Click on the button below to go to the main page:
INTRODUCTION
Over the last two decades bedside cardiac US has become an important tool in the management of the patient with undifferentiated shock because it improves diagnostic accuracy at the bedside (1). Jones et al (2) showed that bedside cardiac ultrasound (US) in the first 15 lead to greater accuracy and shorter differential diagnoses. Javali et al (3) showed that combining bedside cardiac US to clinical evaluation in undifferentiated shock, increases accuracy of the bedside diagnosis from 45% to 89% (3).
Several protocols have been developed for cardiac US in undifferentiated shock such as FEEL (4), FOCUS (5) and RUSH (6) and there are now, international consensus guidelines for bedside cardiac US (7). Further bedside cardiac US is being used increasingly in the emergency department to diagnose patients with a normal haemodynamic status, but with presentations such as chest pain, shortness of breath and collapse (8).
In all these situations, reliable on axis imaging is required to make an accurate diagnosis. The following pages will describe the perfect cardiac views required and the echo features of common causes of cardiovascular illness.
Click on the button below to go to the next page:
REFERENCES
1. Godement, Mathieu, Malbrain, Manu, Vieillard-Baron, Antoine. Emergency bedside ultrasound-benefits as well as caution: Part 2: Echocardiography. Curr Opin Crit Care. 2019;25(6):605-612. doi:10.1097/MCC.0000000000000674.
2. Jones, Alan, Tayal, Vivek, Sullivan, D, Kline, Jeffrey. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients *. Crit Care Med. 2004;32(8):1703-1708. doi:10.1097/01.CCM.0000133017.34137.82.
3. Javali RH, Loganathan A, Srinivasarangan M, Akkamahadevi P, Ganesha BS, Nisarg S, et al. Reliability of Emergency Department Diagnosis in Identifying the Etiology of Nontraumatic Undifferentiated Hypotension. Indian J Crit Care Med 2020;24(5):313-320.
4. Breitkreutz R, Price S, Steiger HV, Seeger FH, Ilper H, Ackermann H, Rudolph M, Uddin S, Weigand MA, Müller E, Walcher F; Emergency Ultrasound Working Group of the Johann Wolfgang Goethe-University Hospital, Frankfurt am Main. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation. 2010 Nov;81(11):1527-33. doi:
5. Neskovic AN, Skinner H, Price S, Via G, De Hert S, Stankovic I, Galderisi M, Donal E, Muraru D, Sloth E, Gargani L, Cardim N, Stefanidis A, Cameli M, Habib G, Cosyns B, Lancellotti P, Edvardsen T, Popescu BA; Reviewers: This document was reviewed by members of the 2016-2018 EACVI Scientific Documents Committee. Focus cardiac ultrasound core curriculum and core syllabus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2018 May 1;19(5):475-481. doi: 10.1093/ehjci/jey006. PMID: 29529170.
6. Perera P et al. The RUSH Exam: Rapid Ultrasound in Shock in the Evaluation of the Critically Ill. Emerg Med Clin N Am 2010; 28: 29-56. PMID:19945597
7. Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, Summerfield DT, Slonim A, Breitkreutz R, Price S, McLaughlin M, Marik PE, Elbarbary M. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients-Part II: Cardiac Ultrasonography. Crit Care Med. 2016 Jun;44(6):1206-27. doi: 10.1097/CCM.0000000000001847. PMID: 27182849.
8. Vieillard-Baron A, Millington SJ, Sanfilippo F, Chew M, Diaz-Gomez J, McLean A, Pinsky MR, Pulido J, Mayo P, Fletcher N. A decade of progress in critical care echocardiography: a narrative review. Intensive Care Med. 2019 Jun;45(6):770-788. doi: 10.1007/s00134-019-05604-2. Epub 2019 Mar 25. Erratum in: Intensive Care Med. 2019 Apr 15;: PMID: 30911808.