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Bedside cardiac ultrasound training should be mandated in the emergency department

ABSTRACT: Abstract

Background

Bedside cardiac ultrasound can be performed quickly and accurately in the emergency department to diagnose and treat cardiovascular causes of patient deterioration. In Australian emergency departments, it is an underutilised tool. This may be because becoming proficient at performing bedside cardiac ultrasound is not mandated by the Australasian College for Emergency Medicine.

Cases

Case 1: A 45‐year‐old male presented with hypoxia and shock and head injury. Findings consistent with pulmonary embolism on bedside cardiac ultrasound prompted rapid treatment with thrombolysis. The patient survived to hospital discharge. Case 2: A 54‐year‐old female presented with chest pain. Her bedside cardiac ultrasound revealed a dilated proximal aorta and a dissection flap in the abdominal aorta enabling investigations and operative management to be expedited. Case 3: A 21‐year‐old male presented with features of lower respiratory tract infection. Chest X‐ray revealed a large heart and consolidation. Bedside cardiac ultrasound demonstrated severe dilated cardiomyopathy and prompted the patient's admission into the coronary care unit.

Conclusion

Evidence shows that emergency doctors can perform bedside cardiac ultrasound accurately after minimal training. It increases the accuracy of diagnosis. Training in this vital diagnostic tool should be mandated for emergency medicine trainees in Australia.

SUBMITTER: Lokuge A

PROVIDER: S-EPMC8409895 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundPoint-of-care ultrasound is one of useful diagnostic tools in emergency medicine practice and considerably depends on physician's performance. This study was performed to evaluate performance improvements and favorable attitudes through structured cardiac ultrasound program for emergency medicine residents.MethodsRetrospective observational study using the point-of-care ultrasound (PoCUS) database in one tertiary academic-teaching hospital emergency department has been conducted. Cardiac ultrasound education and rotation program has been implemented in emergency medicine residency program. Structured evaluation sheet for cardiac ultrasound and questionnaire toward PoCUS have been developed. An early-phase and a late-phase case were selected randomly for each participant. Two emergency medicine specialists with expertise in PoCUS evaluated saved images independently. We used a paired t-test to compare the performance score of each phase and the results of the questionnaire. Multivariable linear regression analysis was conducted to evaluate the association between the characteristics of participants and performance improvements.ResultsDuring the study period, a total of 1,652 bedside cardiac ultrasounds were administered. Forty-six examinations conducted by 23 emergency medicine residents were randomly selected for analysis. The performance score increased from 39.5 to 56.1 according to expert A and 45.3 to 62.9 according to expert B (p-value <0.01 for both). The average questionnaire score, which was analyzed for 17 participants, showed improvement from 18.9 to 20.7 (p-value <0.01). In multivariable linear regression analysis, younger age, higher early-phase score and higher confidence had a negative association with a greater improvement of performance, while the number of examinations had a positive association.ConclusionsBedside cardiac ultrasound performance and attitudes toward PoCUS have been improved through structured residency program.