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1.
Pediatr Ann ; 50(10): e424-e431, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34617847

RESUMO

Cardiac point-of-care ultrasound (POCUS) provides real-time views of the heart to answer specific questions in a timely manner. This is a valuable tool for managing pediatric patients, from those with congenital heart disease to those who are critically ill. The main echocardiographic findings of pericardial tamponade consist of a pericardial effusion, diastolic right ventricular collapse, systolic right atrial collapse, and a plethoric inferior vena cava with minimal respiratory variation. The main echocardiographic findings of hypertrophic cardiomyopathy consist of increased wall thickness (concentric or eccentric), systolic anterior motion of the anterior mitral leaflet, and a dynamic sub-aortic left ventricular outflow tract obstruction. Additional uses of cardiac POCUS include assessment of dilated cardiomyopathy and the detection of pediatric congenital heart disease, including detection of a patent ductus arteriosus. The use of POCUS in the pediatric population is supported by societal position statements and is expected to develop further with increasingly robust education and training. [Pediatr Ann. 2021;50(10):e424-e431.].


Assuntos
Tamponamento Cardíaco , Cardiomiopatia Hipertrófica , Ecocardiografia , Tamponamento Cardíaco/diagnóstico por imagem , Criança , Emergências , Ventrículos do Coração/diagnóstico por imagem , Humanos , Medicina de Emergência Pediátrica
2.
West J Emerg Med ; 22(5): 1095-1101, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34546885

RESUMO

INTRODUCTION: Residency scholarly tracks are educational programs, designed to help trainees develop an area of expertise. Although the breadth of residency point-of-care ultrasound (POCUS) education has developed considerably in recent years, there is no literature to date describing scholarly tracks specifically in POCUS. In this study we sought to determine the prevalence, characteristics, and outcomes of POCUS scholarly tracks in emergency medicine (EM). METHODS: This was a cross-sectional survey of EM residency programs accredited by the Accreditation Council for Graduate Medical Education. Surveys were distributed between March-August 2020 using a listserv followed by targeted emails to residency and ultrasound leadership. We summarized data using descriptive statistics, and performed logistic regression to identify factors associated with a POCUS scholarly track. RESULTS: Of 267 residency programs 199 (74.5%) completed the survey. Fifty-seven (28.6%) had a POCUS scholarly track as of the 2019-2020 academic year. Scholarly tracks in POCUS were more common in university-based/academic sites and larger residency programs. Of the 57 programs with POCUS scholarly tracks, 48 (84.2%) required residents to present at least one POCUS lecture, 45 (78.9%) required residents to serve as instructor at a hands-on workshop, and 42 (73.7%) required residents to participate in quality assurance of departmental POCUS scans. Only 28 (49.1%) tracks had a structured curriculum, and 26 (45.6%) required POCUS research. In total, 300 EM residents completed a POCUS scholarly track over the past three academic years, with a median of 4 (2-9) per program. Seventy-five (25.0%) proceeded to a clinical ultrasound fellowship after residency graduation, with a median of 1 (interquartile range 0-2) per program. A total of 139 POCUS-specific abstracts (median 2 [0-3]) and 80 peer-reviewed manuscripts (median 1 [0-2]) were published by scholarly track residents over the past three years. CONCLUSION: This survey study describes the current prevalence, characteristics, and outcomes of POCUS scholarly tracks across EM residency programs. The results may inform the decisions of residency programs to create these tracks.


Assuntos
Medicina de Emergência/educação , Internato e Residência/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Estudos Transversais , Currículo , Educação de Pós-Graduação em Medicina , Humanos , Estados Unidos
3.
Anaesth Crit Care Pain Med ; 40(2): 100852, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33781986

RESUMO

INTRODUCTION: Pulmonary embolism (PE) is a potentially fatal disease encountered in the hospital setting. Prompt diagnosis and management can improve outcomes and survival. Unfortunately, a PE may be difficult to diagnose in a timely manner. Point-of-care ultrasound (POCUS) can assist in the evaluation for suspected PE by assessing for acute right ventricular strain. Physicians should thus be aware of these echocardiographic findings. OBJECTIVE: This manuscript will review ten echocardiographic findings of right ventricular strain that may suggest a diagnosis of PE. It will provide a description of each finding along with the associated pathophysiology. It will also summarize the literature for the diagnostic utility of echocardiography for this indication, while providing reference parameters where applicable. Along with labeled images and video clips, the review will then illustrate how to evaluate for each of the ten findings, while offering pearls and pitfalls in this bedside evaluation. DISCUSSION: The ten echocardiographic findings of right ventricular strain are: increased right ventricle: left ventricle size ratio, abnormal septal motion, McConnell's sign, tricuspid regurgitation, elevated pulmonary artery systolic pressure, decreased tricuspid annular plane systolic excursion, decreased S', pulmonary artery mid-systolic notching, 60/60 sign, and speckle tracking demonstrating decreased right ventricular free wall strain. CONCLUSIONS: Physicians must recognize and understand the echocardiographic findings and associated pathophysiology of right ventricular strain. In the proper clinical context, these findings can point toward a diagnosis of PE and thereby lead to earlier initiation of directed management.


Assuntos
Embolia Pulmonar , Disfunção Ventricular Direita , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Artéria Pulmonar , Embolia Pulmonar/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem
4.
Teach Learn Med ; 33(3): 270-281, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33085534

RESUMO

Phenomenon: Point-of-care ultrasound is fast becoming standard clinical bedside practice for diverse specialties. Medical schools are responding by adding ultrasound education, though the majority use it to supplement the learning of basic sciences. Point-of-care ultrasound practice-based clinical skills education is rare. There also is a lack of standardization across curricula, leading to much variability in the ultrasound skills that medical students from different schools bring to residency. To best inform a point-of-care ultrasound curriculum for our Transition-to Residency program, we investigated literature on 1) how medical students are being prepared for use of point-of-care ultrasound in clinical practice, 2) what skills are being taught, 3) what point-of-care ultrasound skills residency programs expect from incoming residents. Approach: We reviewed literature to identify curricula in U.S. medical schools that teach the concepts, knowledge, and skills related to point-of-care ultrasound. We also mapped point-of-care ultrasound expectations set forth by the Entrustable Professional Activities for undergraduate medical education to the specialty-specific milestones identified by the Accreditation Council for Graduate Medical Education. Additionally, we reviewed specialty-specific professional organizations for position statements and guidelines describing the point-of-care ultrasound skills expected for practicing physicians in their respective specialties. The goal was to identify any needs and gaps in education regarding point-of-care ultrasound across the undergraduate to graduate medical education continuum to practice. Findings: We found seven published point-of-care ultrasound curricula for medical students. There was wide variability in these curricula regarding what point-of-care ultrasound content is being taught, as well as when and how this skill is taught. No Entrustable Professional Activity listed point-of-care ultrasound as a skill requirement for graduating medical students. For graduate medical education, there was wide variability across specialties in residency milestones related to point-of-care ultrasound; some (e.g., emergency medicine) listed extensive milestones while others (e.g., internal medicine) listed none. However, we found that many specialty-specific professional organizations do list detailed point-of-care ultrasound expectations for their practicing physicians. Insights: As point-of-care ultrasound is fast becoming common practice across many specialties, standardization of education and related competencies-similar to other clinical skills training-is necessary across medical schools. Mapping point-of-care ultrasound expectations to current teaching across the continuum from undergraduate to graduate medical education may allow schools to tailor point-of-care ultrasound training for Transition-to-Residency programs. We provide a sample pilot point-of-care ultrasound curriculum that we designed for our Transition-to-Residency course.


Assuntos
Medicina de Emergência , Internato e Residência , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina , Medicina de Emergência/educação , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Estados Unidos
5.
MedEdPORTAL ; 16: 11037, 2020 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-33324747

RESUMO

Introduction: Point-of-care ultrasound (POCUS) is a valuable asset in bedside clinical care. Undergraduate medical education is increasingly using POCUS as an adjunct tool for teaching anatomy, pathophysiology, and physical exam in an integrated manner. Many medical schools teach content in an organ systems-based format in the preclerkship years. POCUS teaching can be very effectively tailored to specific organ systems. Though pilot curricula for generalized ultrasound education exist, few teach organ systems-based content using POCUS. To address this gap, we designed and implemented an integrated POCUS module to supplement anatomy, pathophysiology, and physical exam teaching in the renal course. Methods: The module consisted of (1) a 30-minute didactic lecture introducing students to renal ultrasound technique and image interpretation and (2) a practical hands-on skills session. Pre- and postmodule surveys assessed the efficacy and impact of the curriculum. Results: A total of 31 first-year medical students completed the POCUS renal curriculum. A majority reported that the module positively affected their understanding of renal pathophysiology and the physical exam. They also reported increased confidence in using POCUS to detect renal pathology and make clinical decisions. Discussion: It was feasible to implement a POCUS curriculum to supplement integrated teaching of renal system concepts in the first year of medical school, and students found POCUS teaching valuable. POCUS provides educators with another tool to integrate basic and clinical sciences with hands-on relevant clinical skills practice in early medical school years.


Assuntos
Educação de Graduação em Medicina , Sistemas Automatizados de Assistência Junto ao Leito , Currículo , Humanos , Faculdades de Medicina , Ultrassonografia
8.
Can J Anaesth ; 67(12): 1824-1838, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32944839

RESUMO

Right-to-left pulmonary and cardiac shunts (RLS) are important causes of refractory hypoxia in the critically-ill perioperative patient. Using a point-of-care ultrasound (POCUS) agitated saline bubble study for an early diagnosis allows patients with clinically significant RLSs to receive expedited therapy. This narrative review discusses the principles of agitated saline ultrasonography as well as the role of POCUS in detecting the most common RLS types seen in the intensive care unit, including patent foramen ovale, atrial septal defects, and pulmonary arterio-venous malformations. An illustrated discussion of the procedure, as well as shunt-enhancing maneuvers (Valsalva or lung recruitment maneuver with subsequent rapid release) is provided. With the wide dissemination of bedside ultrasound within the perioperative and critical care arena, POCUS practitioners should be knowledgeable of the potential pitfalls leading to both false-positive and false-negative studies. False-positive studies may be due to congenital abnormalities, mischaracterization of intrapulmonary shunts as intracardiac shunts (and vice versa), or evidence of the Valsalva effect. False negatives are typically due to respiratory-phasic variation, performing an inadequate shunt-enhancing maneuver, inadequate injection of agitated saline, or pathophysiologic states of elevated left atrial pressure. Finally, alternative POCUS methods for determining presence of an RLS in patients with poor echocardiographic windows are discussed, with a focus on pulsed-wave Doppler interrogation of arterial signals.


Assuntos
Forame Oval Patente , Sistemas Automatizados de Assistência Junto ao Leito , Ecocardiografia , Forame Oval Patente/diagnóstico por imagem , Humanos , Unidades de Terapia Intensiva , Ultrassonografia Doppler Transcraniana
9.
West J Emerg Med ; 21(5): 1042-1045, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32970551

RESUMO

The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality, as well as large numbers of patients requiring endotracheal intubation. While much of the literature has focused on the intubation technique, there is scant discussion of intubation confirmation. Herein, we discuss the limitations of traditional confirmatory approaches, summarize the literature supporting a role for point-of-care ultrasound in this application, and propose an algorithm for intubation confirmation among COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Intubação Intratraqueal/métodos , Pneumonia Viral/terapia , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia de Intervenção/métodos , Algoritmos , COVID-19 , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Pandemias , Pneumonia Viral/diagnóstico por imagem , SARS-CoV-2
11.
J Ultrasound Med ; 39(11): 2105-2109, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32356589

RESUMO

The ultrasound lung pulse for detecting endobronchial intubation was first described in 2003 in the only study to date assessing its accuracy. It refers to rhythmic movement of the visceral pleura along the stationary parietal pleura as cardiac vibrations transmit through a motionless, airless lung. Compared to delayed visualization on chest radiography, this artifact immediately detects physiologic atelectasis. There is a scarcity of studies assessing the lung pulse, while several others that encountered this artifact did not even identify it. The lung pulse is useful for immediate detection of endobronchial intubation, but it remains unrecognized and underused by physicians.


Assuntos
Intubação Intratraqueal , Pulmão , Humanos , Pulmão/diagnóstico por imagem , Pleura , Radiografia , Ultrassonografia
12.
J Emerg Med ; 58(5): 781-784, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32241705

RESUMO

BACKGROUND: Pseudoaneurysms of the foot are rare and can occur from a range of etiologies, including laceration from a foreign body. The majority of reported cases have been diagnosed by computed tomography, magnetic resonance imaging, or angiography. These tests require intravenous access and contrast, confer radiation, take time to perform and interpret, are expensive, and are not always readily available in the acute setting. No prior reported pseudoaneurysms of the foot have been diagnosed by point-of-care ultrasound (POCUS). CASE REPORT: An 8-year-old boy presented to the emergency department for evaluation of left foot pain and swelling 2 weeks after stepping on small pieces of broken glass. He had a 3 × 3 cm area of painful swelling and erythema at the medial plantar aspect of his foot. A cutaneous abscess was the working diagnosis and preparations were made for an incision and drainage procedure. However, POCUS revealed a medial plantar artery pseudoaneurysm. Incision and drainage would have led to unexpected arterial bleeding. Instead, the pediatric surgery service was consulted for pseudoaneurysm excision and arterial ligation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Incision of a pseudoaneurysm in the sole of the foot-thought to be an abscess based on clinical examination-would lead to unforeseen arterial bleeding. POCUS at the bedside can differentiate between simple abscess and pseudoaneurysm in order to guide appropriate and time-sensitive management. Historical and clinical clues to the diagnosis may include heavier-than-expected bleeding at the time of laceration and a pulsatile quality to the painful erythema and swelling.


Assuntos
Falso Aneurisma , , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Ferimentos Penetrantes , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Artérias/diagnóstico por imagem , Criança , Pé/irrigação sanguínea , Humanos , Masculino , Ferimentos Penetrantes/complicações
14.
Intern Emerg Med ; 15(6): 1075-1079, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32133576

RESUMO

Gastrostomy tubes (G-tubes) are frequently used in children for feeding and nutrition. Complications related to G-tubes (and G-buttons) in children represent a common presentation to the emergency department (ED). G-tube replacement is usually performed by pediatric emergency medicine physicians. Misplacement may lead to tract disruption, perforation, fistula tract formation, or feeding into the peritoneum. Contrast-enhanced radiographs are traditionally used for confirmation. In addition to a longer length-of-stay, repeat ED visits result in repeated radiation exposure. The use of point-of-care ultrasound (POCUS) instead of radiography avoids this exposure to ionizing radiation. Here, we describe three patients who presented with G-tube complications in whom POCUS alone performed by pediatricians was used for confirmation of the tubes' replacement. Two children presented to the ED with G-tube dislodgement, and one child presented with a ruptured balloon. In all three cases, a new G-tube was replaced at the bedside using POCUS guidance without the need for further radiographic studies. There were no known ED or clinic returns for G-tube complaints over the next 30 days. This is the first report of pediatricians using POCUS to guide and confirm G-tube replacement in children. The success of these cases suggests the technique's feasibility. Future prospective studies are needed to evaluate the learning curves, diagnostic accuracy, ED length-of-stay, and use of confirmatory imaging.


Assuntos
Cateterismo/normas , Gastrostomia/instrumentação , Ultrassonografia/métodos , Cateterismo/estatística & dados numéricos , Pré-Escolar , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Gastrostomia/estatística & dados numéricos , Humanos , Lactente , Masculino , Medicina de Emergência Pediátrica/instrumentação , Medicina de Emergência Pediátrica/métodos , Sistemas Automatizados de Assistência Junto ao Leito/normas , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos , Ultrassonografia/estatística & dados numéricos
16.
J Emerg Med ; 58(3): 449-456, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31735658

RESUMO

BACKGROUND: The categorization of pulmonary embolism (PE) as non-massive, sub-massive, and massive helps guide acute management. The presence of right ventricular (RV) strain differentiates sub-massive from non-massive PEs. Unlike laboratory markers and electrocardiogram changes, the classic parameters used in the echocardiographic diagnosis of RV strain have a technical component that is operator-dependent. OBJECTIVE: This narrative review will describe the physiologic effects of a PE on the RV and how this affects prognosis. It will summarize the literature evaluating the accuracy and prognostic ability of tricuspid annular plane systolic excursion (TAPSE) in the echocardiographic assessment of RVfunction. The review will describe the appeal of TAPSE for this purpose, provide cutoff measurements, and then illustrate how to perform the technique itself, while offering associated pearls and pitfalls in this bedside evaluation. DISCUSSION: RV function and dynamics undergo acute changes in the setting of a PE. RV dysfunction predicts poor outcomes in both the short and long term. However, RV strain is difficult to capture on echocardiography due to the chamber's complex geometric shape and contraction. From the apical four-chamber window, TAPSE offers a quantitative measure that is more easily performed with high interobserver reliability for evaluating systolic RV contraction. This measurement carries prognostic value in patients diagnosed with PE. CONCLUSIONS: Along with other more qualitative echocardiographic parameters, TAPSE can be used as a simple quantitative measure of RV dysfunction for differentiating sub-massive from non-massive PEs. This categorization helps guide acute management and disposition.


Assuntos
Embolia Pulmonar , Medição de Risco , Disfunção Ventricular Direita , Humanos , Embolia Pulmonar/diagnóstico por imagem , Reprodutibilidade dos Testes , Valva Tricúspide/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita
18.
Am J Emerg Med ; 37(6): 1144-1152, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30894296

RESUMO

INTRODUCTION: In the catastrophic neurologic emergency, a complete neurological exam is not always possible or feasible given the time-sensitive nature of the underlying disease process, or if emergent airway management is indicated. As the neurologic exam may be limited in some patients, the emergency physician is reliant on the assessment of brainstem structures to determine neurological function. Physicians thus routinely depend on advanced imaging modalities to further investigate for potential catastrophic diagnoses. Acquiring these tests introduces the risks of transport as well as delays in managing time-sensitive neurologic processes. A more immediate, non-invasive bedside approach complementing these modalities has evolved: Transcranial Doppler (TCD). OBJECTIVE: This narrative review will provide a description of scenarios in which TCD may be applicable. It will summarize the sonographic findings and associated underlying pathophysiology in such neurocritical care patients. An illustrated tutorial, along with pearls and pitfalls, is provided. DISCUSSION: Although there are numerous formalized TCD protocols utilizing four views (transtemporal, submandibular, suboccipital, and transorbital), point-of-care TCD is best accomplished through the transtemporal window. The core applications include the evaluation of midline shift, vasospasm after subarachnoid hemorrhage, acute ischemic stroke, and elevated intracranial pressure. An illustrative tutorial is provided. CONCLUSIONS: With the wide dissemination of bedside ultrasound within the emergency department, there is a unique opportunity for the emergency physician to utilize TCD for a variety of conditions. While barriers to training exist, emergency physician performance of limited point-of-care TCD is feasible and may provide rapid and reliable clinical information with high temporal resolution.


Assuntos
Serviço Hospitalar de Emergência , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia Doppler Transcraniana , Vasoespasmo Intracraniano/diagnóstico por imagem , Circulação Cerebrovascular , Cuidados Críticos , Humanos , Hipertensão Intracraniana/diagnóstico por imagem , Exame Neurológico , Acidente Vascular Cerebral/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Vasoespasmo Intracraniano/etiologia
19.
J Emerg Med ; 56(3): 282-287, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30638643

RESUMO

BACKGROUND: In the midst of a nationwide opioid epidemic, focus has been placed on identifying and utilizing safe, effective opioid-free analgesic alternatives. Lower-extremity peripheral nerve blockades are common and often involve both motor and sensory anesthesia, resulting in leg weakness and ambulatory difficulty. The aim of this case report is to describe an ultrasound-guided peripheral nerve block technique (superficial cutaneous anesthesia in a lateral (leg) distribution within the emergency department ['SCALD-ED' block]) that provides motor-sparing, purely sensory anesthesia after a superficial injury to the lateral leg in patients presenting to the emergency department. DISCUSSION: Two separate patients presenting with lateral leg pain after superficial injury (burn, cellulitis) reported continued breakthrough pain despite a standard analgesic modality of combination acetaminophen and ibuprofen. With the patient placed in prone position for ultrasound-guided access to lower-extremity nerve branches, the lateral sural cutaneous nerve (LSCN) was identified by tracing its pathway from the proximal sciatic nerve to the common peroneal (fibular) nerve to the superficial peroneal (fibular) nerve. Five mL of lidocaine (1%, with epinephrine) was injected along the superficial LSCN route for anesthetic blockade. Temporal assessments of anesthetic effect and pain improvement, and monitoring of motor or ambulatory impairment were conducted at regular intervals to assess the efficacy and feasibility of the blockade. Regional anesthesia along the LSCN sensory distribution was experienced at 7-9 min post blockade. Peak analgesic effect was experienced at 25-29 min. The duration of anesthesia was 120-150 min. A negligible amount of delayed sensory anesthesia was noted along the distal sural nerve distribution. No motor deficit, ambulatory difficulty, or adverse effects were experienced in either patient post blockade. CONCLUSION: The LSCN is an identifiable target under ultrasound guidance, susceptible to localized, purely sensory blockade of pain from superficial cutaneous lateral leg injuries.


Assuntos
Bloqueio Nervoso/métodos , Dor/tratamento farmacológico , Adulto , Anestésicos Locais/uso terapêutico , Queimaduras/complicações , Queimaduras/tratamento farmacológico , Celulite (Flegmão)/complicações , Celulite (Flegmão)/tratamento farmacológico , Serviço Hospitalar de Emergência/organização & administração , Humanos , Perna (Membro)/fisiopatologia , Masculino , Bloqueio Nervoso/tendências , Manejo da Dor/métodos , Medição da Dor/métodos , Ultrassonografia de Intervenção/métodos
20.
Am J Emerg Med ; 37(2): 321-326, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30471929

RESUMO

BACKGROUND: Pericardial tamponade is neither a clinical nor an echocardiographic diagnosis alone. The echocardiogram carries diagnostic value and should be performed when there is suspicion for tamponade based on the history and physical exam. A pericardial effusion uncovered on point-of-care ultrasound (POCUS) may be mistaken for tamponade and thereby lead to inappropriate and invasive management with pericardiocentesis. OBJECTIVE: This narrative review will summarize the echocardiographic findings and associated pathophysiology that support the diagnosis of pericardial tamponade. It will provide a succinct description of the core findings for which emergency physicians should evaluate at the bedside, along with potential pearls and pitfalls in this evaluation. Labeled images and video clips are included. DISCUSSION: The core echocardiographic findings of pericardial tamponade consist of: a pericardial effusion, diastolic right ventricular collapse (high specificity), systolic right atrial collapse (earliest sign), a plethoric inferior vena cava with minimal respiratory variation (high sensitivity), and exaggerated respiratory cycle changes in mitral and tricuspid valve in-flow velocities as a surrogate for pulsus paradoxus. CONCLUSION: The emergency physician must recognize and understand the core echocardiographic findings and associated pathophysiology that suggest pericardial tamponade. Together with the history and clinical exam, these findings can help make the overall diagnosis and determine management.


Assuntos
Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Ecocardiografia , Derrame Pericárdico/complicações , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Sistemas Automatizados de Assistência Junto ao Leito
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