Point of care cardiac ultrasound applications in the emergency department and intensive care unit--a review

Abstract

The use of point of care echocardiography by non-cardiologist in acute care settings such as the emergency department (ED) or the intensive care unit (ICU) is very common. Unlike diagnostic echocardiography, the scope of such point of care exams is often restricted to address the clinical questions raised by the patient's differential diagnosis or chief complaint in order to inform immediate management decisions. In this article, an overview of the most common applications of this focused echocardiography in the ED and ICU is provided. This includes but is not limited to the evaluation of patients experiencing hypotension, cardiac arrest, cardiac trauma, chest pain and patients after cardiac surgery.

Fig. (1)

IVC images taken in the same spontaneously breathing patient with sepsis at the bedside in the ED. 1a 2D image shows a small calibre IVC collapsing during spontaneous breathing. 1b M-mode image of the same patient shows collapse with each breath (denoted by '*'). 1c 2D image of the same patient after 90 minutes and 3L of crystalloid shows larger calibre IVC and, as is seen in 1d An M-mode demonstrates the absence of size variation with respiration, suggestive of adequate fluid resuscitation.

Fig. (2)

Images from a hemodynamically unstable patient who presented to the ED with undifferentiated chest pain and abdominal pain. Immediate point of care ultrasound was performed revealing the following images: 2a: Parasternal long axis view demonstrating enlarged ascending aorta and aortic root. 2b: Sub-xiphoid view demonstrating pericardial effusion. 2c: Transabdominal view of the proximal abdominal aorta where a mobile, intraluminal, echogenic line was seen, suggestive of an intimal flap. After the patient was stabilized, CT scan confirmed a Stanford type A aortic dissection extending from the aortic root to the iliac bifurcation.

Fig. (3)

Hemopericardium as seen from a sub-xiphoid view after a penetrating injury to right ventricle (RV). Note clotted blood in pericardium.

Fig. (4)

Right-to-left shunt. On this modified mid-esophageal bicaval view from a bedside, focused TEE in the ICU, agitated saline bubbles (arrow) can be seen passing from the Right Atrium (RA) to the Left Atrium (LA) through a defect in the intra-atrial septum.