Background The viral illness severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more commonly known as coronavirus 2019 (COVID-19), has become a global pandemic, infecting over 100 million individuals worldwide. Objectives The objective of this study was to compare the test characteristics of point-of-care lung ultrasound (LUS) with chest x-ray (CXR) at radiographically detecting COVID-19 pneumonia. Methods This was a single-center, prospective, observational study at an urban university hospital with >105,000 patient visits annually. Patients > 18 years old, who presented to the emergency department with predefined signs and symptoms of COVID-19, were eligible for enrollment. Each patient received a LUS using a portable, handheld ultrasound followed by a single view, portable anteroposterior CXR. Patients with an abnormal LUS or CXR underwent a non-contrast-enhanced computed tomography (NCCT). The primary outcome was the radiographic diagnosis of COVID-19 pneumonia on NCCT. Results 110 patients underwent LUS, CXR, and NCCT. 99 LUS and 73 CXRs were interpreted as positive. 81 NCCT were interpreted as positive providing a prevalence of COVID-19 pneumonia of 75% (95% CI 66-83.2) in our study population. LUS sensitivity was 97.6% (95% CI 91.6-99.7) vs 69.9% (95% CI 58.8-79.5) for CXR. LUS specificity was 33.3% (95% CI 16.5-54) vs 44.4% (95% CI 25.5-64.7) for CXR. LUS positive predictive value (PPV) and negative predictive value (NPV) were 81.8% (95% CI 72.8-88.9) and 81.8% (95% CI 48.2-97.7) vs. 79.5% (95% CI 68.4-88) and 32.4% (95% CI 18-49.8) for CXR. Conclusion LUS was more sensitive than CXR at radiographically identifying COVID-19 pneumonia.

Anterior shoulder dislocations are the most common, large joint dislocations that present to the emergency department (ED). Numerous studies support the use of intraarticular local anesthetic injections for the safe, effective, and time-saving reduction of these dislocations. Simulation training is an alternative and effective method for training compared to bedside learning. There are no commercially available ultrasound-compatible shoulder dislocation models. We utilized a three-dimensional (3D) printer to print a model that allows the visualization of the ultrasound anatomy (sonoanatomy) of an anterior shoulder dislocation.We utilized an open-source file of a shoulder, available from embodi3D® (Bellevue, WA, US). After approximating the relative orientation of the humerus to the glenoid fossa in an anterior dislocation, the humerus and scapula model was printed with an Ultimaker-2 Extended+ 3D® (Ultimaker, Cambridge, MA, US) printer using polylactic acid filaments. A 3D model of the external shoulder anatomy of a live human model was then created using Structure Sensor®(Occipital, San Francisco, CA, US), a 3D scanner. We aligned the printed dislocation model of the humerus and scapula within the resultant external shoulder mold. A pourable ballistics gel solution was used to create the final shoulder phantom.The use of simulation in medicine is widespread and growing, given the restrictions on work hours and a renewed focus on patient safety. The adage of “see one, do one, teach one” is being replaced by deliberate practice. Simulation allows such training to occur in a safe teaching environment. The ballistic gel and polylactic acid structure effectively reproduced the sonoanatomy of an anterior shoulder dislocation. The 3D printed model was effective for practicing an in-plane ultrasound-guided intraarticular joint injection.3D printing is effective in producing a low-cost, ultrasound-capable model simulating an anterior shoulder dislocation. Future research will determine whether provider confidence and the use of intraarticular anesthesia for the management of shoulder dislocations will improve after utilizing this model.

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