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. 2020 Apr 21;1(3):244-251.
doi: 10.1002/emp2.12028. eCollection 2020 Jun.

Clinical ultrasonography in patients who inject drugs (the CUPID protocol): an illustrated case series

Stephanie C DeMasi  1 , Laura E Goyack  1 , Erin F Shufflebarger  1 , Erik P Hess  1 , Rachel M Skains  1 , Maxwell A Thompson  1 , Samuel Luke Burleson  1 , John P Gullett  1 , David C Pigott  1
Affiliations

Clinical ultrasonography in patients who inject drugs (the CUPID protocol): an illustrated case series

Stephanie C DeMasi et al. J Am Coll Emerg Physicians Open. .

Abstract

In 2017, there were ≈47,600 opioid overdose-related deaths in the United States. US emergency department (ED) visits for suspected opioid overdose increased by 30% between July 2016 and September 2017.2 The current US opioid epidemic makes it critical for emergency physicians to be aware of common and uncommon infectious and non-infectious complications of injection drug use. Point-of-care ultrasound has become a widely available, non-invasive diagnostic tool in EDs across the United States and worldwide. The increasing population of injection drug use patients is at risk for serious morbidity and mortality from an array of disease states amenable to ultrasound-based diagnosis. We propose a protocol for clinical ultrasonography in patients who inject drugs (the CUPID protocol), a focused, 3-system point-of-care ultrasound approach emphasizing cardiovascular, thoracic, and musculoskeletal imaging. The protocol is a screening tool, designed to detect high risk infectious and noninfectious complications of injection drug use.

Keywords: emergency medicine; infection; opioid‐related disorders; substance abuse—intravenous; ultrasonography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Anatomic systems evaluated by CUPID protocol
FIGURE 2
FIGURE 2
Transthoracic ultrasound view demonstrating a complex, loculated left pleural effusion with echogenic rind concerning for empyema (arrow). A short axis view of the left ventricle (LV) is also seen to the left of the image
FIGURE 3
FIGURE 3
Subxiphoid cardiac ultrasound view demonstrating a large (>3 cm) vegetation (arrow) adherent to the tricuspid valve consistent with infective endocarditis. A pericardial effusion is also present (asterisk)
FIGURE 4
FIGURE 4
Longitudinal ultrasound view of the right inguinal region demonstrating an echogenic linear foreign body (arrow) with prominent “ring‐down” artifact within the right common femoral vein. Small inguinal lymph nodes are incidentally noted superficial to the vessel (asterisks)
FIGURE 5
FIGURE 5
Longitudinal ultrasound view of the right proximal femur demonstrating a hypoechoic fluid collection anterior to the femoral head and neck (arrow)
See this image and copyright information in PMC

References

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