Original ContributionsBedside echocardiography by emergency physicians*,**
Introduction
Few applications of emergency bedside ultrasonography are more time critical and potentially life-saving as 2-dimensional echocardiography.1 It is well documented that ultrasonography can be learned by emergency physicians2, 3 and that this bedside tool is extremely valuable as part of the focused examination for trauma.4 The ability to rapidly and accurately diagnose pericardial effusions in the emergency department facilitates a wide variety of traumatic and nontraumatic symptoms; echocardiography is the undisputed test of choice for the detection of pericardial effusion.5 Few data exist in this focused area of emergency ultrasonography, especially in a general emergency population. This study prospectively examined the accuracy of echocardiography performed by emergency physicians in the detection of pericardial effusion.
Section snippets
Methods
This study was designed to assess the accuracy of echocardiography performed by emergency physicians to detect pericardial effusions. Emergency patients at high risk were defined before the study and are outlined in Figure 1.We prospectively identified cases, and 2-dimensional echocardiography was performed on these selected patients. The captured studies were subsequently reviewed by a single echocardiographer from the Department of Cardiology to
Results
A total of 515 echocardiographic examinations were completed; of these, 478 (93%) examinations were considered technically adequate. Breakdown by clinical indication and final result is shown in Table 1.Indication Effusion Present Effusion Absent Total Unexplained hypotension or dyspnea 14 35 49 Cancer with chest pain or dyspnea 10 18 28 Congestive heart failure/enlargedcardiac silhouette 30 82 112 Blunt chest injury
Discussion
Bedside echocardiography allows rapid, noninvasive diagnosis of pericardial effusions and acute pericardial tamponade.7 Physical examination findings such as Beck's triad, although commonly emphasized, are notoriously unreliable and do not have a definitive role in modern medicine.8, 9 Bedside 2-dimensional echocardiography is the standard for the acute evaluation of pericardial effusions; however, 24-hour echocardiography services are not commonly available in hospitals in the United States.
Acknowledgements
Author contributions: DPM, RJH, and SOH conceived and designed the study. RJH wrote the protocol and obtained IRB approval. KM helped collect data, and KM and SOH completed data analysis. DPM drafted the manuscript and all authors contributed to its revision. DPM takes responsibility for the paper as a whole.
We thank Susan Currie for her help with this project.
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Author contributions are provided at the end of this article.
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Address for reprints:Diku P. Mandavia, MD, FRCPC, Department of Emergency Medicine, Cedars-Sinai Medical Center, Room 1110, 8700 Beverly Boulevard, Los Angeles, CA 90048; E-mail,[email protected].