ABSTRACT
PURPOSE: We analyzed the efficacy of a point-of-care ultrasonographic protocol, based on a focused multiorgan examination, for the diagnostic process of symptomatic, non-traumatic hypotensive patients in the emergency department. METHODS: We prospectively enrolled 108 adult patients complaining of non-traumatic symptomatic hypotension of uncertain etiology. Patients received immediate point-of-care ultrasonography to determine cardiac function and right/left ventricle diameter rate, inferior vena cava diameter and collapsibility, pulmonary congestion, consolidations and sliding, abdominal free fluid and aortic aneurysm, and leg vein thrombosis. The organ-oriented diagnoses were combined to formulate an ultrasonographic hypothesis of the cause of hemodynamic instability. The ultrasonographic diagnosis was then compared with a final clinical diagnosis obtained by agreement of three independent expert physicians who performed a retrospective hospital chart review of each case. RESULTS: Considering the whole population, concordance between the point-of-care ultrasonography diagnosis and the final clinical diagnosis was interpreted as good, with Cohen's k = 0.710 (95 % CI, 0.614-0.806), p < 0.0001 and raw agreement (Ra) = 0.768. By eliminating the 13 cases where the final clinical diagnosis was not agreed upon (indefinite), the concordance increased to almost perfect, with k = 0.971 (95 % CI, 0.932-1.000), p < 0.0001 and Ra = 0.978. CONCLUSIONS: Emergency diagnostic judgments guided by point-of-care multiorgan ultrasonography in patients presenting with undifferentiated hypotension significantly agreed with a final clinical diagnosis obtained by retrospective chart review. The integration of an ultrasonographic multiorgan protocol in the diagnostic process of undifferentiated hypotension has great potential in guiding the first-line therapeutic approach.
Subject(s)
Hypotension/diagnostic imaging , Hypotension/etiology , Point-of-Care Systems , Shock/diagnostic imaging , Shock/etiology , Abdomen/diagnostic imaging , Adult , Aged , Aged, 80 and over , Echocardiography , Emergencies , Female , Humans , Italy , Lung/diagnostic imaging , Male , Middle Aged , Prospective Studies , Retrospective Studies , Veins/diagnostic imagingSubject(s)
Angina Pectoris/drug therapy , Benzazepines/therapeutic use , Calcium Channel Blockers/therapeutic use , Diltiazem/therapeutic use , Myocardial Infarction/drug therapy , Nifedipine/analogs & derivatives , Adult , Clinical Trials as Topic , Female , Humans , Male , Middle Aged , Nicardipine , Nifedipine/therapeutic useSubject(s)
Arrhythmias, Cardiac/chemically induced , Digitalis Glycosides/poisoning , Aged , Anti-Arrhythmia Agents/therapeutic use , Arrhythmias, Cardiac/drug therapy , Atrial Fibrillation/chemically induced , Bradycardia/chemically induced , Heart Block/chemically induced , Humans , Middle Aged , Potassium/therapeutic use , Tachycardia/chemically inducedSubject(s)
Angina Pectoris/drug therapy , Nifedipine/therapeutic use , Pyridines/therapeutic use , Adult , Aged , Ambulatory Care , Female , Humans , Male , Middle AgedABSTRACT
The relation between intracardial haemodynamics and apicocardiogram (ACG) parameters is explained. A wave (amplitude and duration), A/H ratio, true and total TCI, total systole, total expulsion, RIV, RFW, TE/TCI (total) and TE/TCI (true) findings in 22 patients with acute myocardial infarct are presented. Attention is also given to clinical and radiological signs of cardiac insufficiency and the infarct site. Constant and significant increases in the A wave, A/H ratio and RIV, together with a decrease in total expulsion, were noted, particularly in cases with clinical evident insufficiency. In the pre-expulsive stage, ACG Data could not be taken as a reliable index of myocardial contractility in cases where insufficiency was not manifest. It is felt, therefore, that ACG may be of assistance in the evaluation of changes in myocardial performance, even where clinical and radiological signs of decompensation are absent.