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Point of Care bedside cardiac ultrasound
When performing a bedside abbreviated echo in the emergency department setting to rule out pericardial effusion, do you utilize all three cardiac windows? (sub xyphoid, parasternal and apical 4 chamber) Or if you can answer the question on the first view, do you stop there? During the FAST we just use one view unless it is suboptimal. My question is if you can answer the question (pericardial effusion yes or no) with one view during the FAST, does that same logic apply to a dedicated cardiac in the non-trauma patient or do you feel that all three views should be attempted in a dedicated cardiac. Are there any guidelines for this?
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Replies to This Discussion
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Permalink Reply by Jason T Nomura MD, RDMS on -
It will depend on the clinical indication for the exam and the status/stability of the patient. For example in the E-FAST exam for an unstable patient in the setting of penetrating thoracic trauma the presence of a pericardial effusion from that trauma quickly becomes the next item to manage in the stabilization of the patient. If you have a cardiac arrest patient with the presence of a pericardial effusion with what appears to be tamponade and a PEA state a single view is generally enough to plan the next step in their clinical management.
However, if you have a hemodynamically stable patient with chest pain, shortness of breath, or other complaints leading to a limited echo then multiple views can be helpful. The presence of a trace to small effusion may not be easily seen on a single view. Conversely while a large effusion may be easy to evaluate on a single view signs of tamponade physiology may not be visible in all views equally.
If the patient is hemodynamically stable and can tolerate the exam I advocate a multi-view echo for evaluation to evaluate for not only the presence and size of the effusion but also the effect it has on the heart.
Unfortunately in the end the answer remains an unsatisfying "ti depends" on the patient status. -
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