SonoKids ECHO

If myocardial infarction remains silent, only clinical signs of complications may unveil its presence. Life-threatening complications include myocardial rupture, thrombus formation, or arterial embolization. In the presented case, a 76-year-old patient was admitted with left-sided hemiparesis. In duplex sonography, a critical stenosis of the right internal carotid artery was identified and initially but retrospectively incorrectly judged as the potential cause for ischemia. During operative thromboendarterectomy, arterial embolism of the right leg occurred coincidentally, more likely pointing towards a cardioembolic origin...

BACKGROUND: Acute heart failure (AHF) is one of the most common diagnoses assigned to emergency department (ED) patients who are hospitalized. Despite its high prevalence in the emergency setting, the diagnosis of AHF in ED patients with undifferentiated dyspnea can be challenging. OBJECTIVES: The primary objective of this study was to perform a systematic review and meta-analysis of the operating characteristics of diagnostic elements available to the emergency physician for diagnosing AHF...

OBJECTIVE: To assess the usefulness of hand-held cardiac ultrasound (HCU) performed by family doctors (FDs) in primary care, with web-based remote expert support interpretation, in a cohort of patient with symptoms or physical examination signs suggestive of cardiovascular disease. METHODS: This prospective observational study included 1312 consecutive patients, in three remote primary care areas, with symptoms or physical examination signs suggestive of cardiovascular disease...

STUDY OBJECTIVE: Ascending aortic dissection (AAD) is an uncommon, time-sensitive, and deadly diagnosis with a nonspecific presentation. Ascending aortic dissection is associated with aortic dilation, which can be determined by emergency physician focused cardiac ultrasound (EP FOCUS). We seek to determine if patients who receive EP FOCUS have reduced time to diagnosis for AAD. METHODS: We performed a retrospective review of patients treated at 1 of 3 affiliated emergency departments, March 1, 2013, to May 1, 2015, diagnosed as having AAD...

INTRODUCTION: Determining the etiology of acute dyspnea in emregency department (ED) patients is often difficult. Point-of-care ultrasound (POCUS) holds promise for improving immediate diagnostic accuracy (after history and physical), thus improving use of focused therapies. We evaluate the impact of a three-part POCUS exam, or "triple scan" (TS) - composed of abbreviated echocardiography, lung ultrasound and inferior vena cava (IVC) collapsibility assessment - on the treating physician's immediate diagnostic impression...

Pericardial effusion (PE) is the presence of an excess of fluid in the pericardial cavity. PE symptoms depend from the rate of fluid accumulation, ranging from mild dyspnea on exertion to shock due to cardiac tamponade. Echocardiography is usually the primary diagnostic tool when PE is suspected, as it is accurate, non-invasive, widely available, and feasible also with pocket size devices. Studies have shown a high degree of sensitivity and specificity in the detection of PE using focused cardiac ultrasound (FOCUS), which can be performed also by non-cardiologist in emergency setting or at bedside...

No abstract text is available yet for this article.

For the non-cardiologist emergency physician and intensivist, performing an accurate estimation of left ventricular ejection fraction (LVEF) is essential for the management of critically ill patients, such as patients presenting with shock, severe respiratory distress or chest pain. Our objective was to develop a semi-quantitative method to improve visual LVEF evaluation. A group of 12 sets of transthoracic echocardiograms with LVEF in the range of 18-64% were interpreted by 17 experienced observers (PRO) and 103 untrained observers or novices (NOV), without previous training in echocardiography...

UNLABELLED: The present case is an unusual one of a 21-year-old female with a primary osteosarcoma and left lung metastasis presenting following a witnessed pulseless electrical activity cardiac arrest. The electrocardiogram was unremarkable. A computed tomography pulmonary angiogram (CTPA) demonstrated a tumour within the left inferior pulmonary veins. Transthoracic echocardiography (TTE) revealed a severely hypokinetic left ventricle and a multi-lobulated, mobile mass arising from one of the left pulmonary veins which prolapsed to varying degrees on a beat-to-beat basis back and forth through the mitral valve into the left ventricle (during ventricular diastole) and retracted back into the left atrium (during ventricular systole)...

Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU). Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged...

OBJECTIVE: Echocardiography has become an indispensable bedside diagnostic tool in the realm of pediatric intensive care units (PICU). It has proven to be an influential factor in the formula of clinical decision-making. This study aimed to delineate the impact of echocardiography on the management of critically ill pediatric patients in the PICU at Sultan Qaboos University Hospital, Oman. METHOD: This was a retrospective cohort study conducted in a five-bed PICU...

Pericardiocentesis (PC) is both a diagnostic and a potentially life-saving therapeutic procedure. Currently echocardiography-guided pericardiocentesis is considered the standard clinical practice in the treatment of large pericardial effusions and cardiac tamponade. Although considered relatively safe, this invasive procedure may be associated with certain risks and potentially serious complications. This review provides a summary of pericardiocentesis and a focused overview of the potential complications of this procedure...

OBJECTIVE: To establish evidence-based guidelines for the use of bedside ultrasound by intensivists and specialists in the ICU and equivalent care sites for diagnostic and therapeutic purposes for organs of the chest, abdomen, pelvis, neck, and extremities. METHODS: The Grading of Recommendations, Assessment, Development and Evaluation system was used to determine the strength of recommendations as either strong or conditional/weak and to rank the "levels" of quality of evidence into high (A), moderate (B), or low (C) and thus generating six "grades" of recommendation (1A-1B-1C-2A-2B-2C)...

BACKGROUND: The patient presenting in an undifferentiated shock state can produce a diagnostic challenge for even the most seasoned clinician. CASE REPORT: We present an unusual case of an elderly woman in obstructive shock from a large atrial mass that was promptly diagnosed with point-of-care ultrasound. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ultrasound is a non-invasive tool that can help facilitate the early diagnosis of a patient in undifferentiated shock...

OBJECTIVE: The role of focused assessment by transthoracic echocardiography or focused cardiac ultrasound (FoCUS) in the perioperative setting is uncertain and evolving. To the authors' knowledge, there are no studies that evaluate the current teaching practices regarding FoCUS in US anesthesiology residencies. The authors surveyed residents and residency program directors to examine the frequency, type, and variability of instruction regarding training of FoCUS. DESIGN: A survey study...

BACKGROUND: M-mode or "motion" mode is a form of ultrasound imaging that is of high clinical utility in the emergency department. It can be used in a variety of situations to evaluate motion and timing, and can document tissue movement in a still image when the recording of a video clip is not feasible. OBJECTIVES: In this article we describe several straightforward and easily performed applications for the emergency physician to incorporate M-mode into his or her practice, including the evaluation for: 1) pneumothorax, 2) left ventricular systolic function, 3) cardiac tamponade, and 4) hypertrophic cardiomyopathy...

Ultrasound assessment of patients in shock is becoming the standard of care in emergency and critical care settings worldwide. One of the most common protocols used for this assessment is the rapid ultrasound in shock (RUSH) examination. The RUSH protocol is a rapid evaluation of cardiac function, key vascular structures, and likely sources of hypotension. Stroke volume is an established important value to assess in the setting of shock, allowing the provider to predict the patient's response to treatment. However, the calculation of stroke volume or its surrogates is not part of any protocol, including RUSH...

BACKGROUND: Patients with medical conditions may present with psychiatric symptoms, which may lead to worse physical health care. Here we present the case of a patient with acute aortic dissection masked by psychiatric symptoms after a stressful event. CASE REPORT: A 29-year-old female medical student presented to the Emergency Department (ED) complaining about the feeling of "hysteria" after an argument with her boyfriend earlier the same day. She did not report other symptoms or pain...

Massive pulmonary embolism is a life-threatening emergency that results in circulatory failure. The main challenges in management are early diagnosis and maintenance of hemodynamic stability. We present a case of a 63-year-old male who was in cardiac arrest. After resuscitation, massive pulmonary embolism was diagnosed with the help of bedside echocardiography and extracorporeal membrane oxygenation (ECMO). We were able to maintain hemodynamic stability and improve hypoxia until the patient underwent embolectomy...

The best diagnostic strategy to confirm or exclude pulmonary embolism (PE) suspicion needs an appropriate combination of clinical assessment, plasma D-dimer measurement, and computed tomographic pulmonary angiography (CTPA). CTPA should be used with caution in some patient groups, such as patients with known allergy to contrast media, those with severe renal insufficiency, and pregnant women, and could be not immediately available in case of unstable patients. In the emergency setting, alternative diagnostic strategies should be implemented to overcome CTPA limitations...