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Long‐term mechanical ventilation (MV) is defined as the use of MV for more than 6 hours per day for at least 3 weeks. Children requiring long‐term MV include those with neuromuscular disease, central dysregulation, or lung dysfunction. Such children with medical complexity may be at risk for ventilator‐induced diaphragmatic dysfunction. Ventilator‐induced diaphragmatic dysfunction has been described in adult patients requiring acute MV with ultrasound (US). At this time, diaphragmatic US has not been evaluated in the pediatric post–acute care setting or incorporated into weaning strategies. We present 24 cases of children requiring long‐term MV who underwent diaphragmatic US examinations to evaluate for ventilator‐induced diaphragmatic dysfunction.

Background Despite the utilization of point‐of‐care ultrasound (POCUS) by trauma surgeons, formal POCUS requirements do not exist for general surgery residents. We sought to evaluate surgery resident comfort with performing and interpreting of Extended‐Focused Assessment for Sonography in Trauma (E‐FAST) scans after a brief educational session. Methods A pre‐survey, sent to PGY‐2 and ‐3 surgical residents before their trauma rotation, evaluated comfort with eight components of the E‐FAST. Residents were then required to watch a 15‐min online video and attend a 1‐h bedside training session moderated by emergency medicine ultrasound fellows during which residents practised E‐FAST image acquisition and interpretation. After the rotation, residents completed a post‐survey evaluating their comfort with the E‐FAST. Results All 27 residents rotating on the trauma service during the 2017–2018 academic year were eligible and, therefore, approached by the study team. Twenty‐one (77.78%) residents completed the pre‐survey, training and post‐survey. Initially, only 52% (13/25) of residents reported feeling confident in performing the E‐FAST. After the session, all (100%) reported feeling confident in their training in E‐FAST. Self‐reported mean comfort with each of the eight components of the E‐FAST showed a statistically significant (P < 0.01) increase from pre–post survey for all residents. Isolating only the residents who initially reported feeling confident in E‐FAST still showed a statistically significant (P < 0.01) increase in mean comfort. Conclusion A single POCUS training programme has been shown to improve surgical residents' comfort in performing and interpreting the E‐FAST. This interdisciplinary approach can enhance collaboration and bridge gaps between emergency medicine and surgery residency programmes.

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Point-of-care ultrasound (POCUS) training is well-established in emergency medicine (EM) residency programs in the United States. Demonstration of competency in POCUS has been required for graduates of United States EM residencies since 2001, yet EM resident POCUS education strategies vary widely. 1-4 In 2013, the American College of Emergency Physicians (ACEP), the Society for Academic Emergency Medicine (SAEM), and the Council of Emergency Medicine Residency Directors (CORD) published general guidelines for EM resident POCUS education and assessment. 1 Current EM POCUS education literature suggest that POCUS education and assessment should occur longitudinally and through

We sought to assess whether ultrasound (US) measurements of carotid flow time (CFTc) and carotid blood flow (CBF) predict fluid responsiveness in patients with suspected sepsis. Methods: This was a prospective observational study of hypotensive (systolic blood pressure (SBP) < 90) patients ''at risk'' for sepsis receiving intravenous fluids (IVF) in the emergency department. US measurements of CFTc and CBF were performed at time zero and upon completion of IVF. All US measurements were repeated after a passive leg raise (PLR) maneuver. Fluid responsiveness was defined as normalization of blood pressure without persistent hypotension or need for vasopressors. Results: A convenience sample of 69 patients was enrolled. The mean age was 65; 49% were female. Fluid responders comprised 52% of the cohort. CFTc values increased significantly with both PLR (P ¼ 0.047) and IVF administration (P ¼ 0.003), but CBF values did not (P ¼ 0.924 and P ¼ 0.064 respectively). Neither absolute CFTc or CBF measures, nor changes in these values with PLR or IVF bolus, predicted fluid responsiveness, mortality, or the need for intensive care unit admission. Conclusion: In patients with suspected sepsis, a fluid challenge resulted in a significant change in CFTc, but not CBF. Neither absolute measurement nor delta measurements with fluid challenge predicted clinical outcomes. KEYWORDS-Carotid flow time, emergency ultrasound, fluid responsiveness, point-of-care ultrasound, sepsis Address reprint requests to Hamid Shokoohi,

Pulsus paradoxus (PP) is defined as a fall of systolic blood pressure of greater than 10 mm Hg during the inspiratory phase of respiration. Measurement of PP is recommended by national and international asthma guidelines as an objective measure of asthma severity but is rarely used in clinical practice. Cardiac point‐of‐care ultrasound with pulsed wave Doppler imaging measuring respiratory‐phasic changes of mitral valve inflow velocities is well described in cardiac tamponade as “sonographic” PP. We present 10 cases of acute asthma presenting to an emergency department showing the finding of sonographic determined PP in the apical 4‐chamber view of the heart on pulsed wave Doppler imaging.

Background Corrected carotid flow time (CFTc) and carotid blood flow (CBF) are sonographic measurements used to assess fluid responsiveness in hypotension. We investigated the impacts of mechanical ventilation on CFTc and CBF. Materials and methods Normotensive patients undergoing cardiac surgery were prospectively enrolled. Carotid ultrasound (US) was performed pre and post-intubation. Post-intubation measurements took place after the initiation of mechanical ventilation. To measure CFTc and CBF, a sagittal carotid view was obtained with pulse wave-Doppler (maximum angle 60°). CFTc was calculated with the Bazett formula (CFTc = systolic time/√cycle time). CBF was calculated using CBF (mL/min) = area (cm 2 ) x time average mean velocity (TAMEAN) (cm/sec) x 60 (sec/min). The maximum carotid diameter was measured at the level of the thyroid. Results Twenty patients were enrolled. Mean CFTc pre-intubation was 328 ms (SD 43.9 ms) compared to CFTc post-intubation 336 ms (SD 36 ms). There was no significant difference between pre and post-intubation CFTc (mean differences=-0.008; t(19)=-0.71, p=.49). Mean CBF pre-intubation was 487 mL/min (SD 176 mL/min) compared to CBF post-intubation 447 mL/min (SD 187 mL/min). There was no significant difference between pre and post-intubation CBF (mean differences= 40; t(19)=1.24, p=.23). Conclusions In this study of normotensive patients, there were no detected differences in CFTc or CBF pre and post-intubation with mechanical ventilation.