• Temple EM

EM Physician Echo Assessment of Hypotensive Patients

The Article:

Moore CL, Rose GA, Kline JA et al. “Determination of Left Ventricular Function by Emergency Physician Echocardiography of Hypotensive Patients” Academic Emergency Medicine Journal.  9(2002): 186-193

The Idea:

Systemic hypotension is a common and life threatening emergency. Differentiation of shock determines diagnosis and treatment. Can Emergency Physicians (EP) trained in cardiac ultrasound accurately assess left ventricular function in hypotensive ED patients?

The Study:

Prospective Study: 51 Patients presenting to ED with symptomatic hypotension were enrolled and evaluated by bedside Echo by 4 different Emergency Physicians (EPs) with variable ultrasound experience, but whom had undergone goal-directed transthoracic echo training. The EP obtained 5 cardiac views of each patient and graded LVF quantitatively and qualitatively (EF >50% = normal, EF 30-50% = moderate depressed, EF <30% = severe depression). The echocardiography studies by the EPs were then evaluated by cardiologist, blinded to the EPs LVF estimates.“Symptomatic” Defined as: syncope, lightheadedness, extreme fatigue, AMS.

Inclusion Criteria: age > 18yo, SBP < 100 mmHg x 2 within 15 minutes, no history of trauma, ECG w/o MI

Exclusion Criteria: reported h/o “low blood pressure at baseline,” asymptomatic hypotension, chest compressions or defibrillation received.

The Findings:

EPs categorized 24 patients as normal LVF, 16 with moderately depressed LVF, and 10 with severely depressed LVF.  Primary Cardiologist categorized 22 patients has normal LVF, 18 moderately depressed LVF, 10 with severely depressed LVF. EPs misclassified 5 / 22 patients with normal EF as moderately depressed EF, and 2 /10 patients with severely depressed EF as moderately depressed EF.  EP vs Cardiologist Weight Kappa = .61. EP vs Cardiologist Pearson Correlation Coefficient (N=50) : .86  

The Takeaway:

Emergency Physicians who have undergone goal directed training of LVF using bedside ultrasound, are adequately able to estimate LVF with reasonable accuracy compared to cardiologist estimates, in ED patient’s presenting with symptomatic hypotension.

#Cardiovascular #Ultrasound

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