This was such a great talk. Having an algorithm on what exactly you're trying to rule out in a systematic fashion makes so much sense. Too many times i've just plopped the ultrasound down on the patient hoping to find SOMETHING but not really having those binary decisions in mind (i.e. B-lines yes/no, PTX yes/no move on).
Definitely a great talk! And a hot topic with more handheld US devices on the market. I don't know where to take this, given some evidence doesn't support the use of POCUS in undifferentiated hypotension....I am curious what others think. Certainly I've had anecdotal success once finding tamponade.
https://www.annemergmed.com/article/S0196-0644(18)30325-1/pdf "this is the first randomized controlled trial to compare point-of-care ultrasonography to standard care without point-of-care ultrasonography in undifferentiated hypotensive ED patients. We did not find any benefits for survival, length of stay, rates of CT scanning, inotrope use, or fluid administration."
The 1st thing to keep in mind is that most of the time ultrasound confirms what we already thought as clinicians. It just helps to raise our diagnostic certainty thus helping us to avoid having too much gray hair. It definitely helps to decrease our cognitive load as we are more certain that we're doing "the right thing" and even though I will still get a CT in my massive PE patient, I might choose a better timing to send him there. These are all benefits that are hard to study !
Sporadically, like your tamponnade example, it will radically change the management in a given patient. The same thing holds when you uncover an unsuspected heart failure in a septic patient.
My clinical experience is that ultrasound is definitely helpful when we're faced with a single patient (n=1), but that might end up difficult to prove in populations of patients like those that studies require. Absence of evidence is not evidence of absence !
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6 AMA PRA Category 1 Credits™ certified by CEME (EM:RAP)
Daniel P., DO - June 6, 2019 4:55 PM
This was such a great talk. Having an algorithm on what exactly you're trying to rule out in a systematic fashion makes so much sense. Too many times i've just plopped the ultrasound down on the patient hoping to find SOMETHING but not really having those binary decisions in mind (i.e. B-lines yes/no, PTX yes/no move on).
gm - June 11, 2019 11:11 PM
Definitely a great talk! And a hot topic with more handheld US devices on the market. I don't know where to take this, given some evidence doesn't support the use of POCUS in undifferentiated hypotension....I am curious what others think. Certainly I've had anecdotal success once finding tamponade.
https://www.annemergmed.com/article/S0196-0644(18)30325-1/pdf
"this is the first randomized controlled trial to compare point-of-care ultrasonography to standard care without point-of-care ultrasonography in undifferentiated hypotensive ED patients. We did not find any benefits for survival, length of stay, rates of CT scanning, inotrope use, or fluid administration."
Maxime V., M.D. - June 17, 2019 11:41 AM
The 1st thing to keep in mind is that most of the time ultrasound confirms what we already thought as clinicians. It just helps to raise our diagnostic certainty thus helping us to avoid having too much gray hair. It definitely helps to decrease our cognitive load as we are more certain that we're doing "the right thing" and even though I will still get a CT in my massive PE patient, I might choose a better timing to send him there. These are all benefits that are hard to study !
Sporadically, like your tamponnade example, it will radically change the management in a given patient. The same thing holds when you uncover an unsuspected heart failure in a septic patient.
My clinical experience is that ultrasound is definitely helpful when we're faced with a single patient (n=1), but that might end up difficult to prove in populations of patients like those that studies require. Absence of evidence is not evidence of absence !