I Will Be at Your (Bed)Side – The Role of Bedside Echocardiography for Non-Cardiologists

Abstract

As the availability of portable echocardiographic equipment is becoming more and more widespread, physicians can add a powerful tool to their bedside examination skills, thus helping them to more effectively face the growing complexity of patients admitted to internal medicine departments or the emergency room. Focused cardiac ultrasound (FoCUS) can be defined as a goal-directed, simplified, qualitative examination performed at the bedside using portable echocardiographic devices. FoCUS is not meant to be a substitute for a standard 2D color Doppler echocardiographic examination. Nevertheless, it can provide rapid and reliable information when limited to basic questions, even when performed by non-cardiologists with brief training. Furthermore, a focused cardiac ultrasound examination maximizes its diagnostic role when integrated with an ultrasonographic assessment of the lung, abdomen and deep veins, in a multisystem approach that is particularly dear to internists. In this article, we will focus on the specific targets of a focused cardiac ultrasound examination, as well as the most common pitfalls that can be encountered in ultrasonographic practice. We will also address the application of FoCUS in the management of two typical scenarios in clinical practice, such as dyspnea and non-post-traumatic hypotension.

Zusammenfassung

Mit der zunehmenden breiten Verfügbarkeit tragbarer echokardiografischer Geräte können Ärzte eine leistungsstarke Methode hinzufügen, um ihre Fähigkeiten in der bettseitigen Untersuchung zu erweitern. So können sie der wachsenden Komplexität der Patienten, die in den Abteilungen für Innere Medizin oder in der Notaufnahme aufgenommen werden, wirksamer begegnen. Fokussierter kardialer Ultraschall (FoCUS) kann als zielgerichtete, vereinfachte, qualitative Untersuchung definiert werden, die am Krankenbett mittels tragbarer Echokardiografie-Geräte durchgeführt wird. FoCUS ist kein Ersatz für eine standardmäßige echokardiografische 2D-Farbdoppler-Untersuchung. Dennoch kann er bei Beschränkung auf grundlegende Fragestellungen schnelle und zuverlässige Informationen liefern, selbst wenn kurz ausgebildete Nicht-Kardiologen ihn durchführen. Darüber hinaus wird der diagnostische Wert des fokussierten kardialen Ultraschalls maximiert, wenn dieser in eine sonografische Beurteilung von Lunge, Abdomen und tiefen Venen integriert wird, und zwar in einem Multisystemansatz, der Internisten besonders am Herzen liegt. In diesem Artikel konzentrieren wir uns auf die spezifischen Ziele einer fokussierten kardialen Ultraschalluntersuchung sowie auf die häufigsten Fallstricke, die in der Ultraschallpraxis auftreten können. Wir werden uns auch mit der Anwendung von FoCUS bei der Behandlung von 2 typischen Szenarien in der klinischen Praxis befassen – Dyspnoe und nichtposttraumatische Hypotonie.

Publication History

Article published online:
04 August 2020

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