POCUS

The goal of this clinical trial is to learn if adding an abdominal ultrasound scan to the standard examination helps emergency physicians make a correct diagnosis in adults with acute abdominal pain in the emergency department. The main question it aims to answer is: Does adding an abdominal point of care ultrasound scan to the standard examination increase the number of patients with acute abdominal pain in the emergency department, who get a correct preliminary diagnosis? Researchers will compare patients examined with an abdominal point-of-care ultrasound scan in addition to the standard examination to patients examined with the standard examination alone, to see if adding ultrasound improves diagnostic accuracy. Participants will: * Be randomly assigned to also have an abdominal point-of-care ultrasound scan performed by their doctor, or not * Have their doctor record a preliminary diagnosis and differential diagnosis * Have their medical records reviewed by an independent panel 30 days after their visit, to determine their final diagnosis

Ultrasonographic evaluation of the inferior vena cava (IVC) is widely used in emergency and critical care settings for noninvasive assessment of intravascular volume status. The subcostal (SC) window is the standard approach; however, it is frequently limited by obesity, bowel distension, or postoperative anatomical changes. In such cases, the right coronal (RC) and anterior transhepatic (aTH) windows have been proposed as alternatives.

This study aims to develop and evaluate a wearable ultrasound imaging sensor for the early diagnosis and real-time monitoring of various diseases, such as cardiovascular conditions and structural abnormalities of superficial organs. With advancements in medical technology, wearable devices have attracted increasing attention for their portability and real-time capabilities.

Mechanical ventilation is an essential, life-saving therapy in the ICU, allowing critically ill patients to rest and recover. Transitioning patients back to spontaneous breathing-known as weaning-is clinically challenging. The first attempt, the Spontaneous Breathing Trial (SBT), fails in 10-30% of cases. Identifying the mechanisms behind failure is crucial, as unsuccessful weaning prolongs ICU stay and increases the risk of reintubation, which worsens prognosis. The SCOUT study aims to improve prediction and management of weaning failure. The main objective of the study is to evaluate whether a specific ultrasound-based method, the Venous Excess Ultrasound Score (VExUS), can predict failure of weaning from mechanical ventilation. A key pathophysiological factor is systemic venous congestion. When a patient initiates an SBT, the increased respiratory effort shifts venous return and may precipitate cardiovascular decompensation with pulmonary fluid accumulation, termed weaning-induced pulmonary edema (WIPO). Notably, this may occur even in patients without known cardiac disease. Detecting clinically relevant congestion before SBT is difficult. Fluid balance and body weight are imprecise, physical examination lacks sensitivity, and biomarkers such as NT-proBNP have limited predictive capacity. VExUS offers a promising, non-invasive approach by directly assessing venous flow patterns in major veins (inferior vena cava, hepatic, portal, and renal veins), providing an estimation of systemic venous pressure and congestion. The central hypothesis is that elevated VExUS grades prior to SBT will identify patients at high risk of failure, enabling proactive optimization and potentially improving outcomes. SCOUT is designed as a prospective, multicenter, observational study. Standard clinical management of mechanical ventilation and weaning remains unchanged. After informed consent, baseline data will be obtained immediately before SBT, including vital signs, ventilator parameters, blood sampling, and three non-invasive ultrasound assessments: cardiac, pulmonary, and VExUS. During the 30-120-minute SBT, the patient breathes with reduced ventilatory support while their clinical tolerance is evaluated. At the end of the SBT, selected measurements are repeated. Weaning failure is defined as: early termination of SBT due to intolerance, need for invasive or non-invasive ventilation within 48 h after extubation, or death within 48 h. Data are anonymized and stored securely (REDCap) in compliance with Spanish and EU data protection regulations. The study is low-risk and provides no direct individual benefit, but may benefit future ICU patients by improving weaning strategies and prognostication.