Echocardiography for ED Dyspnea Evaluation
Purpose of Review
The undifferentiated dyspneic patient is one of the most common critically ill patients encountered by hospital providers and continues to present a diagnostic challenge. Since its advent, bedside ultrasonography has demonstrated increasing clinical utility in identifying cardiopulmonary causes of dyspnea including left-sided heart failure, pulmonary edema, acute and chronic right-sided heart strain and failure, pneumonia, pleural fluid collections, airway processes such as chronic obstructive pulmonary disease, and cardiac tamponade. This review discusses the ability of point of care ultrasound to identify the cause of dyspnea in patients both in the emergency department, before hospitalization, and during hospitalization.
Recent trends include demonstrable feasibility in novice users such as resident physicians and emergency triage nurses with no previous exposure to ultrasound and development of an automated algorithm to direct management of the dyspneic patient. Notable advances in employing ultrasound include demonstrable efficacy of multiorgan protocols, diaphragmatic assessment, and bedside echocardiography in elucidating the etiology of dyspnea. Recent evidence highlights ultrasound’s diagnostic accuracy in identifying pulmonary edema and feasibility when using portable units and when performed by relatively inexperienced users.
As ultrasound technology and its omnipresence in medicine advances, clinicians will encounter robust evidence that point of care ultrasound aids in understanding undifferentiated dyspnea. Additionally, providers will be exposed to novel uses of ultrasound that may advance patient care.
KeywordsPoint-of-care ultrasound Dyspnea Heart failure Right heart dysfunction
Compliance with Ethical Guidelines
Conflict of Interest
Drs Carnell and Wu declare that they have no conflicts of interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the author.
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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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