Point-of-care cardiac ultrasound in acute medicine – the quick scan

Abstract

Point-of-care cardiac ultrasound in acute medicine -the quick scanThe optimum management of acute medical patients requires prompt and accurate diagnosis, monitoring and treatment. The clinical history and physical examination remain central to diagnosis, but often need supplementation by laboratory testing or imaging. Echocardiographic assessment of cardiac structure and function provides valuable information that can aid diagnosis and assess clinical progress. It has many advantages as an imaging modality, and recent technological advances have resulted in hand-held, battery-powered ultrasound devices that provide high-quality images. Three broad applications of cardiac ultrasound now exist: conventional echocardiography, focussed echocardiography and the quick-scan. A quick-scan using a hand-held ultrasound device is readily integrated into the bedside clinical assessment, providing information that can be used immediately in diagnostic reasoning; it can also guide pericardiocentesis. Hand-held ultrasound devices can also be used in acute situations, as well as geographically remote areas or special situations (eg disaster zones) where other imaging is not available. However, the diagnostic yield of echocardiography is user dependent, and training is required for its benefi ts to be realised, adding to the hardware costs. More data are needed on the incremental value of hand-held ultrasonography and a quickscan over conventional methods of assessment, their impact on clinical outcomes, and cost effectiveness.

Point-of-care cardiac ultrasound in acute internal medicine: how can it be delivered?

“…Acute internal medicine (AIM) physicians frequently need to rule out potentially life-threatening pathology more quickly than is possible with a comprehensive standard echocardiogram. Point-of-care examinations using hand-held devices 1 are designed to identify key pathologies: pericardial tamponade; severe left ventricular impairment; critical valve disease; right ventricular dilatation as a sign of pulmonary embolism; and inferior vena cava (IVC) size and reactivity as a sign of loading. It is vital that such scans are performed by operators appropriately trained, qualifi ed and regulated, but no nationally agreed accreditation system in the UK exists.…”

“…The correlation between strong clinical leadership and improvement across various healthcare measures -patient experience, outcomes, organisational performance, staff engagement and overall care quality -has generated considerable interest. 1 By contrast, effective healthcare management remains under-celebrated, despite evidence suggesting that management responsibility is widely distributed in the NHS, with most clinicians receiving minimal management training. 2 As the UK's healthcare architecture assimilates increasing complexity, there is a growing implication that clinicians should formally acquire capability in subjects traditionally considered non-clinical, including fi nancial and operational management, human resources and service transformation, to better understand healthcare as both system and industry, and best navigate, lead and improve services for patients.…”

“…Efforts to introduce general leadership themes into core curricula have achieved mixed reception, 3 and little robust evidence indicates that existing approaches have improved leadership development. 1 A restricted number of medical schools offer intercalated bachelor degrees in management principles, conferring comparable competency to undergraduate science. Students demonstrating early potential as clinician researchers, however, can further undertake integrated MB/PhD degrees at a selection of institutions, while ongoing clinical and management preparation remains separate.…”

Detecting heart valve disease: can we do better?

“…These scans take about 10 minutes and can be performed using a hand-held device allowing near-patient testing anywhere in the community. They are best regarded as an extension of the clinical examination and are increasingly used in the acute setting 11 to aid immediate management and to triage the urgency with which a full scan is required.…”

Feasibility of an Outpatient Point-of-Care Echocardiography Service

“…However this could potentially be accomplished with abbreviated point-of-care (POC) scans. [2][3][4] We therefore established a pilot outpatient POC service for commonly requested indications judged unlikely by the triaging consultant of the day to reveal structural abnormalities.…”