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Güllüpınar B, Sağlam C, Karagöz A, Koran S, Ünlüer EE. Ultrasound-Guided Radial Artery Puncture by Nurses in Emergency Department: A Randomized Controlled Study. J Emerg Nurs 2024; 50:373-380. [PMID: 38530698 DOI: 10.1016/j.jen.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/02/2024] [Accepted: 01/02/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Radial artery puncture has been performed by palpation as a standard method in many emergency departments and intensive care units. Nurses play an important role in the care of patients in various settings. Ultrasonography can be performed and interpreted not only by physicians but also by nurses. This study aimed to evaluate whether emergency nurses would be more successful in radial artery puncture procedure by using ultrasonography instead of palpation. METHODS This single-center, prospective, randomized controlled study was conducted in the emergency department. The patients included in the study were randomized into 2 groups as ultrasonography and palpation groups. Data were recorded on the number of interventions, the duration of the procedure in seconds, total time in seconds, whether the puncture was successfully placed, whether there were complications, the types of complications (hematoma, bleeding, and infection), or whether it was necessary to switch to an alternative technique. RESULTS A total of 72 patients, 36 patients in the ultrasonography group and 36 patients in the palpation group, participated in the study. The success rate at the first attempt was statistically significantly higher in the ultrasonography group. Although hematoma formation among the complications occurred in the entire palpation group, it was observed in 72.2% of the ultrasonography group. Puncture time and total time were statistically significantly lower in the ultrasonography group. DISCUSSION Our study shows that emergency nurses can use bedside ultrasonography for radial artery puncture successfully.
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Mongodi S, Arioli R, Quaini A, Grugnetti G, Grugnetti AM, Mojoli F. Lung ultrasound training: how short is too short? observational study on the effects of a focused theoretical training for novice learners. BMC MEDICAL EDUCATION 2024; 24:166. [PMID: 38383377 PMCID: PMC10882777 DOI: 10.1186/s12909-024-05148-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Lung ultrasound has been increasingly used in the last years for the assessment of patients with respiratory diseases; it is considered a simple technique, now spreading from physicians to other healthcare professionals as nurses and physiotherapists, as well as to medical students. These providers may require a different training to acquire lung ultrasound skills, since they are expected to have no previous experience with ultrasound. The aim of the study was to assess the impact of a short theoretical training focused on lung ultrasound pattern recognition in a population of novice nurse learners with no previous experience with ultrasound. METHODS We included the nurses attending a critical care advanced course for nurses performed at the University of Pavia. Images' interpretation skills were tested on two slide sets (a 25-clip set focused on B-pattern recognition and a 25-clip set focused on identification of pleural movement as lung sliding, lung pulse, lung point, no movement) before and after three 30-minute teaching modules dedicated to general ultrasound principles, B-lines assessment and lung sliding assessment. A cut off of 80% was considered acceptable for correctly interpreted images after this basic course. RESULTS 22 nurses were enrolled (age 26.0 [24.0-28.0] years; men 4 (18%)); one nurse had previous experience with other ultrasound techniques, none of them had previous experience with lung ultrasound. After the training, the number of correctly interpreted clips improved from 3.5 [0.0-13.0] to 22.0 [19.0-23.0] (p < 0.0001) for B-pattern and from 0.5 [0.0-2.0] to 8.5 [6.0-12.0] (p < 0.0001) for lung sliding assessment. The number of correct answers for B-pattern recognition was significantly higher than for lung sliding assessment, both before (3.5 [0.0-13.0] vs. 0.5 [0.0-2.0]; p = 0.0036) and after (22.0 [19.0-23.0] vs. 8.5 [6.0-12.0]; p < 0.0001) the training. After the training, nurses were able to correctly recognize the presence or the absence of a B-pattern in 84.2 ± 10.3% of cases; lung sliding was correctly assessed in 37.1 ± 15.3% of cases. CONCLUSIONS Lung ultrasound is considered a simple technique; while a short, focused training significantly improves B-pattern recognition, lung sliding assessment may require a longer training for novice learners. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Silvia Mongodi
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, Rianimazione I, Viale Golgi 19, 27100, Pavia, Italy.
| | - Raffaella Arioli
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, Rianimazione I, Viale Golgi 19, 27100, Pavia, Italy
| | - Attilio Quaini
- Department of Health Professions, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Giuseppina Grugnetti
- Department of Health Professions, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Anna Maria Grugnetti
- Department of Health Professions, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Francesco Mojoli
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S. Matteo, Rianimazione I, Viale Golgi 19, 27100, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care , University of Pavia, Pavia, Italy
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Panebianco N, Baston C. Training, Competency, and Interdisciplinary Collaboration in Point-of-Care Ultrasound. Semin Ultrasound CT MR 2024; 45:91-97. [PMID: 38056786 DOI: 10.1053/j.sult.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Point-of-care ultrasound can provide critical diagnostic information and add to procedural safety. As with any clinical skill, however, it must be applied by an adequately trained provider, with systems to ensure safety. Training can include a mix of hands-on training with traditional didactics, online coursework, and simulation, but each carries its own costs and benefits worth of review. Following training it is essential to think about assessment of competency in point-of-care ultrasound to reflect the combination of cognitive and procedural skills that makes up the practice. Within the frameworks described, expansion can be expected across specialty and professional boundaries.
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Affiliation(s)
- Nova Panebianco
- Perelman School of Medicine at the University of Pennsylvania, Department of Emergency Medicine, Philadelphia, PA.
| | - Cameron Baston
- Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, Philadelphia, PA
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Nagaharu K, Tsumura N, Itoh T, Murata T. Diagnostic utility of lung echography for congestive heart failure performed by junior resident doctors. J Gen Fam Med 2022; 23:401-406. [PMID: 36349208 PMCID: PMC9634130 DOI: 10.1002/jgf2.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/25/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Dyspnea is a high priority symptom in the emergency department, with heart failure (HF) as one of its leading causes. Recently, the “comet tail sign (CTS),” a pulmonary ultrasonographic sign, has been proposed as an efficacious tool for detecting pulmonary edema. However, to the best of our knowledge, there have been no published data regarding its utility when performed by non‐experts, including junior residents. Methods Between September 2017 and December 2018, patients with dyspnea, who were admitted to the ER, were enrolled. CTS was evaluated by junior residents at the ER. All patients were evaluated by cardiologists independently, and clinical HF was defined as requiring pharmacological intervention by a cardiologist. At the end of this study, we investigated the results of CTS, laboratory data, and available radiological images. Results A total of 95 patients were enrolled in the current study, wherein 42 patients were treated by cardiologists as those with clinical HF. Our results showed that CTS could identify clinical HF with a sensitivity of 71.4% and a specificity of 81.1%. The sensitivity of CTS against brain natriuretic peptide (BNP) (cut‐off value, 100 pg/ml) was calculated at 92.5%. Furthermore, when evaluated together with peripheral edema, CTS identified clinical HF with a sensitivity of 96%. False positives for CTS included bilateral pneumonia, hypoalbuminemia, and interstitial pneumonitis. Conclusions Our results indicate that CTS is a simple and effective tool for the use of non‐experts, including junior residents.
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Affiliation(s)
- Keiki Nagaharu
- Department of Hematology and Oncology Suzuka General Hospital Suzuka Japan
| | - Natsumi Tsumura
- Department of Internal medicine Suzuka General Hospital Suzuka Japan
| | - Toshiyuki Itoh
- Department of Internal medicine Suzuka General Hospital Suzuka Japan
| | - Tetsuya Murata
- Department of Pathology Suzuka General Hospital Suzuka Japan
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Swamy V, Brainin P, Biering-Sørensen T, Platz E. Ability of non-physicians to perform and interpret lung ultrasound: A systematic review. Eur J Cardiovasc Nurs 2019; 18:474-483. [PMID: 31018658 DOI: 10.1177/1474515119845972] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Lung ultrasound is a useful tool in the assessment of pulmonary congestion in heart failure that is typically performed and interpreted by physicians at the point-of-care. AIMS To investigate the ability of nurses, students, and paramedics to accurately identify B-lines and pleural effusions for the detection of pulmonary congestion in heart failure and to examine the training necessary. METHODS AND RESULTS We conducted a systematic review and searched online databases for studies that investigated the ability of nurses, students, and paramedics to perform lung ultrasound and detect B-lines and pleural effusions. Of 979 studies identified, 14 met our inclusion criteria: five in nurses, eight in students, and one in paramedics. After 0-12 h of didactic training and 58-62 practice lung ultrasound examinations, nurses were able to identify B-lines and pleural effusions with a sensitivity of 79-98% and a specificity of 70-99%. In image adequacy studies, medical students with 2-9 h of training were able to acquire adequate images for B-lines and pleural effusions in 50-100%. Only one eligible study investigated paramedic-performed lung ultrasound which did not support the ability of paramedics to adequately acquire and interpret lung ultrasound images after 2 h of training. CONCLUSIONS Our findings suggest that nurses and students can accurately acquire and interpret lung ultrasound images after a brief training period in a majority of cases. The examination of heart failure patients with lung ultrasound by non-clinicians appears feasible and warrants further investigation.
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Affiliation(s)
- Varsha Swamy
- 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA
| | - Philip Brainin
- 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,2 Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Tor Biering-Sørensen
- 2 Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Elke Platz
- 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,3 Harvard Medical School, Boston, USA
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Lung Ultrasound for the Emergency Diagnosis of Pneumonia, Acute Heart Failure, and Exacerbations of Chronic Obstructive Pulmonary Disease/Asthma in Adults: A Systematic Review and Meta-analysis. J Emerg Med 2018; 56:53-69. [PMID: 30314929 DOI: 10.1016/j.jemermed.2018.09.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/05/2018] [Accepted: 09/01/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Lung ultrasound can accelerate the diagnosis of life-threatening diseases in adults with respiratory symptoms. OBJECTIVE Systematically review the accuracy of lung ultrasonography (LUS) for emergency diagnosis of pneumonia, acute heart failure, and exacerbation of chronic obstructive pulmonary disease (COPD)/asthma in adults. METHODS PubMed, Embase, Scopus, Web of Science, and LILACS (Literatura Latino Americana e do Caribe em Ciências da Saúde; until 2016) were searched for prospective diagnostic accuracy studies. Rutter-Gatsonis hierarchical summary receiver operating characteristic method was used to measure the overall accuracy of LUS and Reitsma bivariate model to measure the accuracy of the different sonographic signs. This review was previously registered in PROSPERO (Centre for Reviews and Dissemination, University of York, York, UK; CRD42016048085). RESULTS Twenty-five studies were included: 14 assessing pneumonia, 14 assessing acute heart failure, and four assessing exacerbations of COPD/asthma. The area under the summary receiver operating characteristic curve of LUS was 0.948 for pneumonia, 0.914 for acute heart failure, and 0.906 for exacerbations of COPD/asthma. In patients suspected to have pneumonia, consolidation had sensitivity of 0.82 (95% confidence interval [CI] 0.74-0.88) and specificity of 0.94 (95% CI 0.85-0.98) for this disease. In acutely dyspneic patients, modified diffuse interstitial syndrome had sensitivity of 0.90 (95% CI 0.87-0.93) and specificity of 0.93 (95% CI 0.91-0.95) for acute heart failure, whereas B-profile had sensitivity of 0.93 (95% CI 0.72-0.98) and specificity of 0.92 (95% CI 0.79-0.97) for this disease in patients with respiratory failure. In patients with acute dyspnea or respiratory failure, the A-profile without PLAPS (posterior-lateral alveolar pleural syndrome) had sensitivity of 0.78 (95% CI 0.67-0.86) and specificity of 0.94 (95% CI 0.89-0.97) for exacerbations of COPD/asthma. CONCLUSION Lung ultrasound is an accurate tool for the emergency diagnosis of pneumonia, acute heart failure, and exacerbations of COPD/asthma.
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Papanagnou D, Secko M, Gullett J, Stone M, Zehtabchi S. Clinician-Performed Bedside Ultrasound in Improving Diagnostic Accuracy in Patients Presenting to the ED with Acute Dyspnea. West J Emerg Med 2017; 18:382-389. [PMID: 28435488 PMCID: PMC5391887 DOI: 10.5811/westjem.2017.1.31223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 01/09/2017] [Indexed: 12/31/2022] Open
Abstract
Introduction Diagnosing acute dyspnea is a critical action performed by emergency physicians (EP). It has been shown that ultrasound (US) can be incorporated into the work-up of the dyspneic patient; but there is little data demonstrating its effect on decision-making. We sought to examine the impact of a bedside, clinician-performed cardiopulmonary US protocol on the clinical impression of EPs evaluating dyspneic patients, and to measure the change in physician confidence with the leading diagnosis before and after US. Methods We conducted a prospective observational study of EPs treating adult patients with undifferentiated dyspnea in an urban academic center, excluding those with a known cause of dyspnea after evaluation. Outcomes: 1) percentage of post-US diagnosis matching final diagnosis; 2) percentage of time US changed providers’ leading diagnosis; and 3) change in physicians’ confidence with the leading diagnosis before and after US. An US protocol was developed and standardized prior to the study. Providers (senior residents, fellows, attendings) were trained on US (didactics, hands on) prior to enrollment, and were supervised by an US faculty member. After patient evaluation, providers listed likely diagnoses, documenting their confidence level with their leading diagnosis (scale of 1–10). After US, providers revised their lists and their reported confidence level with their leading diagnosis. Proportions are reported as percentages with 95% confidence interval (CI) and continuous variables as medians with quartiles. We used the Wilcoxon signed-rank test and Cohen’s kappa statistics to analyze data. Results A total of 115 patients were enrolled (median age: 61 [51, 73], 59% female). The most common diagnosis before US was congestive heart failure (CHF) (41%, 95%CI, 32–50%), followed by chronic obstructive pulmonary disease (COPD) and asthma. CHF remained the most common diagnosis after US (46%, 95%CI, 38–55); COPD became less common (pre-US, 22%, 95%CI, 15–30%; post-US, 17%, 95%CI, 11–24%). Post-US clinical diagnosis matched the final diagnosis 63% of the time (95%CI, 53–70%), compared to 69% pre-US (95%CI, 60–76%). Fifty percent of providers changed their leading diagnosis after US (95%CI, 41–59%). Overall confidence of providers’ leading diagnosis increased after US (7 [6, 8]) vs. 9 [8, 9], p: 0.001). Conclusion Bedside US did not improve the diagnostic accuracy in physicians treating patients presenting with acute undifferentiated dyspnea. US, however, did improve providers’ confidence with their leading diagnosis.
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Affiliation(s)
- Dimitrios Papanagnou
- Thomas Jefferson University, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Michael Secko
- The State University of New York, Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - John Gullett
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Michael Stone
- Brigham and Women's Hospital of Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Shahriar Zehtabchi
- The State University of New York, Downstate Medical Center, Department of Emergency Medicine, Brooklyn, New York
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8
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Carnell J, Wu E. Echocardiography for ED Dyspnea Evaluation. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0119-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gargani L, Sicari R, Raciti M, Serasini L, Passera M, Torino C, Letachowicz K, Ekart R, Fliser D, Covic A, Balafa O, Stavroulopoulos A, Massy ZA, Fiaccadori E, Caiazza A, Bachelet T, Slotki I, Shavit L, Martinez-Castelao A, Coudert-Krier MJ, Rossignol P, Kraemer TD, Hannedouche T, Panichi V, Wiecek A, Pontoriero G, Sarafidis P, Klinger M, Hojs R, Seiler-Mußler S, Lizzi F, Onofriescu M, Zarzoulas F, Tripepi R, Mallamaci F, Tripepi G, Picano E, London GM, Zoccali C. Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: a LUST trial sub-project. Nephrol Dial Transplant 2016; 31:1982-1988. [DOI: 10.1093/ndt/gfw329] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/24/2016] [Indexed: 02/06/2023] Open
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Vitale J, Mumoli N, Giorgi-Pierfranceschi M, Cresci A, Cei M, Basile V, Cocciolo M, Dentali F. Comparison of the Accuracy of Nurse-Performed and Physician-Performed Lung Ultrasound in the Diagnosis of Cardiogenic Dyspnea. Chest 2016; 150:470-1. [DOI: 10.1016/j.chest.2016.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/30/2016] [Indexed: 12/13/2022] Open
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Mumoli N, Vitale J, Giorgi-Pierfranceschi M, Cresci A, Cei M, Basile V, Brondi B, Russo E, Giuntini L, Masi L, Cocciolo M, Dentali F. Accuracy of Nurse-Performed Lung Ultrasound in Patients With Acute Dyspnea: A Prospective Observational Study. Medicine (Baltimore) 2016; 95:e2925. [PMID: 26945396 PMCID: PMC4782880 DOI: 10.1097/md.0000000000002925] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In clinical practice lung ultrasound (LUS) is becoming an easy and reliable noninvasive tool for the evaluation of dyspnea. The aim of this study was to assess the accuracy of nurse-performed LUS, in particular, in the diagnosis of acute cardiogenic pulmonary congestion. We prospectively evaluated all the consecutive patients admitted for dyspnea in our Medicine Department between April and July 2014. At admission, serum brain natriuretic peptide (BNP) levels and LUS was performed by trained nurses blinded to clinical and laboratory data. The accuracy of nurse-performed LUS alone and combined with BNP for the diagnosis of acute cardiogenic dyspnea was calculated. Two hundred twenty-six patients (41.6% men, mean age 78.7 ± 12.7 years) were included in the study. Nurse-performed LUS alone had a sensitivity of 95.3% (95% CI: 92.6-98.1%), a specificity of 88.2% (95% CI: 84.0-92.4%), a positive predictive value of 87.9% (95% CI: 83.7-92.2%) and a negative predictive value of 95.5% (95% CI: 92.7-98.2%). The combination of nurse-performed LUS with BNP level (cut-off 400 pg/mL) resulted in a higher sensitivity (98.9%, 95% CI: 97.4-100%), negative predictive value (98.8%, 95% CI: 97.2-100%), and corresponding negative likelihood ratio (0.01, 95% CI: 0.0, 0.07). Nurse-performed LUS had a good accuracy in the diagnosis of acute cardiogenic dyspnea. Use of this technique in combination with BNP seems to be useful in ruling out cardiogenic dyspnea. Other studies are warranted to confirm our preliminary findings and to establish the role of this tool in other settings.
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Affiliation(s)
- Nicola Mumoli
- From the Department of Internal Medicine, Ospedale Civile di Livorno, Livorno (NM, AC, MC, VB, BB, ER, LG, LM, MC), Department of Internal Medicine, Ospedale di Circolo, Varese (JV, FD), and Emergency Department, Ospedale della Val d'Arda, Piacenza (MGP), Italy
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Russell FM, Rutz M, Pang PS. Focused Ultrasound in the Emergency Department for Patients with Acute Heart Failure. Card Fail Rev 2015; 1:83-86. [PMID: 28785437 DOI: 10.15420/cfr.2015.1.2.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The emergency department (ED) plays a key role in the initial diagnosis and management of acute heart failure (AHF). Despite the advent of novel biomarkers and traditional methods of assessment, such as history, examination, and chest X-ray, diagnosis of the dyspnoeic ED patient is, at times, very challenging. Focused cardiac and pulmonary ultrasound has emerged as a valid, facile and efficient method to aid in the initial diagnosis and management of AHF.
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Affiliation(s)
- Frances M Russell
- Department of Emergency Medicine, Indiana University School of Medicine,Indianapolis, USA
| | - Matt Rutz
- Department of Emergency Medicine, Indiana University School of Medicine,Indianapolis, USA
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine,Indianapolis, USA.,Regenstrief Institute,Indianapolis, USA
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Montoya J, Stawicki SP, Evans DC, Bahner DP, Sparks S, Sharpe RP, Cipolla J. From FAST to E-FAST: an overview of the evolution of ultrasound-based traumatic injury assessment. Eur J Trauma Emerg Surg 2015; 42:119-26. [PMID: 26038031 DOI: 10.1007/s00068-015-0512-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 03/03/2015] [Indexed: 01/12/2023]
Abstract
Ultrasound is a ubiquitous and versatile diagnostic tool. In the setting of acute injury, ultrasound enhances the basic trauma evaluation, influences bedside decision-making, and helps determine whether or not an unstable patient requires emergent procedural intervention. Consequently, continued education of surgeons and other acute care practitioners in performing focused emergency ultrasound is of great importance. This article provides a synopsis of focused assessment with sonography for trauma (FAST) and the extended FAST (E-FAST) that incorporates basic thoracic injury assessment. The authors also review key pitfalls, limitations, controversies, and advances related to FAST, E-FAST, and ultrasound education.
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Affiliation(s)
- J Montoya
- St Luke's Regional Level I Resource Trauma Center, Bethlehem, PA, USA
| | - S P Stawicki
- St Luke's Regional Level I Resource Trauma Center, Bethlehem, PA, USA. .,Department of Research and Innovation, St Luke's University Health Network, Bethlehem, PA, 18015, USA.
| | - D C Evans
- Department of Surgery, Division of Trauma, Critical Care, and Burn, The Ohio State University College of Medicine, Columbus, OH, USA
| | - D P Bahner
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - S Sparks
- St Luke's Regional Level I Resource Trauma Center, Bethlehem, PA, USA
| | - R P Sharpe
- St Luke's Regional Level I Resource Trauma Center, Bethlehem, PA, USA
| | - J Cipolla
- St Luke's Regional Level I Resource Trauma Center, Bethlehem, PA, USA
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Gallard E, Redonnet JP, Bourcier JE, Deshaies D, Largeteau N, Amalric JM, Chedaddi F, Bourgeois JM, Garnier D, Geeraerts T. Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea. Am J Emerg Med 2014; 33:352-8. [PMID: 25572643 DOI: 10.1016/j.ajem.2014.12.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 11/04/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The etiologic diagnosis of acute dyspnea in the emergency department (ED) remains difficult, especially for elderly patients or those with previous cardiorespiratory medical history. This may lead to inappropriate treatment and potentially a higher mortality rate. Our objective was to evaluate the performance of cardiopulmonary ultrasound compared with usual care for the etiologic diagnosis of acute dyspnea in the ED. METHODS Patients admitted to the ED for acute dyspnea underwent upon arrival a cardiopulmonary ultrasound performed by an emergency physician, in addition to standard care. The performances of the clinical examination, chest x-ray, N-terminal brain natriuretic peptide (NT-proBNP), and cardiopulmonary ultrasound were compared with the final diagnosis made by 2 independent physicians. RESULTS One hundred thirty patients were analyzed. For the diagnosis of acute left-sided heart failure, cardiopulmonary ultrasound had an accuracy of 90% (95% confidence interval [CI], 84-95) vs 67% (95% CI, 57-75), P = .0001 for clinical examination, and 81% (95% CI, 72-88), P = .04 for the combination "clinical examination-NT-proBNP-x-ray". Cardiopulmonary ultrasound led to the diagnosis of pneumonia or pleural effusion with an accuracy of 86% (95% CI, 80-92) and decompensated chronic obstructive pulmonary disease or asthma with an accuracy of 95% (95% CI, 92-99). Cardiopulmonary ultrasound lasted an average of 12 ± 3 minutes. CONCLUSIONS Cardiopulmonary ultrasounds performed in the ED setting allow one to rapidly establish the etiology of acute dyspnea with an accuracy of 90%.
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Affiliation(s)
- Emeric Gallard
- Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France.
| | - Jean-Philippe Redonnet
- Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Jean-Eudes Bourcier
- Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Dominique Deshaies
- Unité de Soutien Méthodologique à la Recherche, Laboratoire d'Épidémiologie, Centre Hospitalier Universitaire de Toulouse, France
| | - Nicolas Largeteau
- Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Jeanne-Marie Amalric
- Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Fouad Chedaddi
- Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Jean-Marie Bourgeois
- Centre Francophone de Formation en Echographie, Centre Médical Delta, Nîmes, France
| | - Didier Garnier
- Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France
| | - Thomas Geeraerts
- Anesthesiology and Critical Care Department, Toulouse University Hospital, University Toulouse 3 Paul Sabatier, Toulouse, France
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