Focused cardiac ultrasound to expedite diagnosis of pulmonary hypertension in children in the emergency department

Dessie, Almaz; Leung, Siu N.; D’Amico, Beth; Fischer, Kayleigh; Binder, Zachary W.; Abo, Alyssa

doi:10.1016/j.ajem.2019.11.015

Cited by 4 publications

(9 citation statements)

References 17 publications

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“…A recent case series demonstrated the utility of POCUS in aiding the diagnosis of primarily subacute presentations of pulmonary hypertension in pediatric patients, while highlighting the heterogeneity of underlying etiologies. 8 Other case reports showed the benefit of POCUS in the rapid identification of undiagnosed pulmonary hypertension among children presenting with acute respiratory distress 16 and syncope. 17 On POCUS, patients exhibited severe right-sided cardiac dilatation, although with varying severities of hemodynamic compromise.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…However, reports of POCUS and the diagnosis of pulmonary hypertension in the pediatric literature are scarce, owing largely to the rarity of this disease. A recent case series demonstrated the utility of POCUS in aiding the diagnosis of primarily subacute presentations of pulmonary hypertension in pediatric patients, while highlighting the heterogeneity of underlying etiologies 8 . Other case reports showed the benefit of POCUS in the rapid identification of undiagnosed pulmonary hypertension among children presenting with acute respiratory distress 16 and syncope 17 .…”

Section: Case Presentationmentioning

confidence: 99%

“…Children most commonly experience dyspnea on exertion and syncope, whereas nonspecific symptoms include fatigue, cough, and chest pain 6,7 . Despite advances in targeted therapies, 5-year survival remains 74%, which is largely impacted by diagnostic delay 8 . Thus, goals early in presentation include rapid diagnosis, assessment of disease severity, evaluation for possible underlying disease, and initiation of an individualized treatment plan 9 …”

Section: Case Presentationmentioning

confidence: 99%

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Point-of-Care Ultrasound and the Discovery of Pulmonary Arterial Hypertension in a Teenager

2022

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We present a case of a teenage patient with new-onset cardiac symptoms discovered to have primary pulmonary arterial hypertension. Point-of-care ultrasound used early in the patient's presentation identified significant right-sided heart dilatation and dysfunction despite the patient's relatively unrevealing physical examination. This article emphasizes the utility of performing focused cardiac ultrasound in pediatric patients early in their presentation. We briefly review focused cardiac ultrasound technique and highlight relevant literature.

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Section: Review Of the Literaturementioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

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Point-of-Care Ultrasound and the Discovery of Pulmonary Arterial Hypertension in a Teenager

2022

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“…Its goal is the early identification of limited hemodynamic changes, thus expediting establishment of initial diagnoses and clinical decision making ( 7 ). Trained non-specialists should be able to asses and focus on left ventricular systolic function, volume status/response to fluid resuscitation, pericardial effusion/cardiac tamponade, and right ventricular systolic function and pulmonary hypertension ( 7 – 10 ). By incorporating a few prechosen echocardiographic views, several conditions of interest can easily be confirmed or ruled out by targeted FOCUS examination ( Table 1 ).…”

Section: Goals Of Focus Performed By Non-specialistsmentioning

confidence: 99%

Subcostal Echocardiographic Imaging in Neonatal and Pediatric Intensive Care

et al. 2021

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“…A published review on the evaluation and management of pulmonary hypertension in the ED recommends imaging should include a "chest radiograph and bedside echocardiography" [5]. A case series emphasizes the importance of cardiac POCUS with 8 pediatric patients who received an initial diagnosis of pulmonary hypertension by ED evaluation [6].…”

Section: Introductionmentioning

confidence: 99%

Tricuspid Regurgitant Jet Velocity Point-of-Care Ultrasound Curriculum Development and Validation

Binder

O’Brien

Boyle

et al. 2021

pocus

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Introduction: The American College of Emergency Physicians (ACEP) recommends that Emergency Medicine physicians with advanced training can evaluate right ventricular (RV) pressures via point-of-care ultrasound (POCUS) by measuring a tricuspid regurgitant jet (TRJ). We were unable to find a published curriculum to deliver education for this at any skill level. Therefore, we developed, delivered, and evaluated a curriculum for the assessment of TRJ for novice physician sonographers. Methods: We designed an educational intervention for novice physician sonographers. The curriculum was created using a modified Delphi methodology. All novice sonographers participated in the educational intervention which consisted of a didactic lecture followed by hands-on-deliberate practice on healthy medical student volunteers with expert feedback in a simulated setting. Sonographer’s knowledge was assessed at 3 time points: pre-intervention, immediately post-intervention, and 3 months post-intervention (retention assessment) by multiple choice exam. Results: Nine novice physician sonographers participated in the intervention. Mean exam performance increased from 55.6% [standard deviation (SD) 11.3%] on the pre-intervention exam to 94.4% (SD 7.3%) on the post-intervention exam and 92.9% (SD 12.5%) on the retention exam. The mean improvement between the pre- and post- exam was +38.9% (95% CI 31.8 - 46.0), and between the pre-exam and retention exam +37.1% (95% CI 22.3 - 52.0). Conclusion: Sonographer knowledge of TRJ assessment improved following a brief educational intervention as measured by exam performance. Given the expanding role of POCUS it is increasingly important to provide effective resources for teaching these skills. This work establishes the basis for further study and implementation of our TRJ curriculum.

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Focused cardiac ultrasound to expedite diagnosis of pulmonary hypertension in children in the emergency department

Cited by 4 publications

References 17 publications

Point-of-Care Ultrasound and the Discovery of Pulmonary Arterial Hypertension in a Teenager

Point-of-Care Ultrasound and the Discovery of Pulmonary Arterial Hypertension in a Teenager

Subcostal Echocardiographic Imaging in Neonatal and Pediatric Intensive Care

Tricuspid Regurgitant Jet Velocity Point-of-Care Ultrasound Curriculum Development and Validation

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