array:23 [ "pii" => "S2387020624000263" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.08.011" "estado" => "S300" "fechaPublicacion" => "2024-02-23" "aid" => "6436" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2024;162:190-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775323005833" "issn" => "00257753" "doi" => "10.1016/j.medcli.2023.08.016" "estado" => "S300" "fechaPublicacion" => "2024-02-23" "aid" => "6436" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Med Clin. 2024;162:190-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo especial</span>" "titulo" => "Ecografía a pie de cama. Indicaciones y utilidad en medicina interna" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "190" "paginaFinal" => "196" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Point-of-care ultrasound: Indications and utility in internal medicine" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1697 "Ancho" => 2340 "Tamanyo" => 283767 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Aspecto ecográfico del líquido libre (asteriscos) en varias localizaciones:</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A) líquido peritoneal en el espacio hepatorrenal, en un plano longitudinal sobre la línea axilar media. H: hígado; R: riñón.</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">B) Líquido peritoneal alrededor de la vejiga (V), en un plano transversal suprapúbico.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">C) Derrame pericárdico en un plano de ecocardioscopia subcostal.AD: aurícula derecha; H: hígado; VD: ventrículo derecho; VI: ventrículo izquierdo.</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">D) Derrame pleural en un plano longitudinal a la altura del ángulo costofrénico posterolateral izquierdo, en el que se observa también un área de colapso pulmonar (flechas). Ba: bazo.</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Todos estos planos son ejemplos de algunos de los que se deben obtener durante un examen eFAST.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alejandro Morales-Ortega, Miguel Ángel Duarte-Millán, Jesús Canora-Lebrato, Antonio Zapatero-Gaviria" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Morales-Ortega" ] 1 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "Duarte-Millán" ] 2 => array:2 [ "nombre" => "Jesús" "apellidos" => "Canora-Lebrato" ] 3 => array:2 [ "nombre" => "Antonio" "apellidos" => "Zapatero-Gaviria" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020624000263" "doi" => "10.1016/j.medcle.2023.08.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624000263?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323005833?idApp=UINPBA00004N" "url" => "/00257753/0000016200000004/v1_202402130513/S0025775323005833/v1_202402130513/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2387020624000329" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.08.013" "estado" => "S300" "fechaPublicacion" => "2024-02-23" "aid" => "6434" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;162:197-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Intestinal pseudo-obstruction due to IgG4-related disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "197" "paginaFinal" => "198" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pseudo-obstrucción intestinal por enfermedad relacionada con IgG4" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 556 "Ancho" => 755 "Tamanyo" => 41495 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Peritoneal thickening with radiotracer uptake.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Joan Esplugues Clos, Carlos Feijoo-Massó, Cristina Solé" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Joan" "apellidos" => "Esplugues Clos" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Feijoo-Massó" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "Solé" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624000329?idApp=UINPBA00004N" "url" => "/23870206/0000016200000004/v1_202402182139/S2387020624000329/v1_202402182139/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020624000305" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.09.017" "estado" => "S300" "fechaPublicacion" => "2024-02-23" "aid" => "6446" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Med Clin. 2024;162:182-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Hidradenitis suppurativa" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "182" "paginaFinal" => "189" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hidradenitis supurativa" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1087 "Ancho" => 1634 "Tamanyo" => 151341 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Groin and perineal region involvement. In addition to inflammatory nodules and fistulas/tunnels, the characteristic scarring of hidradenitis suppurativa is seen.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marcos A. González-López" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Marcos A." "apellidos" => "González-López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775323006036" "doi" => "10.1016/j.medcli.2023.09.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323006036?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624000305?idApp=UINPBA00004N" "url" => "/23870206/0000016200000004/v1_202402182139/S2387020624000305/v1_202402182139/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Point-of-care ultrasound: Indications and utility in internal medicine" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "190" "paginaFinal" => "196" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alejandro Morales-Ortega, Miguel Ángel Duarte-Millán, Jesús Canora-Lebrato, Antonio Zapatero-Gaviria" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Alejandro" "apellidos" => "Morales-Ortega" "email" => array:1 [ 0 => "alejandro.morales@salud.madrid.org" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Miguel Ángel" "apellidos" => "Duarte-Millán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Jesús" "apellidos" => "Canora-Lebrato" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Antonio" "apellidos" => "Zapatero-Gaviria" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ecografía a pie de cama. Indicaciones y utilidad en medicina interna" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2791 "Ancho" => 2925 "Tamanyo" => 577339 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Examples of the most common ultrasound modalities.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A) B-mode provides a two-dimensional grey-scale image of anatomical structures: in the example, a kidney with hydronephrosis (sagittal plane). B) The image generated by M-mode represents the movement, over time, of the structures traversed by an ultrasound beam, which is useful, for example, to assess changes in the diameter of the inferior vena cava (asterisk) with breathing. C) With colour Doppler, moving fluids (usually blood) are coloured; the panel shows a transverse view of the liver in which, thanks to this modality, the blood vessels can be distinguished from the dilated bile duct, which is not coloured (arrows). Doppler analysis also makes it possible to calculate the velocity of the fluid, either along an entire ultrasound beam (continuous Doppler) or at a specific point in the beam (pulsed Doppler). D) 4-chamber apical focused cardiac ultrasound view in which the velocity of the tricuspid valve regurgitation jet (arrow) is measured by continuous Doppler to estimate pulmonary systolic pressure. E) Sagittal plane of an internal carotid artery in which blood flow velocity is measured by pulsed Doppler as it passes through an area with a calcified atherosclerotic plaque (asterisk) to assess the existence of significant stenosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">During the 1940s, the Austrian neurologist and psychiatrist Karl Theodore Dussik unveiled his idea of using ultrasound (already used at that time as a method of underwater localisation) to explore the brain. By assessing the transmission of these waves through the skull, he obtained a series of images which he interpreted – erroneously – as representing the ventricles of the brain.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> After his assumption was proved wrong, systems based on the study of ultrasound reflection<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> began to be used successfully in the following years, and thanks to the advent of various technical improvements, ultrasonography, or ultrasound, was incorporated into clinical practice, initially in the fields of cardiology, gynaecology and radiodiagnosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, it was in the 1990s when its use began to spread to other medical specialties and different healthcare scenarios due to two characteristics that ultrasound equipment had acquired by then: the capacity to obtain images in real time and the ability to move the ultrasound equipment from one place to another with a certain degree of ease.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is in this context that point-of-care ultrasound emerged, and its use and applications, as well as the interest it arouses in the medical community, continue to grow exponentially, and will most likely continue to do so as a result of the development of smaller and smaller portable equipment and artificial intelligence. This article reviews the indications, advantages and limitations of this technique, as well as the objectives to be achieved to achieve its safe and effective implementation in the field of internal medicine.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Point-of-care ultrasound definition and characteristics</span><p id="par0010" class="elsevierStylePara elsevierViewall">Point-of-care ultrasound (POCUS), also known as clinical ultrasound, can be defined as ultrasound performed and interpreted by the physician at the patient’s site,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> as opposed to conventional ultrasound scanning, which is typically performed by a specialist (radiologist, cardiologist, <span class="elsevierStyleItalic">etc</span>.) in a dedicated room. However, point-of-care ultrasound is not limited to this, but has additional characteristics that help to define it more precisely<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0015" class="elsevierStylePara elsevierViewall">Within the diagnostic process, the aim is not so much to constitute a complementary test to be carried out after the history-taking and physical examination, but rather to form part of the latter.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0020" class="elsevierStylePara elsevierViewall">Each scan is performed in a focused, targeted manner; selected structures are assessed to answer one or more predefined clinical questions. In contrast, conventional ultrasound usually provides a complete description of all the findings identified in a systematised and comprehensive evaluation of an organ or anatomical region.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall">The information obtained with point-of-care ultrasound provides immediacy: it makes it possible to modify the clinical approach and make medical decisions at the time of the scan, shortening waiting times and sometimes speeding up diagnoses, a factor of great impact, especially in time-dependent diseases.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">Acquired images are not always saved, and a separate report of the results is often not prepared; instead, they are usually recorded in the medical records as part of the patient’s examination. Even so, the European Federation of Internal Medicine (EFIM) Ultrasound Working Group recommends storing the images as far as possible and specifying in the medical record that the ultrasound was performed by an internist.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Along these lines, the American College of Emergency Physicians offers guidelines for standardised reporting of clinical ultrasound.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></li></ul></p><p id="par0035" class="elsevierStylePara elsevierViewall">For all these reasons, point-of-care ultrasound should not be considered as a substitute for the regular ultrasound performed by a specialist, but as a tool that complements the clinician’s physical examination and allows him/her to make decisions in real time regarding therapeutic measures, requesting complementary tests and performing invasive procedures.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> Depending on the question he/she seeks to answer, the professional may need different ultrasound modalities, which are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Utility and indications of point-of-care ultrasound in internal medicine</span><p id="par0040" class="elsevierStylePara elsevierViewall">The clinical essence, multidisciplinary and global nature of internal medicine make it one of the specialties in which point-of-care ultrasound has the greatest number of uses and areas of application: it can be used in the emergency department, hospital wards, clinics – including specialty consultations – and even in non-hospital contexts (home hospitalisation, nursing homes, <span class="elsevierStyleItalic">etc</span>.).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Basically, the uses of point-of-care ultrasound in internal medicine can be divided into 3 main groups:</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis: complementary to physical examination</span><p id="par0045" class="elsevierStylePara elsevierViewall">Several studies endorse the benefits of ultrasound as a complement to physical examination, as it makes it possible to identify pathological states and assess certain organs with greater precision.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> In fact, with the development of “pocket-sized” devices, some authors have equated the incorporation of clinical ultrasound into medical practice with the advent of the stethoscope,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and it has even been suggested that “insonation” should be established as an additional element of routine physical examination.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the main possible uses of clinical ultrasound in internal medicine; however, due to their peculiarities and relevance, it is worth mentioning 2 of its areas in more detail: lung ultrasound and focused cardiac ultrasound.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Lung ultrasound</span><p id="par0055" class="elsevierStylePara elsevierViewall">Traditionally, the lung has been considered a poorly assessable organ by ultrasound since air is a poor ultrasound conductor. However, in the 1990s, Lichtenstein and his team, by studying critically ill patients, classified and named the main artefacts that ultrasound generates when reaching the lung surface. Based on the presence or absence of pleural sliding, A lines, B lines, consolidations and pleural effusion, they defined the ultrasound patterns of different conditions, such as pneumothorax, interstitial lung involvement, airway diseases, atelectasis and lung consolidations.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Lung ultrasound, having been developed primarily by clinicians in routine practice rather than in research centres or radiodiagnostic wards, is a very illustrative example of the benefits of point-of-care ultrasound in the diagnostic process. Furthermore, this technique has been of particular interest recently in the wake of the emergence of the 2019 coronavirus disease (COVID-19), as it allows the attending physician to assess <span class="elsevierStyleItalic">in situ</span>, and quite accurately, the respiratory involvement typical of the type 2 coronavirus causing severe acute respiratory syndrome (SARS). This is particularly useful in a context similar to the pandemic, as it reduces travel to radiodiagnostic areas for other imaging tests (<span class="elsevierStyleItalic">e.g.</span> computed tomography), thus helping to shorten waiting times for medical decisions and to reduce the risk of healthcare worker infection.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Focused cardiac ultrasound</span><p id="par0060" class="elsevierStylePara elsevierViewall">The heart, on the other hand, was one of the first organs to be evaluated by ultrasound.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The cardiac echocardiography, performed by cardiologists, is a widely developed technique, which allows not only structural assessment of the heart, but also estimation of haemodynamic variables. Although extremely useful, it can be very complex: to reach an advanced level requires several months or even years of training and hundreds of scans.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> However, it is possible to perform a simpler and more targeted assessment that meets the characteristics of point-of-care ultrasound, which has been termed <span class="elsevierStyleItalic">focused cardiac ultrasound.</span><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This allows assessment of key cardiac features (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) that facilitate diagnosis in various clinical scenarios: patient with chest pain, dyspnoea, arterial hypotension, <span class="elsevierStyleItalic">etc</span>.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In contrast to standard echocardiography, focused cardiac ultrasound uses a smaller number of views (between 2 and 4, the most useful being the parasternal long axis and apical 4-chamber) and ultrasound modalities (B-mode and colour Doppler are usually sufficient); Moreover, its diagnostic value is fundamentally qualitative (for example, it does not seek to estimate the specific value of the left ventricle ejection fraction or to obtain exact measurements of the cardiac cavities, but rather to determine whether or not the former is diminished, or whether or not there is dilatation of the latter)<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>. Focused cardiac ultrasound is a very versatile scan, capable of providing multiple useful data, which is why it is included in several multiorgan ultrasound protocols (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Although it is one of the most training-intensive types of point-of-care ultrasound, it is estimated that the skills needed to achieve the basic objectives of this technique can be obtained after performing 50 supervised studies.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">As it is not restricted to a single anatomical territory, point-of-care ultrasound allows the same doctor to perform a multi-organ assessment in specific clinical scenarios (which is particularly interesting for the internist, given his or her global vision of the patient). Some of these examinations have been standardised in specific protocols. The best known and most studied is probably the <span class="elsevierStyleItalic">focused assessment with sonography for trauma</span> (FAST) protocol, whose usefulness in the management of the polytrauma patient is recognised by the <span class="elsevierStyleItalic">Advanced Trauma Life Support</span> programme.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows some examples of this type of studies, although it should be noted that multi-organ ultrasound can be helpful in other scenarios, such as fever without focus, renal failure, certain systemic autoimmune diseases, <span class="elsevierStyleItalic">etc</span>.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,15</span></a></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Monitoring the patient’s clinical condition</span><p id="par0070" class="elsevierStylePara elsevierViewall">The accessibility of point-of-care ultrasound, the speed with which it can be performed and the immediacy of its results mean that it can be repeated more often than other imaging tests (even daily, or several times in the same day), thus constituting a way of monitoring the patient’s medical progression, something unfeasible with regulated studies. In this sense, it is particularly useful for assessing parameters that can change rapidly, such as those related to the patient’s haemodynamic status and extravascular volume<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> (<span class="elsevierStyleItalic">e.g.</span> FAST/eFAST (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) can be repeated several times during the assessment of the polytrauma patient,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> or to monitor the degree of congestion in heart failure and right ventricular function in pulmonary thromboembolism). It has also been suggested that clinical ultrasound could help guide fluid resuscitation in sepsis or <span class="elsevierStyleItalic">shock</span>,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and may even be useful during cardiac arrest<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,19</span></a> or for monitoring respiratory status in COVID-19.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Guidance on performing invasive procedures</span><p id="par0075" class="elsevierStylePara elsevierViewall">A number of invasive techniques – diagnostic or therapeutic – become easier to perform with point-of-care ultrasound. These can be carried out by the internist (usually centesis), either by determining the puncture site, as well as the angle and depth of the puncture, by means of a scan prior to the procedure, or by allowing real-time monitoring of the needle position.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Thoracentesis and abdominocentesis are among the procedures that benefit most from ultrasound guidance, as recommended by several guidelines.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,21</span></a> Several studies have shown that such guiding improves success rates and, above all, reduces adverse events (mainly pneumothorax in thoracentesis and haemorrhage in abdominocentesis, although it may also reduce the risk of puncturing the liver, spleen or intestinal loops).<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,21</span></a> In addition, clinical ultrasound can be used in arthrocentesis to choose the best puncture site and avoid potentially injured structures (tendons, blood vessels and nerves).<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> It has also been postulated that it may be able to facilitate lumbar punctures, especially in those patients in whom anatomical assessment of the spine by palpation is difficult.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Although it is not often the internist who cannulates vascular accesses, it is well known that real-time ultrasound guidance provides a clear benefit in the placement of arterial and central venous catheters (especially in the case of the internal jugular vein) and is therefore recommended whenever possible. In addition, it can also be useful in peripheral deep venous catheterization or those that are difficult to catheterize.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Finally, it should be noted that, in general, it is estimated that the skills required to use point-of-care ultrasound to guide invasive procedures are acquired more quickly than those required to use it for diagnostic purposes, with as few as 10 procedures being sufficient.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Point-of-care ultrasound training: position papers of medical societies and accreditation of clinical ultrasound units</span><p id="par0095" class="elsevierStylePara elsevierViewall">Although the many advantages of point-of-care ultrasound for the internist are now widely recognised, it is particularly important to regulate its training, as it is highly dependent on the examiner who both performs and interprets it.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Although it can be performed in a few minutes in a seemingly simple manner, a variety of skills are required to perform it properly. The examiner must not only have medical knowledge (which allows him/her to decide when and for what purpose to perform the ultrasound, as well as to integrate the information obtained into the diagnostic and therapeutic process of the patient); he/she must also be familiar with basic aspects of the nature of ultrasound and the handling of ultrasound equipment, know which ultrasound views and modalities to use, be able to obtain quality images and know the normal anatomy and the main ultrasound artefacts and pathological signs.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,10,25</span></a> Therefore, it is essential for the internist to have specific training in point-of-care ultrasound before incorporating it into his or her daily practice, as doing so without the appropriate qualifications may lead to misdiagnosis and patient harm.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,25</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Although numerous training programmes and courses have emerged in recent years (some of which are listed in Appendix A Supplementary material), there is still no single consensus on what specific competencies are sufficient to apply clinical ultrasound in internal medicine and how to acquire them. However, various medical organisations have attempted to define and standardise these aspects. Thus, in a position paper published in 2020, the EFIM Ultrasound Working Group established core competencies in point-of-care ultrasound, which represent, in most cases, medically relevant questions that can be answered in a dichotomous way after a relatively short training.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> These competencies consist of being able to detect the presence or absence of: serous fluid, evidence of pulmonary congestion, dilated cardiac ventricles, severe ventricular dysfunction, splenomegaly, cholelithiasis, bile duct dilatation, palpable abdominal masses (and whether their contents are solid or liquid), hydronephrosis, urinary retention, small bowel dilatation, abdominal aortic aneurysms and proximal deep vein thrombosis in the lower limbs; In addition, correct bladder catheterisation and ultrasound-guided invasive techniques (thoracentesis, abdominocentesis, puncture of peripheral veins and arteries and central venous catheterisation) should be assessed.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Point-of-care ultrasound training should include both a theoretical and a practical part. The latter, which is usually based on performing ultrasound studies on real patients, is essential. In fact, its duration is one of the most important parameters defining training programmes (as it is a reflection of the difficulty of the technique they intend to teach) and is usually expressed in units of time or in the number of scans that need to be performed. However, there is no single criterion on this point either.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,25</span></a> The EFIM recommends the completion of 150 supervised studies over 1–6 months to achieve the core competencies described in its position paper.</p><p id="par0110" class="elsevierStylePara elsevierViewall">This document also specifies that national medical societies should be involved in the development and implementation of specific programmes to ensure the acquisition of these competencies, which, ideally, should be incorporated into the conventional training itinerary of residents.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The Spanish Society of Internal Medicine (SEMI) published a position paper in 2018 to address this issue.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> It estimates the minimum number of supervised studies necessary to acquire the main competencies in this technique. In general terms, these could be achieved with a minimum of 20 scans, except in 2 cases: biliary tract assessment and, above all, focused cardiac ultrasound. These are more difficult and would require 30–50 scans. In addition, a clinical ultrasound rotation model is proposed for residents and internal medicine specialists: optimally, they should perform 150 examinations for 1–2 months, each of which should include at least abdominal ultrasound, pulmonary ultrasound and focused cardiac ultrasound.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Finally, the need to include point-of-care ultrasound in the official internal medicine syllabus in Spain is recognised, since the current syllabus (published in the Official State Gazette in 2007) does not refer to this technique.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However, the new training programme for the speciality (currently pending approval by the Ministry of Health)<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> will include specific competencies in clinical ultrasound, in line with the European curriculum for internal medicine.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The incorporation of clinical ultrasound into internal medicine departments can follow different organisational models, such as having common ultrasound scanners for generalised use, designating referring physicians to perform the examinations or creating specialty units. Since 2020, SEMI has also been responsible for granting accreditations that certify the care, teaching and research work of the clinical ultrasound units within internal medicine departments. This accreditation is granted for care purposes, teaching purposes (the unit is able to train residents from other centres) or advanced teaching purposes (it can train residents and internists from other hospitals). Information on certification requirements and how to apply for certification can be found on the SEMI Clinical Ultrasound Working Group website (<a href="https://www.fesemi.org/grupos/ecografia/acreditaciones">https://www.fesemi.org/grupos/ecografia/acreditaciones</a>), which also contains the list of centres that have obtained this accreditation.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Despite these efforts to establish standards in point-of-care ultrasound training (to which consensus documents between the SEMI and other Spanish medical societies should be added),<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,27</span></a> there is still a long way to go and issues to be addressed in this field, such as the definitive inclusion of clinical ultrasound in the official internal medicine speciality programme in our country, the introduction of training in this technique during undergraduate studies, the standardisation of competence acquisition assessment systems and the development of continuous training and knowledge updating programmes, as it is well known that ultrasound skills decline over time if they are not exercised on a regular basis.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,25</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Point-of-care ultrasound limitations</span><p id="par0125" class="elsevierStylePara elsevierViewall">Despite its benefits, clinical ultrasound is not without certain limitations. Firstly, it should never be considered a substitute for history-taking and physical examination – essential pillars of internal medicine – but rather a complement to the latter; its findings should always be interpreted within the context built from the medical record of each patient.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Secondly, although learning curves for this technique are feasible, the examiner must have acquired the necessary skills to avoid harming the patient (during the performance of an invasive procedure or as a result of a misdiagnosis). To ensure this, further progress in the standardisation of training programmes, assessment methods and accreditation systems is essential.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,19</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">On the other hand, although several studies support the diagnostic advantages of clinical ultrasound, there is as yet no robust evidence to confirm that it actually leads to a reduction in patient morbidity and mortality.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,19</span></a> Furthermore, from a methodological point of view, it is not easy to design prospective studies that evaluate diagnostic clinical ultrasound. This is largely due to differences in scanning protocols, examiner training, equipment used and the clinical settings in which the technique is applied,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> which is an additional reason to continue striving for standardisation in all these areas.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Finally, more material issues, such as lack of appropriate equipment or time to perform ultrasound examinations due to care overload, may hinder the implementation of point-of-care ultrasound.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However, the increasing availability of portable equipment and transducers that can be connected to mobile devices helps to mitigate these problems.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,10,19</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Future prospects</span><p id="par0140" class="elsevierStylePara elsevierViewall">Pocket-sized ultrasound devices, accessible and capable of obtaining good quality images, are no longer a matter of the future, but a reality.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Although their use is not yet fully widespread (it is not common for every internist to have one), it is likely to become more widespread over time, which would help to facilitate point-of-care ultrasound examinations, especially in care settings other than the hospital or health centre.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Clinical ultrasound can also be integrated into telemedicine systems. In this way, an expert could guide the performance of the ultrasound (indicating to the examiner how to position the probe to obtain better views and directly adjusting parameters such as gain or image depth) and assist in its interpretation.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Finally, one of the fields currently attracting most attention, due to its immense potential, is the implementation of artificial intelligence in diagnostic imaging, including ultrasound. In this sense, systems have been developed that are able to recognise and point out the structures that are being visualised, as well as providing real-time instructions to the examiner about which movements to make with the probe in order to achieve optimal views, even enabling untrained personnel to obtain good quality images.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> The application of artificial intelligence is not limited to improving imaging but is potentially capable of assisting in taking measurements (or taking them automatically), identifying pathological findings and guiding diagnoses.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> This technology could also contribute to the standardisation of ultrasound examinations, which would not only be of benefit to healthcare, but also to teaching and research.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">Point-of-care ultrasound is already a very useful tool for the internist, complementing his or her physical examination in a quick and relatively simple way. It helps to improve the diagnostic process, assists in real-time clinical decision-making and facilitates invasive procedures. Moreover, as it is a more focused examination than standard ultrasound scans, it requires less time-consuming training.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Currently, many internal medicine departments already have equipment for point-of-care ultrasound, and it is expected that this technique will be increasingly integrated into routine clinical practice, given the greater availability of portable devices and the growing interest among internists. Similar to other newly emerging technologies, its expansion has preceded the development of a regulatory framework defining its specific indications and objectives, the skills required and the training necessary to acquire them. For this reason, over the last few years various medical societies have been making an effort to specify and standardise these aspects, which is necessary for the appropriate application of clinical ultrasound in the fields of care, teaching and research.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Therefore, the main question today about clinical ultrasound is not whether or not internists should use it, but to ensure that they are properly trained to do so safely and reliably. In any case, it is crucial to bear in mind that this technique is a complement and not a substitute for the existing Internal Medicine methods, and that it should always be used in line with the clinical essence of our specialty, which is precisely what ultimately differentiates point-of-care ultrasound from other types of ultrasounds.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">This article has not been funded in any way.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflict of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest in relation to this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Point-of-care ultrasound definition and characteristics" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Utility and indications of point-of-care ultrasound in internal medicine" "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0020" "titulo" => "Diagnosis: complementary to physical examination" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Lung ultrasound" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Focused cardiac ultrasound" ] ] ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Monitoring the patient’s clinical condition" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Guidance on performing invasive procedures" ] ] ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Point-of-care ultrasound training: position papers of medical societies and accreditation of clinical ultrasound units" ] 4 => array:2 [ "identificador" => "sec0050" "titulo" => "Point-of-care ultrasound limitations" ] 5 => array:2 [ "identificador" => "sec0055" "titulo" => "Future prospects" ] 6 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusions" ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Funding" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-07-04" "fechaAceptado" => "2023-08-26" "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0185" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0080" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2791 "Ancho" => 2925 "Tamanyo" => 577339 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Examples of the most common ultrasound modalities.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A) B-mode provides a two-dimensional grey-scale image of anatomical structures: in the example, a kidney with hydronephrosis (sagittal plane). B) The image generated by M-mode represents the movement, over time, of the structures traversed by an ultrasound beam, which is useful, for example, to assess changes in the diameter of the inferior vena cava (asterisk) with breathing. C) With colour Doppler, moving fluids (usually blood) are coloured; the panel shows a transverse view of the liver in which, thanks to this modality, the blood vessels can be distinguished from the dilated bile duct, which is not coloured (arrows). Doppler analysis also makes it possible to calculate the velocity of the fluid, either along an entire ultrasound beam (continuous Doppler) or at a specific point in the beam (pulsed Doppler). D) 4-chamber apical focused cardiac ultrasound view in which the velocity of the tricuspid valve regurgitation jet (arrow) is measured by continuous Doppler to estimate pulmonary systolic pressure. E) Sagittal plane of an internal carotid artery in which blood flow velocity is measured by pulsed Doppler as it passes through an area with a calcified atherosclerotic plaque (asterisk) to assess the existence of significant stenosis.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1697 "Ancho" => 2340 "Tamanyo" => 283767 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ultrasound appearance of free fluid (asterisks) at various locations.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A) Peritoneal fluid in the hepatorenal space, in a sagittal plane on the mid axillary line. L: liver; K: kidney.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">B) Peritoneal fluid around the bladder (B), in a transverse suprapubic plane.</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">C) Pericardial effusion in a subcostal focused cardiac ultrasound plane. RA: right atrium; L: liver; RV: right ventricle; LV: left ventricle.</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">D) Pleural effusion in a sagittal plane at the level of the left posterolateral costophrenic angle, also showing an area of lung collapse (arrows). Sp: spleen.</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">All of these are examples of some of the planes that should be obtained during an eFAST exam.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Source: adapted from Torres Macho et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Lung and pleura</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Assessment of pleural disease: pneumothorax and pleural effusion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Detection of parenchymal consolidation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Assessment of interstitium disorders (interstitial lung disease, heart failure) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Heart and pericardium (focused cardiac ultrasound)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Detection of pericardial effusion and cardiac tamponade data \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Assessment of the size of the cardiac chambers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Assessment of left ventricular ejection fraction (reduced or preserved) and suspicion of diastolic dysfunction \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Identification of signs of right ventricular overload \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Approach to valvular disease: potentially relevant regurgitations and stenosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Abdomen</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Detection of free peritoneal fluid \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hepatic assessment: size, steatosis, evidence of chronic liver disease and portal hypertension, detection of focal lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Assessment of biliary disease: cholelithiasis, cholecystitis, bile duct dilatation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Spleen size assessment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Renal assessment: size, corticomedullary differentiation, hydronephrosis. Detection of clinically significant nephrolithiasis. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bladder assessment: urine retention and bladder catheterisation. Suspected bladder lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Identification of dilated bowel loops in intestinal obstruction \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Blood vessels and Doppler studies</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Detection of deep vein thrombosis in the limbs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Detection of aortic aneurysms \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Haemodynamic and venous congestion assessment: inferior vena cava, internal jugular and splanchnic veins \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Approach to peripheral arterial disease and vascular risk: identification of atheroma plaques and suspicion of significant stenosis, carotid intima-media thickness assessment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Assessment of large vessel arteritis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Soft tissues, muscle and joints</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Detection of thyroid nodules \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Morphology study of major salivary glands (Sjögren’s syndrome) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Identification of lymphadenopathy suspicious for malignancy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Assessment of oedema in subcutaneous cellular tissue. Detection of abscesses and haematomas. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Complementary to nutritional and vascular risk assessment: estimation of sarcopenia, assessment of subcutaneous, preperitoneal and visceral fat. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Detection of joint effusion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Assistance in invasive procedures</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peripheral and central venous catheterization \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Abdominocentesis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Thoracocentesis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arthrocentesis \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3462447.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Point-of-care ultrasound use in internal medicine.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Examination/protocol \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Structures examined \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Utility \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FAST <span class="elsevierStyleItalic">(focused assessment with sonography for trauma</span>)<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pericardium (subxiphoid space), hepatorenal and splenorenal spaces and pelvis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Detect post-traumatic pericardial effusion/cardiac tamponade and intraperitoneal free fluid \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">eFAST (<span class="elsevierStyleItalic">extended FAST</span>)<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lung ultrasound (posterior costophrenic recess and midclavicular line) is added to the FAST exam. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adds the possibility of detecting pneumothorax and pleural effusion to the FAST scan. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BLUE <span class="elsevierStyleItalic">(bedside lung ultrasound in emergency)</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lung ultrasound (6 areas of the chest wall) and deep venous system of the lower extremities. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Facilitating the diagnosis of the patient with acute respiratory failure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RUSH <span class="elsevierStyleItalic">(rapid ultrasound in shock)</span><a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Focused cardiac ultrasound (4 planes), lung and abdominal ultrasound (FAST), inferior vena cava/internal jugular vein, aorta and deep venous system of lower limbs. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Facilitating the diagnosis of the patient with haemodynamic instability \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CAUSE <span class="elsevierStyleItalic">(cardiac arrest ultrasound exam)</span><a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Focused cardiac ultrasound (single plane) and anterior lung ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Facilitating diagnosis of the cause of cardiac arrest with pulseless electrical activity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VExUS <span class="elsevierStyleItalic">(venous excess ultrasound)</span><a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inferior vena cava and flow assessment (pulsed Doppler) of portal, suprahepatic and intrarenal veins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Assessing and quantifying the degree of venous congestion \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3462448.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Examples of protocolised multiorgan point-of-care ultrasound examinations.</p>" ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 16503 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physics and engineering: milestones in medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Wells" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s1350-4533(01)00042-x" "Revista" => array:6 [ "tituloSerie" => "Med Eng Phys" "fecha" => "2001" "volumen" => "23" "paginaInicial" => "147" "paginaFinal" => "153" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11410379" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.L. Moore" 1 => "J.A. Copel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra0909487" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "364" "paginaInicial" => "749" "paginaFinal" => "757" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21345104" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mapping the ultrasound landscape to define point-of-care ultrasound and diagnostic ultrasound: a proposal from the Society of Radiologists in ultrasound and ACR Commission on ultrasound" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.D. Patel" 1 => "M.M. Horrow" 2 => "A. Kamaya" 3 => "M.C. Frates" 4 => "N. Dahiya" 5 => "L. Golding" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacr.2020.09.013" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Radiol" "fecha" => "2021" "volumen" => "18" "paginaInicial" => "42" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33007309" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Time to add a fifth pillar to bedside physical examination: inspection, palpation, percussion, auscultation, and insonation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Narula" 1 => "Y. Chandrashekhar" 2 => "E. Braunwald" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamacardio.2018.0001" "Revista" => array:6 [ "tituloSerie" => "JAMA Cardiol" "fecha" => "2018" "volumen" => "3" "paginaInicial" => "346" "paginaFinal" => "350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29490335" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care ultrasound in internal medicine: a position paper by the ultrasound working group of the European federation of internal medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Torres-Macho" 1 => "T. Aro" 2 => "I. Bruckner" 3 => "C. Cogliati" 4 => "O.H. Gilja" 5 => "A. Gurghean" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejim.2019.11.016" "Revista" => array:6 [ "tituloSerie" => "Eur J Intern Med" "fecha" => "2020" "volumen" => "73" "paginaInicial" => "67" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31836177" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emergency Ultrasound Standard Reporting Guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "American College of Emergency Physicians" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.acep.org/siteassets/uploads/uploaded-files/acep/clinical-and-practice-management/policy-statements/information-papers/emergency-ultrasound-standard-reporting-guidelines---2018.pdf" "fecha" => "2018" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Torres Macho" 1 => "F.J. García Sánchez" 2 => "P. Garmilla Ezquerra" 3 => "L. Beltrán Romero" 4 => "J. Canora Lebrato" 5 => "J.M. Casas Rojo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2018.02.001" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp (Barc)" "fecha" => "2018" "volumen" => "218" "paginaInicial" => "192" "paginaFinal" => "198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29519537" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento de consenso de SEMI, semFYC, SEN y SEC sobre ecocardioscopia en España" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Pérez de Isla" 1 => "S. Díaz Sánchez" 2 => "J. Pagola" 3 => "G. García de Casasola Sánchez" 4 => "T. López Fernández" 5 => "I.M. Sánchez Barrancos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Española Cardiol" "fecha" => "2018" "volumen" => "71" "paginaInicial" => "935" "paginaFinal" => "940" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care cardiac ultrasound techniques in the physical examination: better at the bedside" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.J. Kimura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/heartjnl-2016-309915" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2017" "volumen" => "103" "paginaInicial" => "987" "paginaFinal" => "994" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28259843" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care ultrasonography for primary care physicians and general internists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Bhagra" 1 => "D.M. Tierney" 2 => "H. Sekiguchi" 3 => "N.J. Soni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.mayocp.2016.08.023" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "2016" "volumen" => "91" "paginaInicial" => "1811" "paginaFinal" => "1827" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27825617" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.A. Lichtenstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.14-1313" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2015" "volumen" => "147" "paginaInicial" => "1659" "paginaFinal" => "1670" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26033127" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care lung ultrasound assessment for risk stratification and therapy guiding in COVID-19 patients: a prospective noninterventional study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Rubio-Gracia" 1 => "I. Giménez-López" 2 => "V. Garcés-Horna" 3 => "D. López-Delgado" 4 => "J.L. Sierra-Monzón" 5 => "L. Martínez-Lostao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.04283-2020" "Revista" => array:5 [ "tituloSerie" => "Eur Respir J" "fecha" => "2021" "volumen" => "58" "paginaInicial" => "2004283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33574074" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Task force 4: training in echocardiography endorsed by the American Society of Echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Ryan" 1 => "W.F. Armstrong" 2 => "B.K. Khandheria" 3 => "American Society of Echocardiography" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2007.11.012" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2008" "volumen" => "51" "paginaInicial" => "361" "paginaFinal" => "367" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18206753" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advanced Trauma Life Suupport® Student Course Manual. Décima edición" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "American College of Surgeons Committee on Trauma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2018" "editorial" => "American College of Surgeons" "editorialLocalizacion" => "Chicago (IL)" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "en representación del Grupo de Trabajo de Ecografía Clínica y del Grupo de Trabajo de Enfermedades Autoinmunes Sistémicas de la Sociedad Española de Medicina Interna Ecografía clínica en las enfermedades autoinmunes sistémicas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Serralta San Martín" 1 => "J. Canora Lebrato" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Clin Esp (Barc)" "fecha" => "2020" "volumen" => "220" "paginaInicial" => "297" "paginaFinal" => "304" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The RUSH exam: rapid ultrasound in shock in the evaluation of the critically ill" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Perera" 1 => "T. Mailhot" 2 => "D. Riley" 3 => "D. Mandavia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.emc.2009.09.010" "Revista" => array:6 [ "tituloSerie" => "Emerg Med Clin North Am" "fecha" => "2010" "volumen" => "28" "paginaInicial" => "29" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19945597" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "C.A.U.S.E.: cardiac arrest ultra-sound exam—a better approach to managing patients in primary non-arrhythmogenic cardiac arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Hernandez" 1 => "K. Shuler" 2 => "H. Hannan" 3 => "C. Sonyika" 4 => "A. Likourezos" 5 => "J. Marshall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2007.06.033" "Revista" => array:6 [ "tituloSerie" => "Resuscitation" "fecha" => "2008" "volumen" => "76" "paginaInicial" => "198" "paginaFinal" => "206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17822831" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W. Beaubien-Souligny" 1 => "P. Rola" 2 => "K. Haycock" 3 => "J. Bouchard" 4 => "Y. Lamarche" 5 => "R. Spiegel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13089-020-00163-w" "Revista" => array:5 [ "tituloSerie" => "Ultrasound J" "fecha" => "2020" "volumen" => "12" "paginaInicial" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32270297" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-Care ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. Díaz-Gómez" 1 => "P.H. Mayo" 2 => "S.J. Koenig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra1916062" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2021" "volumen" => "385" "paginaInicial" => "1593" "paginaFinal" => "1602" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34670045" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations on the use of ultrasound guidance for adult abdominal paracentesis: a position statement of the society of hospital medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Cho" 1 => "T.P. Jensen" 2 => "K. Reierson" 3 => "B.K. Mathews" 4 => "A. Bhagra" 5 => "R. Franco-Sadud" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Hosp Med" "fecha" => "2019" "volumen" => "14" "paginaInicial" => "E7" "paginaFinal" => "E15" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations on the use of ultrasound guidance for adult thoracentesis: a position statement of the society of hospital medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Dancel" 1 => "D. Schnobrich" 2 => "N. Puri" 3 => "R. Franco-Sadud" 4 => "J. Cho" 5 => "L. Grikis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Hosp Med" "fecha" => "2018" "volumen" => "13" "paginaInicial" => "126" "paginaFinal" => "135" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound should be considered for all arthrocentesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Gottlieb" 1 => "S. Alerhand" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annemergmed.2019.04.018" "Revista" => array:6 [ "tituloSerie" => "Ann Emerg Med" "fecha" => "2020" "volumen" => "75" "paginaInicial" => "261" "paginaFinal" => "262" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31959309" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Better with ultrasound: lumbar puncture" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.J. Millington" 1 => "M. Silva Restrepo" 2 => "S. Koenig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2018.07.010" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2018" "volumen" => "154" "paginaInicial" => "1223" "paginaFinal" => "1229" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30036497" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. Troianos" 1 => "G.S. Hartman" 2 => "K.E. Glas" 3 => "N.J. Skubas" 4 => "R.T. Eberhardt" 5 => "J.D. Walker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.echo.2011.09.021" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Echocardiogr" "fecha" => "2011" "volumen" => "24" "paginaInicial" => "1291" "paginaFinal" => "1318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22115322" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emergency point-of-care ultrasound stewardship — a joint position paper by EuSEM and EFSUMB and endorsed by IFEM and WFUMB" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Osterwalder" 1 => "S. Tabakovic" 2 => "C. Jenssen" 3 => "C.F. Dietrich" 4 => "J. Connolly" 5 => "E. Polyzogopoulou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/a-2041-3302" "Revista" => array:2 [ "tituloSerie" => "Ultraschall Med" "fecha" => "2023" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El nuevo programa formativo de Medicina Interna" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.A. Vargas-Núñez" 1 => "M. Aranda-Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rceng.2023.05.002" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp (Barc)" "fecha" => "2023" "volumen" => "223" "paginaInicial" => "329" "paginaFinal" => "330" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37182727" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Sociedad Española de Medicina Interna (SEMI) y Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) para la definición de competencias mínimas de ecograf" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Vives" 1 => "A. Hernández" 2 => "A. González" 3 => "J. Torres" 4 => "P. Cuesta" 5 => "T. Villen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2021" "volumen" => "68" "paginaInicial" => "143" "paginaFinal" => "148" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Handheld Point-of-Care ultrasound probes: the new generation of POCUS" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Baribeau" 1 => "A. Sharkey" 2 => "O. Chaudhary" 3 => "S. Krumm" 4 => "H. Fatima" 5 => "F. Mahmood" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jvca.2020.07.004" "Revista" => array:6 [ "tituloSerie" => "J Cardiothorac Vasc Anesth" "fecha" => "2020" "volumen" => "34" "paginaInicial" => "3139" "paginaFinal" => "3145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32736998" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utility of a deep-learning algorithm to guide novices to acquire echocardiograms for limited diagnostic use" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Narang" 1 => "R. Bae" 2 => "H. Hong" 3 => "Y. Thomas" 4 => "S. Surette" 5 => "C. Cadieu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA Cardiol" "fecha" => "2021" "volumen" => "6" "paginaInicial" => "624" "paginaFinal" => "632" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Artificial Intelligence (AI)-empowered echocardiography interpretation: a state-of-the-art review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Akkus" 1 => "Y.H. Aly" 2 => "I.Z. Attia" 3 => "F. Lopez-Jimenez" 4 => "A.M. Arruda-Olson" 5 => "P.A. Pellikka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/jcm10071391" "Revista" => array:5 [ "tituloSerie" => "J Clin Med" "fecha" => "2021" "volumen" => "10" "paginaInicial" => "1391" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33808513" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016200000004/v1_202402182139/S2387020624000263/v1_202402182139/en/main.assets" "Apartado" => array:4 [ "identificador" => "44145" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016200000004/v1_202402182139/S2387020624000263/v1_202402182139/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624000263?idApp=UINPBA00004N" ]
Journal Information
Share
Download PDF
More article options