Current Issues with Emergency Cardiac Ultrasound Probe and Image Conventions

Moore, Chris

doi:10.1111/j.1553-2712.2008.00052.x

Cited by 19 publications

(8 citation statements)

References 30 publications

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“…6,8 For images in this article, we will use an emergency medicine convention for cardiac imaging with the probe marker oriented to the patient's right, which keeps the anatomic right on the screen-left, as is the convention for other US imaging. 9 This is in contrast with image and probe orientation utilized in traditional cardiologyperformed US, but has been recognized as an accepted convention that we find to be conceptually easier, particularly when performing EP FOCUS as part of an integrated examination such as the focused assessment with sonography for trauma (FAST) or the rapid US for shock and hypotension. 3,6 As has been discussed previously in the emergency US literature, EP FOCUS is not intended to replace comprehensive echocardiography (echo) when more thorough cardiology evaluation is indicated.…”

Section: Approach To Exammentioning

confidence: 97%

The “5Es” of Emergency Physician–performed Focused Cardiac Ultrasound: A Protocol for Rapid Identification of Effusion, Ejection, Equality, Exit, and Entrance

Hall

Coffey

Herbst

et al. 2015

Academic Emergency Medicine

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Emergency physician (EP)-performed focused cardiac ultrasound (EP FOCUS) has been increasingly recognized as a crucial tool to help clinicians diagnose and treat potentially life-threatening conditions. The existing literature demonstrates a variety of EP FOCUS applications and protocols; however, EP FOCUS is not taught, practiced, or interpreted consistently between institutions. Drawing on over 12 years of experience in a large-volume, high-acuity academic emergency department, we have developed a protocol for teaching and performing EP FOCUS known as "The 5Es," where each E represents a specific assessment for immediately relevant clinical information. These include pericardial effusion, qualitative left ventricular ejection, ventricular equality, exit (aortic root diameter), and entrance (inferior vena cava diameter and respirophasic variation). Each of these assessments has been well described in the emergency medicine literature and is within the scope of EP-performed echocardiography. This approach provides a reliable and easily recalled framework for assessing, teaching, and communicating EP FOCUS findings that are essential in caring for the patient in the emergency setting.ACADEMIC EMERGENCY MEDICINE 2015;22:583-593 © 2015 by the Society for Academic Emergency Medicine I t has been recognized for more than 25 years that emergency physician (EP)-performed focused cardiac ultrasound (EP FOCUS) is an important skill for the care of patients with potentially life-threatening presentations.1,2 A recent review detailed 16 specific protocols that included cardiac ultrasound (US) as part of the point-of-care US assessment in medical shock. 3The term "focused cardiac ultrasound" has been addressed in some detail (FOCUS, 4 FCU, 5 and FoCUS 6 ). However, this term is not specialty-specific, may include assessments that are not relevant in the acute/emergency setting, and has not included assessment of the thoracic aortic root ("exit"), which may be particularly applicable to acute and emergent presentations. We have found that the proximal thoracic aorta can be reliably assessed, providing vital information about potential aortic pathology in patients presenting with acute symptoms. 7 We thus propose the "5Es" to assess for the presence of a pericardial effusion, left ventricular ejection, ventricular equality, exit (aortic root diameter), and entrance (inferior vena cava [IVC] diameter and respirophasic variation). The 5Es protocol provides an easy-toteach, evidence-based, and standardized approach to EP FOCUS for the rapid identification and management of time-sensitive pathologic conditions. APPROACH TO EXAMTypically EP FOCUS uses one or more of three windows and five views: a parasternal long-axis (PSLA), a

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Section: Approach To Exammentioning

confidence: 97%

The “5Es” of Emergency Physician–performed Focused Cardiac Ultrasound: A Protocol for Rapid Identification of Effusion, Ejection, Equality, Exit, and Entrance

Hall

Coffey

Herbst

et al. 2015

Academic Emergency Medicine

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“…To obtain the cardiac windows, there are 3 different orientations commonly used in the ED. 1 One such technique maintains the indicator on the left side of the screen, as is the orientation for other POCUS applications. For the parasternal long-axis view, the transducer is placed perpendicular to the chest wall, immediately left of the sternum between the third and fourth intercostal space.…”

Section: Techniquementioning

confidence: 99%

Point-of-Care Ultrasound and the Discovery of Pulmonary Arterial Hypertension in a Teenager

2022

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We present a case of a teenage patient with new-onset cardiac symptoms discovered to have primary pulmonary arterial hypertension. Point-of-care ultrasound used early in the patient's presentation identified significant right-sided heart dilatation and dysfunction despite the patient's relatively unrevealing physical examination. This article emphasizes the utility of performing focused cardiac ultrasound in pediatric patients early in their presentation. We briefly review focused cardiac ultrasound technique and highlight relevant literature.

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“…Cardiac, Including Inferior Vena Cava [32][33][34][35][36][37] For the assessment of patients with cardiopulmonary complaints and undifferentiated shock, performance of a focused cardiac ultrasound examination can assist in narrowing the differential diagnosis. Focused cardiac ultrasound may identify the presence or absence of pericardial effusion and cardiac tamponade, left ventricular dysfunction, right ventricular strain, and thoracic aortic dilatation.…”

Section: Infection Controlmentioning

confidence: 99%

Curriculum for Fundamentals of Ultrasound in Clinical Practice

2019

J of Ultrasound Medicine

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Current Issues with Emergency Cardiac Ultrasound Probe and Image Conventions

Cited by 19 publications

References 30 publications

The “5Es” of Emergency Physician–performed Focused Cardiac Ultrasound: A Protocol for Rapid Identification of Effusion, Ejection, Equality, Exit, and Entrance

The “5Es” of Emergency Physician–performed Focused Cardiac Ultrasound: A Protocol for Rapid Identification of Effusion, Ejection, Equality, Exit, and Entrance

Point-of-Care Ultrasound and the Discovery of Pulmonary Arterial Hypertension in a Teenager

Curriculum for Fundamentals of Ultrasound in Clinical Practice

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