Browsing by Author "Markus, Nathan"

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    A Novel Approach to Point-of-Care Ultrasound (POCUS) Education: One-page Documents with Embedded E-Curriculum
    (2025-04-25) Markus, Nathan; Brenner, Daniel; Duncan, Francesca; Sanjuan, Adriano; Osborn, Eric; Carlos, Grahm; Jackson; Rishi, Muhammed; Jackson, Edwin
    Background: Point-of-care ultrasound (POCUS) has proven to be a valuable adjunct to the modern physical exam. The gold-standard approach of 1-on-1 learning image acquisition from sonographers and interpretation from clinician-experts is resource intensive, highlighting a need for alternative methods of teaching POCUS. Methods: This educational project utilized iterative development with the help of established POCUS educators and learner feedback in the form of surveys. Pre- and post- 30-day rotation surveys were administered and collected in Microsoft Forms. The survey questions comprised several categories including interest in learning POCUS, technical skill/image acquisition, and confidence in image interpretation. Learners were asked to rate their confidence in image acquisition and interpretation on a 5-level scale from “no skill” to “expert skill” as defined in the figures. Results: Preliminary survey data (n = 14) have been collected. Detailed results available in figures 2 and 3. In summary, 60% of learners were likely/very likely to use POCUS in clinical practice and 40% of learners were unlikely/very unlikely. Pre-intervention, 10% of learners rated their proficiency at image acquisition/probe placement at “no skill”, which decreased to 0% post-intervention. Sufficient skill in image acquisition increased from 20% pre-intervention to 50% post-intervention. Regarding image interpretation, 30% of learners rated skill in identifying anatomy as “no skill” or “little skill”. After the intervention, these groups decreased to 0%. Lastly, all participants felt that they were more confident in identifying cardiac anatomy after engaging with this project. All participants also reported that they would continue to use this resource this to learn POCUS. Conclusions: Learners perceive both value and effectiveness of this educational module. More work must be done to improve objectivity of results including engagement data, competency-based assessments, and randomization against the current standard education model.
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    Leveraging Advanced Cardiac POCUS in the Diagnosis of Infective Endocarditis with Negative Conventional Imaging: A Case Report
    (2025-04) Sanjuan, Adriano; Andrade, Heather; Bundy, Alyson; Clapham, Philip; Markus, Nathan; Brenner, Daniel; Hariri, Irina; Jackson, Edwin
    Introduction. Infective endocarditis (IE) is a life-threatening condition that includes bacteremia and echocardiographic findings. However, many cases yield inconclusive results with transthoracic (TTE) or transesophageal echocardiography (TEE), creating diagnostic challenges. This report highlights the role of advanced cardiac point-of-care ultrasound (POCUS) in addressing these limitations, using daily POCUS exams to address these limitations. Case report. A 68-year-old male with methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and recurrent fevers underwent multiple conventional TTEs and a TEE, that failed to detect valvular vegetations. Advanced cardiac POCUS, including parasternal long-axis (PLAX), parasternal short-axis (PSAX), right ventricular (RV) inflow/outflow, and apical four-chamber views, was performed daily at the bedside. The PLAX view enabled visualization of new onset of aortic regurgitation, and Color Doppler imaging was applied to assess the severity of the valve disfunction. A vegetation in the aortic valve was identified, later confirmed by a consultative TTE and TEE, leading to a change in management. Discussion. This case highlights the utility of advanced cardiac POCUS in diagnosing IE when conventional imaging is inconclusive. Advanced cardiac POCUS offers immediate, bedside diagnostic insights, making it a valuable tool for critically ill patients. Compared to basic cardiac POCUS, the advanced cardiac POCUS includes the RV inflow/outflow (that can be achieved through tilting or fanning of the probe), and use of color Doppler. A study by Hellmann et al. demonstrated that medical residents could achieve significant proficiency with color Doppler, with minimal formal training, aligning with our experience. Despite limitations such as operator dependency and patient characteristics, the integration of advanced cardiac POCUS into diagnostic workflows has the potential to improve diagnostic accuracy and outcomes. Additionally, the case emphasizes the need for advanced cardiac POCUS education among trainees, expanding their ability to address complex clinical scenarios.