A major risk factor for morbidity and mortality in critical illness is the presence of right ventricular dysfunction (RVD). However, characterizing and grading the severity of RVD remains highly subjective, with significant inter-operator and intra-operator variability and the potential for the inappropriate treatment of patients. To address these issues, this study aimed to synthesize multiple echocardiographic parameters, which have been demonstrated to affect clinical outcomes, into a framework for the comprehensive evaluation of RVD. During the study's first phase, a scoping review of the literature was conducted and identified four routinely obtained echocardiographic findings that had been validated as part of multi-parametric scoring methods for scoring the severity RVD: (1) RV systolic dysfunction; (2) RV dilation; (3) RV-PA uncoupling; and (4) interventricular septal flattening. In the second phase described in the present manuscript, these four echocardiographic findings were operationalized into an image acquisition protocol and integrated into a proposed RVD scoring system compatible with the constraints of either point-of-care or consultative ultrasound workflows.

A major cause of morbidity and healthcare resource utilization is gastrointestinal (GI) dysfunction. Although GI symptoms are frequently evaluated with computed tomography (CT), this modality subjects patients to ionizing radiation, high costs, and high resource utilization (including sometimes inter-facility transfers from non-hospital settings). Thus, alternative methods of screening for GI dysfunction that do not subject patients to radiation and transport risk are highly desirable. One such emerging option that may help with bedside decision-making is GI point-of-care ultrasound (POCUS). However, utilization of GI POCUS is limited by a lack of training of providers and standardization in image acquisition and interpretation. To address this unmet need, we propose an evidence-based image acquisition protocol using point-of-care ultrasound to screen for two important types of GI dysfunction: ileus or obstruction. This protocol includes guidance on probe selection, patient positioning, and image acquisition sequence. Further, we review image interpretation and the limitations of this protocol.

Patients presenting with abdominal pain and/or distension require rapid diagnostics to narrow the differential diagnosis from a long list of obstructive gastrointestinal (GI) pathologies that may appear clinically similar but warrant distinct management. While the workup of abdominal distension currently centers around computed tomography (CT), this modality is costly, requires radiation exposure, and necessitates patient transport, potentially delaying care. In contrast, point-of-care ultrasound (POCUS) avoids ionizing radiation and the need for patient transport while providing some insight into the gastrointestinal size and function. While POCUS cannot currently replace CT in the definitive diagnosis of GI obstructive pathologies, it remains a promising tool to help with the initial triage and monitoring responses to therapy for several causes of functional and/or mechanical GI obstruction, such as gastric dilation, ileus, and small bowel obstruction. Because the obstruction severity and features can evolve over time, POCUS enables serial examinations to monitor the progression or resolution. This manuscript reviews characteristic sonographic findings that help distinguish obstructive GI conditions and highlights practical techniques for integrating gastric and intestinal POCUS to improve diagnostic accuracy and expedite treatment.

A major risk factor for morbidity and mortality in critical illness is the presence of right ventricular dysfunction (RVD). However, characterizing and grading the severity of RVD remains highly subjective, with significant inter-operator and intra-operator variability and the potential for the inappropriate treatment of patients. To address these issues, this study aimed to synthesize multiple echocardiographic parameters, which have been demonstrated to affect clinical outcomes, into a framework for the comprehensive evaluation of RVD. During the study's first phase, a scoping review of the literature was conducted and identified four routinely obtained echocardiographic findings that had been validated as part of multi-parametric scoring methods for scoring the severity RVD: (1) RV systolic dysfunction; (2) RV dilation; (3) RV-PA uncoupling; and (4) interventricular septal flattening. In the second phase described in the present manuscript, these four echocardiographic findings were operationalized into an image acquisition protocol and integrated into a proposed RVD scoring system compatible with the constraints of either point-of-care or consultative ultrasound workflows.

Patients presenting with abdominal pain require expedited diagnosis and treatment. Computed tomography (CT) scans, which are frequently ordered in the inpatient and emergency departments, have high diagnostic sensitivity and specificity. However, CTs are costly, have radiation exposure, can create hospital workflow inefficiencies, and create a potential safety risk with patient transport. Point-of-care ultrasound (POCUS) use is growing as an efficient, safe, and bedside assessment tool for diagnosing and treating gastrointestinal (GI) pathologies. This manuscript synthesizes key sonographic findings and techniques for a series of important GI pathologies that physicians should recognize: diverticulitis, hernia, appendicitis, intussusception, and intra-abdominal mass.