We are back for our first ever trio podcast! We have two previous PA guests, Patrick Bafuma and Frank Norman, to discuss a new paper regarding dyspnea and POCUS. At this time, the paper has not received much publicity but we agreed it was important to cover. Like our last podcast, this one is a bit longer but it is well worth your time so please look over the blog and listen to the podcast. A quick apology though as to the audio quality, especially in the second half. Due to a technical issue, it could not be refined to the same extent but it is still worth the listen.
The paper is Point-of-care ultrasonography for evaluation of acute dyspnea in the emergency department. It was published in Chest February 2017. Patrick also reviewed the paper recently on his blog. Quite simply, the results are incredible. This is a paper that simply has to be read but basically, point of care ultrasound (POCUS) is amazingly beneficial in the undifferentiated dyspnea patient.
As Patrick pointed out from the study, the likelihood ratios are ridiculously strong. In all dyspnea patients over the age of 18 years and not trauma related (a total of 2,683 patients) were evaluated by 10 emergency physicians that were given a history and physical, and an EKG, as well as access to a Chest X-Ray, Chest CT, cardiologist performed echo, and labs including an ABG. These same patient were then evaluated by POCUS and the ultrasonographers were only provided with a history and physical, vital signs, EKG, and their ultrasound skills. The emergency physician did not have the POCUS results.
Here are some of the likelihood (LR) findings taken from Patrick's site:
+LR for acute heart failure? 22 (-LR 0.12)
+LR for acute coronary syndrome? 105 !!!
+LR for pneumonia? 10.5 (-LR 0.13)
+LR for pleural effusion? 95 (-LR 0.23)
+LR for pericardial effusion? 325!!! (-LR 0.14)
+LR for COPD/asthma? 22 (-LR 0.14)
+LR for pulmonary embolism? 345!!!
+LR for pneumothorax? 4635!!! (-LR 0.12)
+LR for ARDS? 90
Above you will see an example of a lung ultrasound from emDocs in their pulmonary section. A big part of this study is the importance of likelihood ratios which has been covered in many areas with one ultrasound related example being with Casey Parker's Broome Docs post. For an example of some likelihood ratios that are well documented chest out theNNT.
When it comes to the simplicity and ease of ultrasound, Frank gave an example from Timothy Young who was able to demonstrate how easy it was to learn ultrasound and do scans with minimal training including forDVT. Keep in mind we have talked about competency based ultrasound in the past with Frank Norman and again emphasized the ease of doing this in a department that may not even have a skilled clinician with ultrasound experience. Consider going to a course such as the one SEMPA offers for further education in ultrasound basics. Frank's SPACUS can also help with resources. If you want to start learning how to do these awesome lung ultrasounds on your own, check out the Ultrasound Podcast.
Again, apologies for the audio quality especially at the end. Please let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook. Remember to look us up on Libsyn and on iTunes. If you have any questions you can also comment below, email at firstname.lastname@example.org, or send a message from the page. We hope to talk to everyone again soon. Until then, continue to provide total care everywhere.
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