point of care ultrasound in critically ill patient … · 2016-10-01 · point of care ultrasound...
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POINT OF CARE ULTRASOUND IN CRITICALLY ILL PATIENT WITH ACUTE
DYSPNEAHE CAN’T BREATHE BUT YOU CAN SCAN
Olivier Felix UMUHIRE, MD
Emergency Medicine & Critical Care Resident/UR
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OUTLINE
1. Life threatening Conditions
2. Work up
3. Evidence of POCUS in critical care areas: ED & ICU
4. Scanning protocols
5. Cases
6. References
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ACUTE DYSPNEA DiagnosisPro, an online medical expert system,
listed 497 distinct causes in October 2010.
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ACUTE DYSPNEA DiagnosisPro, an online medical expert system,
listed 497 distinct causes in October 2010.
Most Common &Life
threatening
ACS/MI*
ADHF/CHF
Pneumothorax
PE
COPD
Asthma
Pneumonia
Pulmonary edema
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DIAGNOSTIC APPROCH:CHALLENGES
D-Dimer
BNP
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DIAGNOSTIC APPROCH:CHALLENGES
D-Dimer
BNP
RESSOURCES
TIME
IRRADIATION
*Hx+Phy Ex.
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EVIDENCE OF POCUS IN CRITICALLY SICK
DYSPNEIC PATIENT
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PE Signs and symptoms are non
specific
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SCANNING ALGORITHMS
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1. BLUE PROTOCOL
Daniel A. Lichtenstein Annals of Intensive Care 2014, 4:1
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2. THE RADIUS PROTOCOLE
Heart
Lung parenchyma
Lung Pleura
IVC
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3. TRIPLE SCAN
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4. MULTI ORGAN SCANS
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PUTTING TOGETHER
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PE
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TO CONLUDE
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”Speed of sound”
Portable. Issue of CXR or CT for
Critically sick patient in Critically ill
Non radiating, Non invasive
Recordable information vs Auscultation
Cost effective
Repeatable
Much better than CXR (poor quality,
suppine)
Operator dependent-Training
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” Radiography is a familiar tool that lacks
sensitivity : 60-70%, all fields considered.
Prof Daniel Lichtenstein
Service de Réanimation Intensive Care Dept,
Ambroise-Paré, Boulogne (Paris-West), France.
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Jang, Timothy B., et al. "The predictive value of physical examination findings in patients with suspected acute heart failure syndrome." Internal and emergency medicine 7.3 (2012): 271-274
Volpicelli, Giovanni, et al. "Usefulness of lung ultrasound in the bedside distinction between pulmonary edema and exacerbation of COPD."Emergency radiology 15.3 (2008): 145-151.
Morrison, L. Katherine, et al. "Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea." Journal of the American College of Cardiology39.2 (2002): 202-209.
Logeart, Damien, et al. "Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea."Journal of the American College of Cardiology 40.10 (2002): 1794-1800.
Mantuani D, Frazee BW, Fahimi J, Nagdev A. Point-of-Care Multi-Organ Ultrasound Improves Diagnostic Accuracy in Adults Presenting to the Emergency Department with Acute Dyspnea. Western Journal of Emergency Medicine. 2016;17(1):46-53. doi:10.5811/westjem.2015.11.28525.
Volpicelli, Giovanni, et al. "Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome." The American journal of emergency medicine24.6 (2006): 689-696.
Lichtenstein, Daniel A., et al. "Ultrasound diagnosis of occult pneumothorax." Critical care medicine 33.6 (2005): 1231-1238.
Sweeney, Daniel A. "Point-of-Care Ultrasound." Critical Care Medicine 43.8 (2015): e330.
Volpicelli, Giovanni, et al. "International evidence-based recommendations for point-of-care lung ultrasound." Intensive care medicine 38.4 (2012): 577-591.