Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial

Pocket-sized point-of-care cardiac ultrasound devices

“…Consequently, some patients were not included who were later deemed by the clinician to have significant dyspnoea on examination. A previous study by Laursen et al [10] placed less emphasis on expressed breathlessness as a symptom or perceived breathlessness at triage or by ambulance staff, but more on physiological parameters (in this case saturations less than 95%, oxygen therapy commenced or a respiratory rate over 20) followed by a broader definition of "respiratory symptoms" including present or recent cough, chest pain or dyspnoea in addition to those physiological parameters. As a relatively large proportion of the patients included in the study group were well enough to be discharged from the emergency department without follow-up, it would be helpful to add measures to include a more unwell patient group with abnormal physiological parameters being a logical step in place of triage categories and patient presenting complaint.…”

“…Pocket-sized devices are convenient, becoming more affordable and image quality is rapidly improving to a standard that their use is now widespread. Currently there is no established recommendation for performing echocardiography in patients presenting with breathlessness, although its efficacy for the diagnosis of several conditions has previously been demonstrated [10] with a suggestion that this should be become part of good clinical practice. At present the curriculum of the Royal College of Emergency Physicians requires level 1 ultrasound competencies, which include echocardiography in life support where a FoCUS scan is delivered [3].…”

Lung ultrasound in heart failure: Lessons from re‐analysis of Lung Ultrasound 2011 database

“…Scanning by expert sonologists 6 , 12 – 14 , 19 Recruiting only acute or severe dyspnoea (higher pre‐test probability) 6 , 9 , 12 , 14 Exclusion of patients with possible lung pathology other than pulmonary oedema 14 …”

“…Researchers have examined patterns of B lines in ALI/ARDS 19 , 21 – 23 and identified pleural line abnormalities in pleuritis, 24 pneumonia 24 – 28 and pulmonary emboli 29 . These signs reduced the false positive rate among the more sick patients although some were present in the true positives.…”

“…The skilled sonologist can add cardiac and IVC views to the lung scan. Expert operator trials 19 and small groups have been successful in this practice 7 16 , 17 , 30 , 31 The addition of further cardiac or IVC views appears feasible for inexpert sonologists, even if the clips are read at a later date by an experienced practitioner.…”