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Point-of-care ultrasound (POCUS) plays a strategic role in the diagnostic and therapeutic evaluation of critically ill patients and, especially, in those who are haemodynamically unstable. In this context, POCUS allows a more precise identification of the cause, its differential diagnosis, the eventual coexistence with another entity and, finally, guiding of the therapeutic approach. It implies a portable use of ultrasound in acute settings covering different specified protocols, such as echocardiography, vascular, lung or abdominal ultrasound. This article reviews POCUS application in the emergency department or the intensive care unit, focused on severely compromised patients with cardiogenic shock with an emergent bedside assessment. Considering the high mortality rate of this entity, POCUS provides the intensivist/clinician with an appropriate tool for accurate diagnoses and a timely management plan. The authors propose practical algorithms for the diagnosis of patients using POCUS in these settings. This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment

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BackgroundLung cancer (LC) screening improves LC survival; the best screening method in terms of improving survival is low-dose CT (LDCT), outpacing chest X-ray and sputum cytology.MethodsA consensus of experts in Argentina was carried out to review the literature and generate recommendations for LC screening programmes. A mixed-method study was used with three phases: (1) review of the literature; (2) modified Delphi consensus panel; and (3) development of the recommendations. The Evidence to Decision (EtD) framework was used to generate 13 evaluation criteria. Nineteen experts participated in four voting rounds. Consensus among participants was defined using the RAND/UCLA method.ResultsA total of 16 recommendations scored ≥7 points with no disagreement on any criteria. Screening for LC should be performed with LDCT annually in the population at high-risk, aged between 55 and 74 years, regardless of sex, without comorbidities with a risk of death higher than the risk of death from LC, smoking ≥30 pack-years or former smokers who quit smoking within 15 years. Screening will be considered positive when finding a solid nodule ≥6 mm in diameter (or ≥113 mm3) on baseline LDCT and 4 mm in diameter if a new nodule is identified on annual screening. A smoking cessation programme should be offered, and cardiovascular risk assessment should be performed. Institutions should have a multidisciplinary committee, have protocols for the management of symptomatic patients not included in the programme and distribute educational material.ConclusionThe recommendations provide a basis for minimum requirements from which local institutions can develop their own protocols adapted to their needs and resources.

Objective: Safe and efficient tissue dissection requires division of certain critical structures which act as 'gateways' to progressing the dissection. The aim of this educational video is to demonstrate important gateways in liver and pancreas surgery, with a primary target audience of surgical residents and general surgeons who are occasionally involved in liver and pancreas surgery. Methods: Using video from common liver and pancreas procedures, combined with computer generated animation, six key anatomical gateways are demonstrated. Explanations are provided on why each structure must be divided in order to progress the dissection along a plane or to expose a structure at a deeper level. Results: The video demonstrates that division of the gastroepiploic vein and gastroduodenal artery exposes the superior mesenteric vein and portal vein, respectively, during pancreaticoduodenectomy. Division of the left gastric vein exposes the origin of the splenic artery during distal pancreatectomy and mulivisceral organ procurement. During portal dissection for right hepatectomy the cystic duct and artery are divided in order to expose the right hepatic artery and right portal vein. The right hepatic vein, during right hepatectomy, may only be fully encircled by first dividing the hepatocaval ligament. Finally, the ligamentum venosum must be divided to allow the left hepatic vein to be fully encircled during left hepatectomy. Conclusion: Knowledge of six key anatomical gateways in liver and pancreas surgery allows tissue dissection to proceed appropriately. By opening up these gateways, surgeons are more likely to develop safe and efficient tissue dissection.