EMOttawa - Emergency Medicine Ottawa

A male in his 60’s presents with progressive dyspnea on exertion x 1 month starting while he was swimming in the ocean. He had not been diving.  He has no significant medical history and takes no medications.

Point-of-Care Ultrasonography (POCUS) is a valuable tool in the diagnostic armamentarium of the emergency physician. We have been successfully using it to the place lines, diagnose AAAs and assess the cardiac function of our dyspnea patients for awhile now. But what about the lungs? Typically air is thought of as the enemy of ultrasound, but can we successfully use it to diagnose acute respiratory conditions despite this? In this Grand Rounds review, Dr. Elizabeth Lalande goes through the use of POCUS in the diagnosis of Acute Cardiogenic Pulmonary Edema in the undifferentiated, dyspneic patient. 

This case is brought to you by Dr. Robert Ohle, PGY5 in emergency medicine, who assessed the patient and captured all of the ultrasound images! Case Vignette: A female in her 20's presents to the emergency department 15 days after major cardiac surgery to repair a congenital aortic valve defect. Her chief complaint is palpitations and shortness of breath, which have been constant and ongoing for the last 4 days. She has no PND or orthopnea, no calf swelling, or history of DVT/PE. She has no past medical history other than the aortic valve defect and is on no medications. Her exam shows a well looking young female in no acute distress. Her vitals are BP 110/40, HR 110, afebrile, O2 99% on room air, RR 18. Her sternotomy incision site looks healthy. Her lungs are clear and there is a loud cardiac murmur, but both the senior resident and staff are unable to tell if it is systolic or diastolic because of the patient’s tachycardia. There are no signs of DVT. Routine bloodwork including car…

Methodology Score: 3/5                    Usefulness Score: 3.5/5
Herbst MK, Rosenberg G, Daniels B, Gross CP, Singh D, Molinaro AM, Luty S, Moore CL. Ann Emerg Med. 2014 Sep;64(3):269-76.
Abstract Link
This prospective study of ED patients undergoing CT scan for renal colic found that bedside ultrasound performed by the emergency provider had excellent test characteristics for diagnosing hydronephrosis if the provider had fellowship training in ultrasound, but was only moderately helpful if the provider did not have an ultrasound fellowship. While JC attendees had concerns about the possibility of selection bias due to the number of excluded patients, this paper showed that with proper training, bedside ultrasound can be useful for the diagnosis of renal colic.  By:Dr. Brandon Ritcey (Presented February 2015) 

Epi Lesson:The Value of Consecutive Enrollment in Prospective Cohort Studies