Zusammenfassung
Hintergrund
Die bettseitige Diagnostik von kardiorespiratorisch instabilen Patienten ist zeitkritisch und für das weitere erfolgreiche Management von betroffenen Patienten essentiell („golden hour of shock“). Die fokussierte Echokardiographie (Focused Cardiac Ultrasound: FOCUS) ergänzt die körperliche Untersuchung. Sie hilft dem Notfallmediziner, durch die direkte Visualisierung des Herzens rasch behandelbare Ursachen zu identifizieren.
Ergebnisse
Der diagnostische Stellenwert dieser Untersuchungsmethode wird durch interdisziplinäre Empfehlungen internationaler Fachgesellschaften unterstützt. Jeder in der Notfall- und Intensivmedizin tätige Arzt sollte diese Methodik, die auch durch den Nichtkardiologen schnell erlernbar ist, als „must-have“ beherrschen. Die sich auf wenige kardiale Pathologien beschränkenden getroffenen Aussagen sind mit hoher Validität für das weitere therapeutische Management verwertbar. Jedoch müssen die Limitationen der Methodik bekannt sein.
Schlussfolgerung
Die FOCUS ersetzt nicht die ausführliche Echokardiographie des kardiologisch erfahrenen Kollegen, sondern stellt ein „must-have“ in der Erstevaluation für die kritische Notfallsituation dar.
Abstract
Background
The timely diagnostic evaluation of critically ill patients presenting to the emergency department or the intensive care unit is mandatory for further management of affected patients (golden hour of shock). In addition to a physical examination, rapid focused cardiac ultrasound (FoCUS) is increasingly used to evaluate cardiac function and pathologies.
Results
FoCUS is recommended as a bedside diagnostic tool by international societies in the evaluation and prompt management of patients in shock. A wide range of emergency and critical care specialists should be able to perform this evidence-based cardiac ultrasound technique. The use of FoCUS can be learned relatively easily by expert-guided and subsequent training under supervision. Of note, the accuracy of diagnosing a limited number of critical cardiac pathologies by FoCUS is high even for noncardiologists. However, inherent limitations of FoCUS have to be appreciated.
Conclusion
Thus, FoCUS is a „must-have“ to evaluate the critically ill patient in shock but cannot replace expert-guided comprehensive echocardiography.
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C. Waydhas, Essen
M. Christ, Nürnberg
Elektronisches Supplement – Videoloops Notfallechokardiographie
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Schmidt, J. Fokussierte Notfallechokardiographie. Notfall Rettungsmed 18, 465–470 (2015). https://doi.org/10.1007/s10049-015-0021-0
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DOI: https://doi.org/10.1007/s10049-015-0021-0