Tag Archive for: Ultrasound

Beyond ACLS – POCUS in Cardiac Arrest

20 Aug
August 20, 2015

Beyond ACLS - POCUS in Cardiac ArrestAs we have discussed in previous posts, the care of patients with cardiac arrest is a key skill for Emergency Providers. ACLS provides a foundation for care but is rife with shortcomings including, but not limited to, reliance on outdated data and inability to adapt in the face of improved understanding of cardiac arrest pathophysiology. The incorporation of technological advances and skills is another massive limitation of ACLS. One of these technologies is point of care ultrasound (POCUS).

Over the last two decades, POCUS has become a integral part of Emergency Medicine training and practice. POCUS allows for rapid, bedside diagnosis of a number of conditions including cholecystitis, urinary retention and ectopic pregnancy. Additionally, it is becoming a greater component in the management of the critical patient where it can be used to assess cardiac contractility, wall motion abnormalities, intraperitoneal free fluid and more. Application of POCUS in all patients with cardiac arrest is simply the next step. This diagnostic modality is not highlighted in the current iteration of ACLS but is a practice changer. The bottom line is that application of POCUS in cardiac arrest allows the emergency provider to guide resuscitation with a direct look into the body – we are no longer blind.

For this post, I want to discuss two ways that we can use ultrasound in cardiac arrest patients, specifically in pulseless electrical activity (PEA), in the Emergency Department:

  1. Assessment for the presence or absence of cardiac output and
  2. As an alternate framework to the Hs and Ts.

A quick disclaimer – I am not an ultrasound expert, I did not do a fellowship but I am passionate about it’s application in our sickest patients. Read more →

Ultrasound for Detection of Pneumothorax

16 Jun
June 16, 2014

Ultrasound for Detection of PneumothoraxTypically, the initial evaluation of blunt trauma patients involves a supine anteroposterior (AP) chest x-ray (CXR) which has a poor sensitivity for the detection of pneumothorax (PTX), and has been reported as low as 20% – 48%. Following the CXR computed tomography (CT) has been the standard for the diagnosis of pneumothorax. The use of ultrasonography to diagnose pneumothorax was first described in 1986 in animal studies. Since then there have been many studies that have shown bedside ultrasound can rapidly detect pneumothorax, helping avoid serious potential consequences (i.e. tension pneumothorax), especially in patients requiring mechanical ventilation. There are several different sonographic signs that can be used to detect pneumothorax, specifically, sonographic lung sliding. But how good is ultrasound for the detection of pneumothorax?

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Diagnosis of Right Ventricular Strain with Transthoracic Echocardiography

07 Apr
April 7, 2014

Pulmonary EmbolismAbnormal vital signs are poor predictors of mortality associated with pulmonary embolism (PE).  Diagnosis of PE and right ventricular (RV) strain with transthoracic echocardiography (TTE) however, has been well documented as a predictor for pending shock and significant in-hospital mortality.  One study done by Grifoni S et al, showed that 10% of normotensive patients with PE and RV strain on echo developed PE related shock, and 3% died, whereas normotensive patients without signs of RV strain remained hemodynamically stable. 
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