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• Is a key component of an initial (and ongoing) evaluation of a patient in shock (or respiratory failure) - especially if unclear etiology. Goal Directed Echocardiography (GDE) Goal D[r]
(1)Ken Lyn-Kew – National Jewish, Denver, CO
(2)How Do We Teach Ultrasound?
• The general way point of care ultrasound is taught is to exam an organ or set of organs
– Eg: Lung exam
(3)However…
• We use ultrasound to answer questions
– Why is this person in shock?
(4)Whole Body Ultrasound
• Idea that putting together the different exams allows you to answer your question
– Why is this patient dyspneic?
(5)Putting things together
• Basic echo findings (size, function, etc)
– PLUS
• Patterns of A lines versus B lines
– PLUS
• Lung sliding or absence
– PLUS
• Presence or absence of effusions / free fluid
– PLUS
• Presence of absence of DVT
– Plus
(6)• Qualitative
• Designed to answer specific questions
• Repeatable
• Can be performed in a few minutes
• Is a key component of an initial (and ongoing) evaluation of a patient in shock (or respiratory failure) - especially if unclear etiology
6
(7)Dx Resp Failure Etiology? Blue Protocol
• 260 pts with respiratory failure – had a
diagnosis categorized by US findings alone
compared to ultimate “gold standard” diagnosis
• Correctly categorized Dx in > 90% of cases
(8)(9)– 139 consecutive pts with acute respiratory failure
– US heart, lungs and deep veins
– 96% could have exam completed
– 14% found condition missed with primary assessment
– Using audit as gold standard:
(10)(11)(12)(13)Case #1
• Pt presents to the ED via EMS; family called after not hearing from pt and pt was found breathing but
non-responsive
• HR: 130 • RR: 24
• BP: 80/60
(14)(15)(16)(17)NO
NO
YES
NO
(18)(19)(20)Case #2
• HR: 130 • RR: 24
• BP: 80/60
• SaO2: 86%
(21)(22)(23)(24)(25)NO
YES
NO
NO
(26)Case #3
• HR: 100 • RR: 20
• BP: 85/59
• SaO2: 98%
(27)(28)(29)(30)(31)NO
YES
YES - but no evidence that this is acute cause of shock
YES
(32)(33)Case #4
• HR: 120 • RR: 20
• BP: 70/55
(34)(35)(36)(37)YES
NO
YES - RV failure
NO
(38)(39)(40)