Point-of-care echocardiography is ideally suited to the care of the critical patient in the emergency department or intensive care unit. It is highly accurate, noninvasive, portable, rapidly performed, easily repeatable, and simple to learn. It can provide critical information in real time that otherwise may not be available, particularly in the setting of life-threatening emergencies. Point-of-care echocardiography increases patient safety, improves diagnostic accuracy, reduces diagnostic uncertainty, improves efficiency, and saves lives.
The purpose of this chapter is to provide a general understanding of point-of-care echocardiography, as it is applied and accepted in the emergency department and ICU setting. We present an overview of how echocardiography can be utilized in the management of the critically ill patient. This chapter is not intended as a complete reference and assumes a basic understanding of ultrasound physics, image generation, ultrasound modes, terminology, and system operation.
Point-of-care ultrasound developed originally in Japan and Europe, and came into emergency medicine practice in United States in the 1990s. Point-of-care echocardiography is considered core content of the specialty of emergency medicine by the American Board of Emergency Medicine.1 The American Medical Association supports the use of ultrasound by appropriately trained clinicians in varied specialties, and supports specialty-specific guidelines for training, education, and oversight.2
Point-of-care echocardiography is not the same as a comprehensive echocardiogram or an ultrasound study done in a traditional imaging suite. It is performed, interpreted, and integrated into patient care in real time at the bedside. Our goal is to immediately impact patient care by quickly and accurately performing a brief or focused exam designed to answer simple yes/no questions. Our exam will focus on immediate life-threatening conditions and to assess response to resuscitative measures. Point-of-care echocardiography has evolved over the past two decades into a bedside diagnostic tool, a method to safety guide invasive procedures, and a way to noninvasively assess and monitor ongoing resuscitation. The most current American College of Emergency Physicians (ACEP) Emergency Ultrasound Guidelines provide a comprehensive overview of the scope of practice, and training and credentialing guidelines, and serve as an excellent reference for any department starting and developing a point-of-care ultrasound program.3
Echocardiography is an essential skill for emergency physicians and is especially well suited to the critically ill patient. Using simple qualitative echocardiography, emergency physicians can rapidly and definitively assess for cardiac activity in cardiac arrest, evaluate for pericardial effusion and tamponade, estimate left ventricular systolic function, noninvasively estimate preload and right ventricular filling pressure, identify acute right heart strain, direct resuscitation and medical decision making, and immediately differentiate treatable causes of PEA and shock. This chapter will focus on image acquisition, image interpretation, and integration of this information obtained into the care of the critically ill patient.
Echocardiography is a technically challenging study to perform for many reasons. The heart is surrounded by the bony ribs and sternum, as well as the air-filled lungs that expand and ...