E-point septal separation: a bedside tool for emergency physician assessment of left ventricular ejection fraction

McKaigney, Conor; Krantz, Mori J.; Rocque, Cherie L. La; Hurst, Nicole; Buchanan, Matthew S.; Kendall, John L.

doi:10.1016/j.ajem.2014.01.045

Cited by 72 publications

(85 citation statements)

References 18 publications

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“…If only the parasternal views are available, the mitral-septal separation may be used. A separation of less than 7 mm between the anterior mitral valve leaflet and the interventricular septum, in early diastole, is indicative of normal ejection fraction [44].…”

Section: Ventricular Contractilitymentioning

confidence: 99%

Transthoracic echocardiography in the perioperative setting

Jørgensen¹,

Juhl-Olsen²,

Frederiksen

et al. 2016

Current Opinion in Anaesthesiology

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Hemodynamically significant cardiac disease or pathophysiology can be disclosed using TTE. Focused TTE is feasible for perioperative patient management and monitoring and will be an inevitable and indispensable tool for the anesthetist. Future research should focus on the outcome of perioperative TTE performed by anesthetists, using rigorous study designs and patient-centered outcomes such as mortality and morbidity.

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Section: Ventricular Contractilitymentioning

confidence: 99%

Transthoracic echocardiography in the perioperative setting

Jørgensen¹,

Juhl-Olsen²,

Frederiksen

et al. 2016

Current Opinion in Anaesthesiology

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“…EPSS measurements greater than 7 mm have been shown to correlate with severely depressed LVEF. 31 Rotating from the PSLA to a PSSA view at the level of the papillary muscles shows the entire circumference of the muscular portion of the LV. 32 This is an optimal window to observe the concentric squeeze of the LV by estimating the degree of internal chamber collapse in systole versus diastole.…”

Section: Techniques For Assessing Ejection Fractionmentioning

confidence: 99%

“…Two-dimensional images (especially in the A4C view) can be limited by poor lateral resolution and decreased visualization of endocardial borders. 31 While the basic EP FOCUS assessment is for estimation of global ejection fraction, focal wall motion abnormalities can affect overall function and represent a pitfall if not appropriately recognized or characterized. Incomplete visualization of all portions of the LV can result in missed focal wall motion abnormalities.…”

Section: Pearls and Pitfalls Of Ejection Fractionmentioning

confidence: 99%

The “5Es” of Emergency Physician–performed Focused Cardiac Ultrasound: A Protocol for Rapid Identification of Effusion, Ejection, Equality, Exit, and Entrance

Hall

Coffey

Herbst

et al. 2015

Academic Emergency Medicine

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Emergency physician (EP)-performed focused cardiac ultrasound (EP FOCUS) has been increasingly recognized as a crucial tool to help clinicians diagnose and treat potentially life-threatening conditions. The existing literature demonstrates a variety of EP FOCUS applications and protocols; however, EP FOCUS is not taught, practiced, or interpreted consistently between institutions. Drawing on over 12 years of experience in a large-volume, high-acuity academic emergency department, we have developed a protocol for teaching and performing EP FOCUS known as "The 5Es," where each E represents a specific assessment for immediately relevant clinical information. These include pericardial effusion, qualitative left ventricular ejection, ventricular equality, exit (aortic root diameter), and entrance (inferior vena cava diameter and respirophasic variation). Each of these assessments has been well described in the emergency medicine literature and is within the scope of EP-performed echocardiography. This approach provides a reliable and easily recalled framework for assessing, teaching, and communicating EP FOCUS findings that are essential in caring for the patient in the emergency setting.ACADEMIC EMERGENCY MEDICINE 2015;22:583-593 © 2015 by the Society for Academic Emergency Medicine I t has been recognized for more than 25 years that emergency physician (EP)-performed focused cardiac ultrasound (EP FOCUS) is an important skill for the care of patients with potentially life-threatening presentations.1,2 A recent review detailed 16 specific protocols that included cardiac ultrasound (US) as part of the point-of-care US assessment in medical shock. 3The term "focused cardiac ultrasound" has been addressed in some detail (FOCUS, 4 FCU, 5 and FoCUS 6 ). However, this term is not specialty-specific, may include assessments that are not relevant in the acute/emergency setting, and has not included assessment of the thoracic aortic root ("exit"), which may be particularly applicable to acute and emergent presentations. We have found that the proximal thoracic aorta can be reliably assessed, providing vital information about potential aortic pathology in patients presenting with acute symptoms. 7 We thus propose the "5Es" to assess for the presence of a pericardial effusion, left ventricular ejection, ventricular equality, exit (aortic root diameter), and entrance (inferior vena cava [IVC] diameter and respirophasic variation). The 5Es protocol provides an easy-toteach, evidence-based, and standardized approach to EP FOCUS for the rapid identification and management of time-sensitive pathologic conditions. APPROACH TO EXAMTypically EP FOCUS uses one or more of three windows and five views: a parasternal long-axis (PSLA), a

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“…These causes include pericardial tamponade, pneumothorax, massive pulmonary embolism, and intraperitoneal bleeding. [18][19][20][21][22] In addition, bedside ultrasound can provide estimates of ejection fraction 23 and volume status, 24 which provide useful information for titrating hemodynamic support.…”

Section: Rittenberger Et Almentioning

confidence: 99%