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Emergency Ultrasound In Patients With Respiratory Distress

February 2012

Abstract

Emergency ultrasound is a highly valuable and readily learned tool that has expanded rapidly since its introduction more than 20 years ago. In the past decade, emergency ultrasound has progressed from 6 to 11 primary indications. The earliest applications of emergency ultrasound answered questions regarding the presence or absence of life-threatening clinical conditions and enhanced patient safety through procedural guidance. More recently, it has lent itself to the evaluation and management of critically ill patients through the incorporation of multiple ultrasound examinations within a single patient encounter. The information gained can provide crucial, time-dependent information at the bedside, which can enhance diagnostic certainty and guide management. This issue of EMCC provides an evidence-based approach to the use of ultrasound in the evaluation of the critically ill patient with respiratory distress and hypotension. Two clinical scenarios are presented: the progressively dyspneic patient with a history of chronic obstructive pulmonary disease (COPD) and decompensated heart failure and the acutely dyspneic patient with hypotension. These scenarios were chosen because they are commonly encountered in clinical practice and require rapid, complex decision making that is augmented with the use of emergency ultrasound. The evidence supporting emergency ultrasound for diagnosis of pulmonary edema, pneumothorax, left ventricular (LV) dysfunction, and right ventricular (RV) dysfunction is presented, and the technique for image acquisition is discussed.

Keywords: ultrasound in shock, thoracic ultrasound, ultrasound and pneumothorax, ultrasound and dyspnea, ultrasound and pulmonary edema, ultra­sound and pleural effusion, ultrasound and pulmonary embolism, ultrasound in critical care, sonographic B lines, ultrasound comet tails, ultrasound and lung sliding, and emergency echocardiography.

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