Resuscitative Cardiopulmonary Ultrasound and Transesophageal Echocardiography in the Emergency Department

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Key points

  • The use of point-of-care ultrasound is the standard of care in the evaluation of patients with shock, hypotension, or acute hemodynamic decompensation in the emergency department.

  • The scope of focused cardiopulmonary ultrasound has expanded to include some advanced techniques that tailor therapeutic interventions to a patient’s underlying physiology.

  • Qualitative and quantitative evaluation of left and right ventricular function, identification of pericardial effusion and tamponade, evaluation of

Resuscitative cardiopulmonary ultrasound

Resuscitative cardiopulmonary ultrasound can allow the emergency physician (EP) to characterize the predominant physiology of a patient with shock, establish the cause of acute hypoxemia, and assess the effect of therapeutic interventions, such as administration of vasoactive drugs or intravenous fluids.

Although a core set of 5 parasternal and subcostal views is often described in FOCUS, with some additional knowledge, practice, and views, the care provider can improve his or her clinical

Advanced focused cardiac ultrasound techniques

Although the basic applications of FOCUS are sufficient in most cases, the management of complex critically ill patients often requires additional information to understand the patient’s cardiovascular physiology and hemodynamics.

Examples of these scenarios include cases in which LVEF does not accurately represent the SV, when quantitative assessment of the cardiac output is needed to titrate vasoactive drugs, suspected acute RV failure, and in the evaluation of tamponade. By understanding

Resuscitative transesophageal echocardiography

Over the past 2 decades, the practice of TEE has expanded from its traditional indications (ie, patients undergoing cardiac surgery, suspected endocarditis, or cardioversion in atrial fibrillation), to assist the hemodynamic evaluation of patients with acute decompensation, shock, and cardiac arrest.52, 53, 54, 55, 56 Following landmark publications demonstrating the feasibility of EP-performed TEE, a number of institutions in the United States have implemented ED-based TEE programs (Fig. 9).

Summary

Resuscitative cardiopulmonary ultrasound is a powerful tool in the assessment of critically ill patients, and continues to rapidly grow in emergency medicine. The basic elements include the qualitative evaluation of LV and RV function, the identification of pericardial effusion, and the evaluation of preload. Advanced applications such as identification of tamponade physiology, quantitative function of the RV and LV, and hemodynamic monitoring can be incorporated with relatively simple

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