Christopher D. Yang, Christine K. Kim, Melissa M. Chang, Pooya Khosravi, Ajeet Pal Bayo Bhatia, Amanda dos Santos, Kyle Dornhofer, Megan Guy, Edmund Hsu, Soheil Saadat, John Christian Fox
Clin Exp Emerg Med 2025;12(3):188-197. Published online September 6, 2024
Objective To evaluate the current body of literature pertaining to the use of ocular point-of-care ultrasound (POCUS) in the emergency department (ED).
Methods A comprehensive literature search was conducted on Scopus, Web of Science, MEDLINE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Inclusion criteria were studies written in English and primary clinical studies involving ocular POCUS scans in an ED setting. Exclusion criteria were nonprimary studies (e.g., reviews or case reports), studies written in a non-English language, nonhuman studies, studies performed in a nonemergency setting, studies involving non-POCUS ocular ultrasound modalities, or studies published more than 10 years prior. Data extraction was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations.
Results The initial search yielded 391 results with 153 duplicates. Of the remaining 238 studies selected for retrieval and screening, 24 met the inclusion criteria. These 24 included studies encompassed 2,448 patients across prospective, retrospective, cross-sectional, and case series study designs. The majority of included studies focused on the use of POCUS in the ED to measure optic nerve sheath diameter as a proxy for papilledema and metabolic aberrations, while a minority of studies used ocular POCUS to assist in the diagnosis of orbital fractures or posterior segment pathology.
Conclusion The vast majority of studies investigating the use of ocular POCUS in recent years emphasize its utility in measuring optic nerve sheath diameter and fluctuations in intracranial pressure, though additional outcomes of interest include pathology of the posterior segment, orbit, and globe.
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Abdominal pain is one of the most common presenting chief complaints in the emergency department. Erector spinae plane block (ESPB) is an ultrasound-guided nerve block with proven effectiveness in treating visceral and somatic abdominal pain. Despite the increasing popularity of ESPB, its role in the management of nonsurgical abdominal pain has not yet been characterized. Our scoping review aims to synthesize current knowledge on the safety and efficacy of ESPB in the management of patients experiencing intractable, nonsurgical abdominal pain. We searched PubMed and Scopus to evaluate the existing literature on ESPB for nonsurgical abdominal pain. A total of 14 journal articles were included: 12 case-based studies, one systematic review, and one narrative review. All cases described the successful use of ESPB in treating abdominal pain refractory to oral or intravenous analgesic medications, and no complications were reported in any cases. This scoping review provides support for the use of ESPB to manage intractable, nonsurgical abdominal pain. ESPB has demonstrated efficacy in alleviating various conditions such as functional abdominal pain, renal colic, pancreatitis, herpetic pain, and cancer-related pain. Theoretical risks such as pneumothorax, bleeding, and infection are possible, although the studies reviewed did not report such complications.
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