Echocardiography in the Emergency Room

Abstract

Echocardiography in the emergency room presents exciting practice possibilities that can facilitate prompt and reliable diagnostic evaluations in patients with suspected cardiovascular emergencies. Echocardiography has the diagnostic potentials to evaluate the entire spectrum of cardiovascular abnormalities short of delineating coronary anatomy and evaluation of the conduction system. By reliably assessing the global and regional function, visualizing the cardiovascular structures from multiple tomographic planes, and quantitating hemodynamic abnormalities, echocardiography should be able to assist emergency room physician's evaluation and triage of the patients with chest pain syndrome, unexplained dyspnea, hypotension, shock, chest trauma, and cardiac arrest, whereby hopefully minimizing the unnecessary admission to the hospital and facilitating inhospital evaluation of the admitted patients with echocardiographic information. However, the optimal echocardiography practice in the emergency room requires well trained sonographers and echocardiographers who can respond to the clinical needs at anytime. Whether an emergency room physician can perform and interpret echocardiographic examinations satisfactorily will depend on his/her level of training and continuing education in this area. Currently, there is no established guideline for performing echocardiography in the emergency room. Further clinical investigations are necessary to define the most optimal and economical utilization of this versatile imaging and hemodynamic diagnostic modality in the emergency room.

Make it SIMPLE: enhanced shock management by focused cardiac ultrasound

“…Lately, the term “focused cardiac ultrasound” has been recognized as a more appropriate term to take into account the nature of point-of-care application of ultrasound assessment of cardiac anatomy and physiology, distinct from the formal echocardiographic study done by cardiologists, according to the first international evidence-based recommendations issued by World Interactive Network Focused on Critical UltraSound (WINFOCUS) [ 13 ]. FoCUS was first introduced into emergency communities in the 1990s [ 14 , 15 ]. With the wider availability and miniaturization of ultrasound machines, FoCUS has quickly become standard practice in acute care settings across the globe.…”

The diagnostic accuracy of cardiac ultrasound for acute myocardial ischemia in the emergency department: a systematic review and meta-analysis

“…Mean age of the population across studies ranged from 49 to 68 years (average: 59 years [SD 5.2]) and the proportion of male patients ranged from 42.3 to 84.5% (mean 62.6% [SD 11.9]). Patient spectrum varied across the studies, mainly in the inclusion (13 studies) [ 24 , 29 , 30 , 56 , 61 , 63 , 65 , 70 , 72 – 74 , 76 , 77 ] or exclusion (13 studies) [ 25 , 27 , 57 – 60 , 62 , 64 , 66 , 67 , 69 , 71 , 75 ] of patients with previous heart disease. See e-Table 1 (Additional File 1 : e-Appendix 4) for additional information.…”

Ultrasound in emergency medicine

“…Two dimensional echocardiography has been shown to be of benefit in improving the emergency department diagnosis of AMI in numerous recent studies 111,123,124,126,127 . This is particularly so in patients with either normal, equivocal or uninterpretable ECGs (left bundle branch block, paced rhythm) 111,123,124,126 . Ischaemic myocardium develops regional wall motion abnormalities (RWMAs) within minutes of occlusion of the supplying coronary artery 128,129 , and certainly much sooner than the development of either ECG changes or ischaemic chest pain 6,130 .…”

“…Numerous reports testify to the usefulness of echocardiography in a wide variety of cardiac emergencies including acute chest pain syndromes, assessment of possible myocardial infarction, pericardial effusion, cardiac tamponade, cardiothoracic trauma and electromechanical dissociation. Ultrasound is also useful in the assessment of complications of myocardial infarction and may provide important information in the assessment of patients presenting with unexplained hypotension or dyspnoea 6,13,110–112 .…”