Point-of-care echocardiography is ideally suited to the care of the critical patient in the emergency department (ED), intensive care unit (ICU), or perioperative arena. It is highly accurate, noninvasive, portable, rapidly performed, easily repeatable, and simple to learn. It can provide critical information in real time 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 ED 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 it 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. The goal is to immediately impact patient care by quickly and accurately performing a brief or focused exam designed to answer simple yes and no questions. The exam should focus on immediate life-threatening conditions and 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 these guidelines serve as an excellent reference for any department starting and developing a point-of-care ultrasound program.3 In 2010, the ACEP along with the American Society of Echocardiography (ASE) published a consensus statement on the use of ultrasound in the emergent setting.4 These recommendations, along with recent Focused Ultrasound Recommendations published by the ASE in 2013 for the use of ultrasound for critically ill patients, demonstrate the importance of clinical ultrasound in the hands of acute care physicians.5
ECHOCARDIOGRAPHY: CLINICAL INDICATIONS
Echocardiography is an essential skill for emergency medicine physicians and is especially well suited to the critically ill patient. Using simple qualitative echocardiography, emergency medicine physicians can rapidly and definitively assess for cardiac activity in cardiac arrest, evaluate for pericardial effusion and tamponade, estimate left ...