Impact of bedside ultrasonography on emergency department decision making

Authors

DOI:

https://doi.org/10.18041/2665-427X/ijeph.2.9983

Keywords:

ultrasound, shock, acute respiratory failure, cardiovascular arrest, POCUS, Rapid Ultrasound in Shock, Bedside lung ultrasound in an emergency, Cardiac stop ultrasound examination

Abstract

Introduction: Ultrasound at the patient's bedside or POCUS (point of care ultrasound), is a strategy that has allowed non-expert physicians to integrate this technology in emergency services, critical care, and even general hospitalization rooms.

Objective: Provide a comprehensive and critical evaluation of the available literature on POCUS in the emergency department, understanding its strengths and the gaps in the current knowledge base regarding its utility in clinical practice.

Methods: A synopsis and review of the literature were carried out according to the paper presented at the Congress of the Colombian Association of Internal Medicine (ACMI) - Valle Chapter, Universidad Libre: "A multidisciplinary approach with a Latin American vision" on the 13th and 14th. May 2022.

Results: The use of POCUS in the emergency department through different protocols such as RUSH (Rapid Ultrasound in Shock), BLUE (Bedside lung ultrasound in an emergency), and CAUSE (Cardiac stop ultrasound examination) has shown an improvement in diagnostic accuracy, time to detection, and change in behaviors compared with the usual history and physical examination.

Conclusion: The POCUS is a valuable tool that allows for accelerating decision-making, improving diagnostic accuracy, explaining, and improving patient outcomes in emergency services.

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References

Faruqi I, Siddiqi M, Buhumaid R. 6 Point-of-Care Ultrasound in the Emergency Department. En: Subhy AA. Essentials of Accident and Emergency Medicine. IntechOpen; 2019. Doi: 10.5772/intechopen.74123.

Filly RA. Ultrasound: the stethoscope of the future, alas. Radiology. 1988; 167(2): 400. doi: 10.1148/radiology.167.2.3282260.

Boniface MP, Helgeson SA, Cowdell JC, Simon LV, Hiroto BT, Werlang ME, et al. A longitudinal curriculum in point-of-care ultrasonography improves medical knowledge and psychomotor skills among internal medicine residents. Adv Med Educ Pract. 2019; 10: 935-942. doi: 10.2147/AMEP.S220153.

Olgers TJ, Azizi N, Blans MJ, Bosch FH, Gans ROB, Ter Maaten JC. Point-of-care Ultrasound (PoCUS) for the internist in Acute Medicine: a uniform curriculum. Neth J Med. 2019; 77(5): 168-176.

Maw A, Jalali C, Jannat-Khah D, Gudi K, Logio L, Evans A, et al. Faculty development in point of care ultrasound for internists. Med Educ Online. 2016; 21: 33287. doi: 10.3402/meo.v21.33287.

Wagner M, Shen-Wagner J, Zhang KX, Flynn T, Bergman K. Point-of-care ultrasound applications in the outpatient clinic. South Med J. 2018; 111(7): 404-410. doi: 10.14423/SMJ.0000000000000835.

Zwank MD, Gordon BD, Truman SM. refining the wild wild west of point-of-care ultrasound at an academic community hospital. J Am Coll Radiol. 2017; 14(12): 1574-1577.e3. doi: 10.1016/j.jacr.2017.04.002.

Ward MJ, Sodickson A, Diercks DB, Raja AS. Cost-effectiveness of lower extremity compression ultrasound in emergency department patients with a high risk of hemodynamically stable pulmonary embolism. Acad Emerg Med. 2011; 18(1): 22-31. doi: 10.1111/j.1553-2712.2010.00957.x.

Mengel-Jørgensen T, Jensen MB. Variation in the use of point-of-care ultrasound in general practice in various European countries. Results of a survey among experts. Eur J Gen Pract. 2016; 22(4): 274-277. doi: 10.1080/13814788.2016.1211105.

Doniger SJ, Kornblith A. Point-of-Care Ultrasound Integrated Into a Staged Diagnostic Algorithm for Pediatric Appendicitis. Pediatr Emerg Care. 2018; 34(2): 109-115. doi: 10.1097/PEC.0000000000000773.

Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008; 134(1): 117-25. doi: 10.1378/chest.07-2800.

Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Emerg Med Clin North Am. 2010; 28(1): 29-56. doi: 10.1016/j.emc.2009.09.010.

Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma. 2004; 57(2): 288-95. doi: 10.1097/01.ta.0000133565.88871.e4.

Hernandez C, Shuler K, Hannan H, Sonyika C, Likourezos A, Marshall J. C.A.U.S.E.: Cardiac arrest ultra-sound exam--a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation. 2008; 76(2): 198-206. doi: 10.1016/j.resuscitation.2007.06.033.

Lichtenstein D. FALLS-protocol: lung ultrasound in hemodynamic assessment of shock. Heart Lung Vessel. 2013; 5(3): 142-7.

Jones AE, Tayal VS, Sullivan DM, Kline JA. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med. 2004; 32(8): 1703-8. doi: 10.1097/01.ccm.0000133017.34137.82.

Shokoohi H, Boniface KS, Pourmand A, et al. Bedside Ultrasound Reduces Diagnostic Uncertainty and Guides Resuscitation in Patients With Undifferentiated Hypotension. Crit Care Med. 2015 Dec;43(12):2562-9. doi: 10.1097/CCM.0000000000001285. PMID: 26575653.

Atkinson PR, Milne J, Diegelmann L, Lamprecht H, Stander M , Lussier D, et al. Does point-of-care ultrasonography improve clinical outcomes in emergency department patients with undifferentiated hypotension? an international randomized controlled trial from the SHoC-ED Investigators. Ann Emerg Med. 2018; 72(4): 478-489. doi: 10.1016/j.annemergmed.2018.04.002.

Nazerian P, Vanni S, Volpicelli G, Gigli C, Zanobetti M, Bartolucci M, et al. Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism. Chest. 2014;145(5):950-957. doi: 10.1378/chest.13-1087.

Maw AM, Hassanin A, Ho PM, McInnes MDF, Moss A, Juarez-Colunga E, et al. Diagnostic accuracy of point-of-care lung ultrasonography and chest radiography in adults with symptoms suggestive of acute decompensated heart failure: a systematic review and meta-analysis. JAMA Netw Open. 201; 2(3): e190703. doi: 10.1001/jamanetworkopen.2019.0703.

Pivetta E, Goffi A, Lupia E, Tizzani M, Porrino G, Ferreri E, et al. Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED: A SIMEU Multicenter Study. Chest. 2015; 148(1): 202-210. doi: 10.1378/chest.14-2608.

Nazerian P, Volpicelli G, Vanni S, Gigli C, Betti L, Bartolucci M, et al. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography. Am J Emerg Med. 2015; 33(5): 620-5. doi: 10.1016/j.ajem.2015.01.035.

Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest. 2012; 141(3): 703-708. doi: 10.1378/chest.11-0131.

Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004; 100(1): 9-15. doi: 10.1097/00000542-200401000-00006.

Yousefifard M, Baikpour M, Ghelichkhani P, Asady H, Shahsavari NK, Moghadas JA, et al. Screening performance characteristic of ultrasonography and radiography in detection of pleural effusion; a meta-analysis. Emerg (Tehran). 2016; 4(1): 1-10.

Staub LJ, Mazzali Biscaro RR, Kaszubowski E, Maurici R. Lung ultrasound for the emergency diagnosis of pneumonia, acute heart failure, and exacerbations of chronic obstructive pulmonary disease/asthma in adults: a systematic review and meta-analysis. J Emerg Med. 2019; 56(1): 53-69. doi: 10.1016/j.jemermed.2018.09.009.

Laursen CB, Sloth E, Lassen AT, Christensen Rd, Lambrechtsen J, Madsen PH, et al. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Respir Med. 2014; 2(8): 638-46. doi: 10.1016/S2213-2600(14)70135-3.

Huis IVMA, Allison MG, Bostick DS, Fisher KR, Goloubeva OG, Witting MD, et al. Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions. Resuscitation. 2017; 119: 95-98. doi: 10.1016/j.resuscitation.2017.07.021.

Fair J3rd, Mallin MP, Adler A, Ockerse P, Steenblik J, Tonna J, et al. Transesophageal echocardiography during cardiopulmonary resuscitation is associated with shorter compression pauses compared with transthoracic echocardiography. Ann Emerg Med. 2019; 73(6): 610-616. doi: 10.1016/j.annemergmed.2019.01.018.

Gaspari R, Weekes A, Adhikari S, Noble VE, Nomura JT, Theodoro D, et al. Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. Resuscitation. 2016; 109: 33-39. doi: 10.1016/j.resuscitation.2016.09.018.

Wallbridge PD, Joosten SA, Hannan LM, Steinfort DP, Irving L, Goldin J, et al. A prospective cohort study of thoracic ultrasound in acute respiratory failure: the C3PO protocol. JRSM Open. 2017; 8(5): 2054270417695055. doi: 10.1177/2054270417695055.

Breitkreutz R, Campo DOM, Hamm C, Cuca C, Zechner PM, Stenger T, et al. Does the integration of personalized ultrasound change patient management in critical care medicine? Observational trials. Emerg Med Int. 2013; 2013: 946059. doi: 10.1155/2013/946059.

Leidi A, Rouyer F, Marti C, Reny JL, Grosgurin O. Point of care ultrasonography from the emergency department to the internal medicine ward: current trends and perspectives. Intern Emerg Med. 2020; 15(3): 395-408. doi: 10.1007/s11739-020-02284-5.

Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev. 2015; 1(1): CD006962. doi: 10.1002/14651858.CD006962.pub2.

Published

2022-12-30 — Updated on 2022-12-30

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How to Cite

Impact of bedside ultrasonography on emergency department decision making. (2022). Interdisciplinary Journal of Epidemiology and Public Health, 5(2), e-9983. https://doi.org/10.18041/2665-427X/ijeph.2.9983

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