Use of POCUS in Chest Pain and Dyspnea in Emergency Department: What Role Could It Have?

Accuracy of Point-Of-Care Cardiac Ultrasound Performed on Patients Admitted to a Pediatric Intensive Care Unit in Shock

PURPOSE

To assess agreement between a novice pediatric critical care fellow's interpretation of left and right ventricular (LV, RV) function using point-of-care ultrasound (POCUS) compared with assessments by pediatric cardiologists and echocardiography.

METHODS

Echocardiographic clips (parasternal long axis, parasternal short axis, and apical four-chamber) and measurements for LV and RV functions (E-point septal separation, ejection fraction, and tricuspid annular plane systolic excursion) were obtained by PICU fellow in patients 0-18 years old with shock. A pediatric cardiologist reviewed the POCUS images. Agreement between the interpretations by the intensivist, cardiologist, and comprehensive echocardiograms were analyzed using Cohen's kappa.

RESULTS

Thirty-one patients were included: 22 had comprehensive echocardiograms. The PICU fellow detected LV dysfunction with 100% sensitivity and > 85% specificity compared with the cardiologist's interpretation and formal echocardiography. Substantial agreement (κ = 0.62) was noted between the intensivist and cardiologist for interpretation of LV function and RV size and pressure (κ = 0.72). The intensivist's assessments showed perfect agreement (κ = 1.0) with echocardiography for LV and RV function. POCUS images ranged from 100% adequate in the parasternal long axis, 90% in the parasternal short axis, and 43% in apical four-chambered views.

CONCLUSIONS

A novice PICU fellow could reliably use POCUS to assess the cardiac function in pediatric patients with shock.

Chest pain and AI interpretation: The essential role of clinical judgment and quality data

Chest pain is a common and complex condition in emergency departments, often complicating the diagnostic process due to its wide range of potential causes. This case report presents a 72-year-old man with chest pain and ST-segment elevation on ECG, initially suggestive of acute coronary syndrom. AI-assisted ECG analysis reinforced this suspicion; however, angiography revealed patent coronary arteries. When his symptoms persisted, further investigation uncovered a pneumothorax. Additional evaluation identified a digitization error affecting the AI interpretation. This case underscores the importance of a comprehensive clinical approach for chest pain and highlights the need for quality data input and alternative imaging, such as thoracic ultrasound, for accurate and timely differential diagnoses.

Point-of-Care Ultrasound for the Diagnosis of Frequent Cardiovascular Diseases: A Review

Point-of-care ultrasound (POCUS) has emerged as an indispensable diagnostic tool in cardiology, particularly within the emergency department. This narrative synthesis provides a comprehensive exploration of POCUS applications in cardiovascular diseases, elucidating its multifaceted roles and addressing challenges. The review delves into the technical attributes of POCUS, emphasizing its non-invasive nature, radiation-free qualities, and suitability for non-radiologists. It navigates through educational strategies, stressing the importance of structured programs for the seamless integration of POCUS into clinical practice. Highlighting its efficacy, the synthesis discusses POCUS applications in various scenarios such as dyspnea, chest pain, cardiac arrest, aortic dissection, pericardial effusion, and pulmonary embolism. Beyond acute care, the review explores the role of POCUS in outpatient and inpatient settings, focusing on chronic and acute heart failure, valvular heart diseases, and more. Acknowledging operator-dependent challenges and the need for continuous education, the review underscores the transformative potential of POCUS across diverse healthcare settings. This narrative synthesis accentuates POCUS as a valuable and versatile diagnostic tool in cardiology, offering efficiency, safety, and cost-effectiveness. Despite challenges, POCUS stands out as a transformative addition to clinical practices, poised to enhance patient outcomes and reshape the landscape of cardiovascular diagnostics.