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JC: Diastolic Dysfunction + POCUS Detecting Unstable Cervical Spine Fractures

This weeks readings:

Sankar, J. et al. Prevalence and Outcome of Diastolic Dysfunction in Children With Fluid Refractory Septic Shock—A Prospective Observational Study. Online Clinical Investigation. November 2014 V:15, N:9 DOI: 10.1097/PCC.0000000000000249 

Questions to Consider:

  • What is diastolic dysfunction and how can we assess it on focused echo? Don’t worry, I needed to read about it too: 
  • How did they define diastolic dysfunction?
  • Why were children on mechanical ventilation excluded? Children with meningococcemia?
  • There was no significant difference in mortality based on presence or type of echo dysfunction - how do you interpret this result in context of the study design?
  • Some patients were on inotropes at the time of echo - how does this affect your interpretation of the study results? What is an inotrope score?
  • You have a patient in fluid-refractory septic shock. POCUS shows a plethoric IVC and diastolic dysfunction. What would you do next?

Deepak Agrawal, T. P. S., and Bhoi, S. Assessment of ultrasound as a diagnostic modality for detecting potentially unstable cervical spine fractures in pediatric severe traumatic brain injury: A feasibility study. J Pediatr Neurosci. 2015 Apr­Jun; 10(2): 119–122. doi: 10.4103/1817­1745.159196 

Questions to Consider:

  • What is a retro-prospective study?
  • How sensitive would POCUS have to be for you to feel comfortable ruling out C-spine injury prior to CT?
  • For the emergency practitioner, what use is ruling in an unstable C-spine injury in a trauma patient?
  • How much do you trust the POCUS interpretations? How blinded was the POCUS operator to pathology? What training did the POCUS operator have?