An Evidence-Based Approach To Emergency Ultrasound

Abstract

Emergency ultrasound (EUS) continues to develop and expand and is now a core skill in the clinical practice of emergency medicine. The Accreditation Council for Graduate Medical Education (ACGME) training programs now require residents to demonstrate competency in the use of Emergency Ultrasound prior to completing their residency training. Thus, graduating emergency medicine residents are now expected to perform and interpret focused EUS studies as well as they are able to read electrocardiograms and manage emergent airways. With increased focus on patient safety and emergency department (ED) crowding, more and more EDs have purchased ultrasound machines in hopes of improving patient safety and quality of care and decreasing lengths of stay in the ED. Anecdotal stories of the benefits of bedside ultrasound (BUS) abound, yet many emergency clinicians are not familiar with its numerous applications or the body of literature regarding its use.

To date, there are 11 core EUS applications, and the clinical usefulness of each application is covered in the literature to varying degrees. The 6 initially established applications include: 1) the Focused Assessment with Sonography for Trauma (FAST) examination, 2) abdominal aortic aneurysm, 3) emergency echocardiography, 4) pregnancy, 5) hepatobiliary ultrasound, and 6) renal ultrasound. The 5 recently added applications include: 1) deep venous thrombosis, 2) thoracic ultrasound, 3) musculoskeletal ultrasound, 4) ocular ultrasound, and 5) procedural ultrasound.

The American College of Emergency Physicians (ACEP) 2008 revision of their Emergency Ultrasound Guidelines Policy Statement updates the original 2001 policy statement and details how EUS has expanded and where it stands today.¹ Appendix 1 of the 2008 ultrasound policy statement briefly reviews the evidence for the 11 core applications of EUS. This ACEP policy statement is the most current, comprehensive, specialty-specific guideline in the field of EUS. This issue of Emergency Medicine Practice expands on this review and summarizes the existing and best available literature concerning these EUS applications.

Keywords: emergency ultrasound, bedside ultrasound, FAST Exam, thoracic ultrasound, aortic ultrasound, soft tissue ultrasound, musculoskeletal ultrasound, ocular ultrasound, hepatobiliary ultrasound, procedural guidance, urinary ultrasound, echocardiography