The Incremental Role of Multiorgan Point-of-Care Ultrasounds in the Emergency Setting

Abstract

Point-of-care ultrasonography (POCUS) represents a goal-directed ultrasound examination performed by clinicians directly involved in patient healthcare. POCUS has been widely used in emergency departments, where US exams allow physicians to make quick diagnoses and to recognize early life-threatening conditions which require prompt interventions. Although initially meant for the real-time evaluation of cardiovascular and respiratory pathologies, its use has been extended to a wide range of clinical applications, such as screening for deep-vein thrombosis and trauma, abdominal ultrasonography of the right upper quadrant and appendix, and guidance for invasive procedures. Moreover, recently, bedside ultrasounds have been used to evaluate the fluid balance and to guide decongestive therapy in acutely decompensated heart failure. The aim of the present review was to discuss the most common applications of POCUS in the emergency setting.

Keywords: POCUS; VE x US; congestion; deep-vein thrombosis (DTV); echocardiography; emergency medicine (EM); lung ultrasound (LUS); point-of-care.

Figure 1

A-lines (arrow).

Figure 2

Lung point: “seashore sign” (left) turns into “stratosphere sign” (right) in M-mode view during deep inspiration.

Figure 3

Pleural effusion with lung region floating inside (arrow).

Figure 4

B-lines (left, indicated by arrow) and “B-pattern” (right).

Figure 5

“Tissue-like pattern” with air bronchogram inside (arrow).

Figure 6

Systolic bowing of interventricular septum towards the left ventricle (D-shape) is associated with pulmonary embolism and pulmonary hypertension.

Figure 7

Pericardial tamponade: end-diastolic right ventricular chamber collapse is associated with significant pericardial effusion.

Figure 8

Bubble test during pericardiocentesis: appearance of bubbles in the pericardium (arrow) indicates that the needle is correctly positioned in the pericardial space.

Figure 9

Ultrasonography of the right upper quadrant. A distended gallbladder with microlithiasis and large biliary sludge (left); multiple stones with posterior shadowing in the infundibulum (right).

Figure 10

Ultrasonography of normal and abnormal appendixes. On the left, there are longitudinal and transverse USs of acute appendicitis showing thickened walls and diameter > 6 mm. On the right, there is a thinner normal appendix.

Figure 11

Pelvis and caliceal dilatation with proximal ureteral stone.

Figure 12

Intrarenal vein Doppler (above baseline) in a patient with acutely decompensated heart failure before (left) and after (right) decongestive therapy. The flow pattern appears monophasic/diastolic (L), becoming continuous as congestion reduces (R).

Figure 13

Compression ultrasound [Di Vilio A, Vergara A, Desiderio A, et al.: “A. Incremental value of compression ultrasound sonography in the emergency department. World J Crit Care Med. 2021 Sep 9;10(5):194–203].

Figure 14

The image shows the presence of an extensive thrombus with mixed echogenicity occupying the lumen of the femoral vein and the great saphenous vein.