help identify the more specific etiology such as massive pulmonary emboli, pericardial tamponade, and pneumothoraces. By expediting diagnosis, POCUS facilitates faster definitive treatment of life-threatening conditions. In pursuing treatment, US continues to serve a role in the form of visually guiding many procedures that were previously done blindly. US guidance of procedures has improved the safety of central line insertion, thoracentesis, and paracentesis, and has an emerging role in lumbar puncture. Experience in bedside US is becoming a vital tool in the clinician’s bedside assessment and management, filling a void between the stethoscope and the more advanced studies and interventions available through radiology. Understanding the strengths and limitations of US enables clinicians to identify the appropriate situations in which they can apply this tool confidently.This content is limited to qualifying members.
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References
1. Halbfass HJ, Wimmer B, Hauenstein K, et al. Ultrasonic diagnosis of blunt abdominal injuries. Fortschr Med 1981;99:1681-1685.
2. Nishijima DK, Simel DL, Wisner DH, et al. Does this adult patient have a blunt intra-abdominal injury? JAMA 2012;307:1517-1527.
3. Wilson CB, Vidrine A, Jr Rives JD. Unrecognized abdominal trauma in patients with head injuries. Ann Surg 1965;161:608-613.
4. Bilge A, Sahin M. Diagnostic peritoneal lavage in blunt abdominal trauma. Eur J Surg 1991;157:449-451.
5. Peitzman AB, Makaroun MS, Slasky BS, et al. Prospective study of computed tomography in initial management of blunt abdominal trauma. J Trauma 1986;26:585-592.
6. Zhang Z, Hong Y, Liu N, Chen Y. Diagnostic accuracy of contrast enhanced ultrasound in patients with blunt abdominal trauma presenting to the emergency department: a systematic review and meta-analysis. Sci Rep 2017;7:4446.
7. ATLS Subcommittee, American College of Surgeons’ Committee on Trauma, International ATLS working group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg 2013;74:1363-1366.
8. Soto JA, Anderson SW. Multidetector CT of blunt abdominal trauma. Radiology 2012;265:678-693.
9. Branney SW, Wolfe RE, Moore EE, et al. Quantitative sensitivity of ultrasound in detecting free intraperitoneal fluid. J Trauma 1995;39:375-380.
10. Sisley AC, Rozycki GS, Ballard RB, et al. Rapid detection of traumatic effusion using surgeon-performed ultrasonography. J Trauma 1998;44:291-297.
11. Kömer M, Krötz MM, Degenhart C, et al. Current role of emergency US in patients with major trauma. Radiographics 2008;28:225-242.
12. Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest 2012;141:703-708.
13. Plummer D, Brunette D, Asinger R, et al. Emergency department echocardiography improves outcome in penetrating cardiac injury. Ann Emerg Med 1992;21:709-712.
14. Tayal VS, Beatty MA, Marx JA, et al. FAST (focused assessment with sonography in trauma) accurate for cardiac and intraperitoneal injury in penetrating anterior chest trauma. J Ultrasound Med 2004;23:467-472.
15. Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med 2010;17:11-17.
16. Donmez H, Tokmak TT, Yildirim A, et al. Should bedside sonography be used first to diagnose pneumothorax secondary to blunt trauma? J Clin Ultrasound 2012;40:142-146.
17. Rozycki GS, Ballard RB, Feliciano DV, et al. Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg 1998;228:557-567.
18. Rozycki GS, Feliciano DV, Ochsner MG, et al. The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J Trauma 1999;46:543-552.
19. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012;38:577-591.
20. Montoya J, Stawicki SP, Evans DC, et al. From FAST to E-FAST: an overview of the evolution of ultrasound-based traumatic injury assessment. Eur J Trauma Emerg Surg 2016;42:119-126.
21. Stengel D, Bauwens K, Sehouli J, et al. Systematic review and meta-analysis of emergency ultrasonography for blunt abdominal trauma. Br J Surg 2001;88:901-912.
22. Stengel D, Rademacher G, Ekkernkamp A, et al. Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. Cochrane Database Syst Rev 2015;9:CD004446.
23. Moylan M, Newgard CD, Ma OJ, et al. Association between a positive ED FAST examination and therapeutic laparotomy in normotensive blunt trauma patients. J Emerg Med 2007;33:265-271.
24. Dolich MO, McKenney MG, Varela JE, et al. 2,576 ultrasounds for blunt abdominal trauma. J Trauma 2001;50:108-112.
25. Richards JR, McGahan JP. Focused assessment with sonography in trauma (FAST) in 2017: what radiologists can learn. Radiology 2017;283:30-48.
26. Schroeppel TJ, Croce MA. Diagnosis and management of blunt abdominal solid organ injury. Curr Opin Crit Care 2007;13:399-404.
27. Tong GE, Staudenmayer K, Lin F, et al. Use of emergency department imaging in patients with minor trauma. J Surg Res 2015;203:238-245.
28. Natarajan B, Gupta PK, Cemaj S, et al. FAST scan: is it worth doing in hemodynamically stable blunt trauma patients? Surgery 2010;148:695-701.
29. Scalea TM, Rodriguez A, Chiu WC, et al. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma 1999;46:466-472.
30. Tominaga GT, Brown CVR, Schulz JT, et al. The American Association for the Surgery of Trauma uniform grading of hemorrhagic emergency general surgery diseases. J Trauma Acute Care Surg 2018;84:670-673.
31. Kendall JL, Kestler AM, Whitaker KT, et al. Blunt abdominal trauma patients are at very low risk for intra-abdominal injury after emergency department observation. West J Emerg Med 2011;12:496-504.
32. Ma OJ, Gaddis G, Steele MT, et al. Prospective analysis of the effect of physician experience with the FAST examination in reducing the use of CT scans. Emerg Med Australas 2005;17:24-30.
33. Moura FHB, Parreira JG, Mattos T, et al. Ruling out intra-abdominal injuries in blunt trauma patients using clinical criteria and abdominal ultrasound. Rev Col Bras Cir 2017;44:626-632. < Article in English and Portuguese ].
34. Sheng AY, Dalziel P, Liteplo AS, et al. Focused assessment with sonography in trauma and abdominal computed tomography utilization in adult trauma patients: trends over the last decade. Emerg Med Int 2013;2013:678380.
35. Jones AE, Aborn LS, Kline JA. Severity of emergency department hypotension predicts adverse hospital outcome. Shock 2004;22:410-414.
36. Levitov A, Frankel HL, Blaivas M, et al. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part II: cardiac ultrasonography. Crit Care Med 2016;44:1206-1227.
37. Via G, Hussain A, Wells M, et al. International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr 2014;27:683.e1-683.e33.
38. Jones AE, Tayal VS, Sullivan DM, et al. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med 2004;32:1703-1708.
39. Volpicelli G, Lamorte A, Tullio M, et al. Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med 2013;39:1290-1298.
40. Ghane MR, Gharib MH, Ebrahimi A, et al. Accuracy of Rapid Ultrasound in Shock (RUSH) exam for diagnosis of shock in critically ill patients. Trauma Mon 2015;20:e20095.
41. Shokoohi H, Boniface KS, Pourmand A, et al. Bedside ultrasound reduces diagnostic uncertainty and guides resuscitation in patients with undifferentiated hypotension. Crit Care Med 2015;43:2562-2569.
42. Kaul S, Stratienko AA, Pollock SG, et al. Value of two-dimensional echocardiography for determining the basis of hemodynamic compromise in critically ill patients: a prospective study. J Am Soc Echocardiogr 1994;7:598-606.
43. Shokoohi H, Boniface KS, Zaragoza M, et al. Point-of-care ultrasound leads to diagnostic shifts in patients with undifferentiated hypotension. Am J Emerg Med 2017;35:1984.e3-1984.e7.
44. Mandavia DP, Hoffner RJ, Mahaney K, et al. Bedside echocardiography by emergency physicians. Ann Emerg Med 2001;38(4 Suppl):377-382.
45. Ding W, Shen Y, Yang J, et al. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest 2011;140:859-866.
46. Rudoni RR, Jackson RE, Godfrey GW, et al. Use of two-dimensional echocardiography for the diagnosis of pulmonary embolus. J Emerg Med 1998;16:5-8.
47. Mansencal N, Redheuil A, Joseph T, et al. Use of transthoracic echocardiography combined with venous ultrasonography in patients with pulmonary embolism. Int J Cardiol 2004;9:59-63.
48. Kucher N, Luder CM, Dörnhofer T, et al. Novel management strategy for patients with suspected pulmonary embolism. Eur Heart J 2003;24:366-376.
49. Concannon E, McHugh S, Healy DA, et al. Diagnostic accuracy of non-radiologist performed ultrasound for abdominal aortic aneurysm: systematic review and meta-analysis. Int J Clin Pract 2014;68:1122-1129.
50. Breitkreutz R, Price S, Steiger HV, et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation 2010;81:1527-1533.
51. Kanji HD, McCallum J, Sirounis D, et al. Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes. J Crit Care 2014;29:700-705.
52. Atkinson PRT, McAuley DJ, Kendall RJ, et al. Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with undifferentiated hypotension. Emerg Med J 2009;26:87-91.
53. Lanctot JF, Valois M, Beaulieu Y. EGLS: echo-guided life support. Crit Ultrasound J 2011;3:123-129.
54. Lichtenstein D, Karakitsos D. Integrating lung ultrasound in the hemodynamic evaluation of acute circulatory failure (the fluid administration limited by lung sonography protocol). J Crit Care 2012;27:533.e11-9.
55. Jensen MB, Sloth E, Larsen KM, Schmidt MB. Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol 2004;21:700-707.
56. Perera P, Mailhot T, Riley D, et al. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically ill. Emerg Med Clin North Am 2010;28:29-56.
57. Rose JS, Bair AE, Mandavia D, et al. The UHP ultrasound protocol: a novel ultrasound approach to the empiric evaluation of the undifferentiated hypotensive patient. Am J Emerg Med 2001;19:299-302.
58. Spencer KT, Kimura BJ, Korcarz CE, et al. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013;26:567-581.
59. Labovitz AJ, Noble VE, Bierig M, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr 2010;23:1225-1230.
60. Rezayat T, Stowell JR, Kendall LJ, et al. Ultrasound-guided cannulation: time to bring subclavian central lines back. West J Emerg Med 2016;17:216-221.
61. Bodenham Chair A, Babu S, Bennett J, et al. Association of Anaesthetists of Great Britain and Ireland: safe vascular access 2016. Anaesthesia 2016;71:573-585.
62. Calvache JA, Rodrí MV, Trochez A, et al. Incidence of mechanical complications of central venous catheterization using landmark technique: do not try more than 3 times. J Intensive Care Med 2016;31:397-402.
63. Brass P, Hellmich M, Kolodziej L, et al. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev 2015;1:CD006962.
64. Brass P, Hellmich M, Kolodziej L, et al. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev 2015;1:CD011447.
65. Lalu MM, Fayad A, Ahmed O, et al. Ultrasound-guided subclavian vein catheterization: a systematic review and meta-analysis. Crit Care Med 2015;43:1498-1507.
66. Czarnik T, Gawda R, Nowotarski J. Real-time ultrasound-guided infraclavicular axillary vein cannulation: a prospective study in mechanically ventilated critically ill patients. J Crit Care 2016;33:32-37.
67. Buzancais G, Roger C, Bastide S, et al. Comparison of two ultrasound guided approaches for axillary vein catheterization: a randomized controlled non-inferiority trial. Br J Anaesth 2016;116:215-222.
68. Calvert N, Hind D, McWilliams R, et al. Ultrasound for central venous cannulation: economic evaluation of cost-effectiveness. Anaesthesia 2004;59:1116-1120.
69. Karakitsos D, Labropoulos N, De Groot E, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care 2006;10:R162.
70. Gao YB, Yan JH, Ma JM, et al. Effects of long axis in-plane vs short axis out-of-plane techniques during ultrasound-guided vascular access. Am J Emerg Med 2016;34:778-783.
71. Ablordeppey EA, Drewry AM, Beyer AB, et al. Diagnostic accuracy of central venous catheter confirmation by bedside ultrasound versus chest radiography in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2017;45:715-724.
72. Lichtenstein D, Goldstein I, Mourgeon E, et al. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004;100:9-15.
73. Soni NJ, Lucas BP. Diagnostic point-of-care ultrasound for hospitalists. J Hosp Med 2015;10:120-124.
74. Sajadieh H, Afzali F, Sajadieh V, et al. Ultrasound as an alternative to aspiration for determining the nature of pleural effusion, especially in older people. Ann N Y Acad Sci 2004;1019:585-592.
75. Liang SJ, Tu CY, Chen HJ, et al. Application of ultrasound-guided pigtail catheter for drainage of pleural effusions in the ICU. Intensive Care Med 2009;35:350-354.
76. Bugalho A, Ferreira D, Dias SS, et al. The diagnostic value of transthoracic ultrasonographic features in predicting malignancy in undiagnosed pleural effusions: a prospective observational study. Respiration 2014;87:270-278.
77. Chian CF, Su WL, Soh LH, et al. Echogenic swirling pattern as a predictor of malignant pleural effusions in patients with malignancies. Chest 2004;126:129-134.
78. Usta E, Mustafi M, Ziemer G. Ultrasound estimation of volume of postoperative pleural effusion in cardiac surgery patients. Interact Cardiovasc Thorac Surg 2010;10:204-207.
79. Remérand F, Dellamonica J, Mao Z, et al. Multiplane ultrasound approach to quantify pleural effusion at the bedside. Intensive Care Med 2010;36:656-664.
80. Balik M, Plasil P, Waldauf P, et al. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med 2006;32:318.
81. Xirouchaki N, Kondili E, Prinianakis G, et al. Impact of lung ultrasound on clinical decision making in critically ill patients. Intensive Care Med 2014;40:57-65.
82. Medford AR, Entwisle JJ. Indications for thoracic ultrasound in chest medicine: an observational study. Postgrad Med J 2010;86:8-11.
83. Tu CY, Hsu WH, Hsia TC, et al. Pleural effusions in febrile medical ICU patients: chest ultrasound study. Chest 2004;126:1274-1280.
84. Diacon AH, Brutsche MH, Solèr M. Accuracy of pleural puncture sites: a prospective comparison of clinical examination with ultrasound. Chest 2003;123:436-441.
85. Salamonsen M, Ellis S, Paul E, et al. Thoracic ultrasound demonstrates variable location of the intercostal artery. Respiration 2012;83:323-329.
86. Salamonsen M, Dobeli K, McGrath D, et al. Physician-performed ultrasound can accurately screen for a vulnerable intercostal artery prior to chest drainage procedures. Respirology 2013;18:942-947.
87. Alrajab S, Youssef AM, Akkus NI, et al. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care 2013;17:R208.
88. Cantey EP, Walter JM, Corbridge T, et al. Complications of thoracentesis: incidence, risk factors, and strategies for prevention. Curr Opin Pulm Med 2016;22:378-385.
89. Gordon CE, Feller-Kopman D, Balk EM, et al. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med 2010;170:332-339.
90. Kozmic SE, Wayne DB, Feinglass J, et al. Factors associated with inpatient thoracentesis procedure quality at university hospitals. Jt Comm J Qual Patient Saf 2016;42:34-40.
91. Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest 2013;143:532-538.
92. Patel PA, Ernst FR, Gunnarsson CL. Ultrasonography guidance reduces complications and costs associated with thoracentesis procedures. J Clin Ultrasound 2012;40:135-141.
93. Weingardt JP, Guico RR, Nemcek AA, Jr et al. Ultrasound findings following failed, clinically directed thoracenteses. J Clin Ultrasound 1994;22:419-426.
94. Perazzo A, Gatto P, Barlascini C, et al. [Can ultrasound guidance reduce the risk of pneumothorax following thoracentesis?] J Bras Pneumol 2014;40:6-12. [Article in English and Portuguese].
95. de Filho GR, Gomes HP, da Fonseca MH, et al. Predictors of successful neuraxial block: a prospective study. Eur J Anaesthesiol 2002;19:447-451.
96. Whitty R, Moore M, Macarthur A. Identification of the lumbar interspinous spaces: palpation versus ultrasound. Anesth Analg 2008;106:538-540.
97. Duniec L, Nowakowski P, Kosson D, et al. Anatomical landmarks based assessment of intravertebral space level for lumbar puncture is misleading in more than 30%. Anaesthesiol Intensive Ther 2013;45:1-6.
98. Schlotterbeck H, Schaeffer R, Dow WA, et al. Ultrasonographic control of the puncture level for lumbar neuraxial block in obstetric anaesthesia. Br J Anaesth 2008;100:230-234.
99. Balki M, Lee Y, Halpern S, et al. Ultrasound imaging of the lumbar spine in the transverse plane: the correlation between estimated and actual depth to the epidural space in obese parturients. Anesth Analg 2009;108:1876-1881.
100. Chin KJ, Perlas A, Singh M, et al. An ultrasound-assisted approach facilitates spinal anesthesia for total joint arthroplasty. Can J Anesth 2009;56:643-650.
101. Sahin T, Balaban O, Sahin L, et al. A randomized controlled trial of preinsertion ultrasound guidance for spinal anaesthesia in pregnancy: outcomes among obese and lean parturients: ultrasound for spinal anesthesia in pregnancy. J Anesth 2014;28:413-419.
102. Barrett NM, Arzola C, Krings T, et al. Lumbar spine anatomy in women sustaining unintentional dural puncture during labor epidural placement: a descriptive study using magnetic resonance imaging and ultrasound. Reg Anesth Pain Med 2018;43:92-96.
103. Farahmand S, Safavi S, Shahriarian S, et al. Preferred view and transducer in lumbar ultrasound in overweight and obese patients. Ultrasound 2017;25:45-52.
104. Ferre RM, Sweeney TW. Emergency physicians can easily obtain ultrasound images of anatomical landmarks relevant to lumbar puncture. Am J Emerg Med 2007;25:291-296.
105. Shaikh F, Brzezinski J, Alexander S, et al. Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta-analysis. BMJ 2013;346:f1720.
106. Nassar M, Abdelazim IA. Pre-puncture ultrasound guided epidural insertion before vaginal delivery. J Clin Monit Comput 2015;29:573-577.
107. Ekinci M, Alici HA, Ahiskalioglu A, et al. The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks. J Clin Anesth 2017;37:82-85.
108. Creaney M, Mullane D, Casby C, et al. Ultrasound to identify the lumbar space in women with impalpable bony landmarks presenting for elective caesarean delivery under spinal anaesthesia: a randomised trial. Int J Obstet Anesth 2016;28:12-16.
109. Tawfik MM, Atallah MM, Elkharboutly WS, et al. Does preprocedural ultrasound increase the first-pass success rate of epidural catheterization before cesarean delivery? A randomized controlled trial. Anesth Analg 2017;124:851-856.
110. Turkstra TP, Marmai KL, Armstrong KP, et al. Preprocedural ultrasound assessment does not improve trainee performance of spinal anesthesia for obstetrical patients: a randomized controlled trial. J Clin Anesth 2017;37:21-24.
111. Lahham S, Schmalbach P, Wilson SP, et al. Prospective evaluation of point-of-care ultrasound for pre-procedure identification of landmarks versus traditional palpation for lumbar puncture. World J Emerg Med 2016;7:173-177.
112. Ansari T, Yousef A, El Gamassy A, et al. Ultrasound-guided spinal anaesthesia in obstetrics: is there an advantage over the landmark technique in patients with easily palpable spines? Int J Obstet Anesth 2014;23:213-216.
113. Peterson MA, Pisupati D, Heyming TW, et al. Ultrasound for routine lumbar puncture. Acad Emerg Med 2014;21:130-136.
114. Nomura JT, Leech SJ, Shenbagamurthi S, et al. A randomized controlled trial of ultrasound-assisted lumbar puncture. J Ultrasound Med 2007;26:1341-1348.
115. Chin KJ, Perlas A, Chan V, et al. Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. Anesthesiology 2011;115:94-101.
116. Grau T, Leipold RW, Conradi R, et al. Ultrasound control for presumed difficult epidural puncture. Acta Anaesthesiol Scand 2001;45:766-771.
117. Neal JT, Kaplan SL, Woodford AL, et al. The effect of bedside ultrasonographic skin marking on infant lumbar puncture success: a randomized controlled trial. Ann Emerg Med 2017;69:610-619. e1.
118. De Gottardi A, Thévenot T, Spahr L, et al. Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study. Clin Gastroenterol Hepatol 2009;7:906-909.
119. Peabody CR, Mandavia D. Deep needle procedures: improving safety with ultrasound visualization. J Patient Saf 2017;13:103-108.
120. Keil-Rios D, Terrazas-Solis H, Gonzalez-Garay A, et al. Pocket ultrasound device as a complement to physical examination for ascites evaluation and guided paracentesis. Intern Emerg Med 2016;11:461-466.
121. Soni NJ, Franco-Sadud R. In reference to “Use of paracentesis in hospitalized patients with decompensated cirrhosis and ascites: opportunities for quality improvement.” J Hosp Med 2015;10:342.
122. Nazeer SR, Dewbre H, Miller AH. Ultrasound-assisted paracentesis performed by emergency physicians vs the traditional technique: a prospective, randomized study. Am J Emerg Med 2005;23:363-367.
123. Stone JC, Moak JH. Feasibility of sonographic localization of the inferior epigastric artery before ultrasound-guided paracentesis. Am J Emerg Med 2015;33:1795-1798.
124. Barsuk JH, Rosen BT, Cohen ER, et al. Vascular ultrasonography: a novel method to reduce paracentesis related major bleeding. J Hosp Med 2018;13:30-33.
