The point of care ultrasound revolution has brought a renaissance to providers of resuscitative care: No longer is determination of shock something that requires invasive monitoring (e.g. Swan Ganz) or an ICU admission. Instead, with good image acquisition and image interpretation skills, point of care echo can answer this question anywhere in the hospital – the ED, the ward, the ICU and, the CT scanner or the cafeteria.
Assessing LV function at the point of care is typically used for patients in shock. Compromised LV function may either be the cause or may significantly complicate shock management. Our approach for managing shock based on LV function is shown in this flowsheet.
The “eyeball” method for addressing LV function is acceptable and even necessary in the point of care setting. Exact determination of ejection fraction (EF) is time consuming and the additional investment in acquiring a more “precise” number does not typically provide incrementally better or more detailed care. A patient with an EF of 20% and one with an EF 25% are typically resuscitated in a similar fashion, for instance.
Not that there should be any doubt, but studies are out there that strongly support the ability of non-cardiologists to interpret LV function accurately.(1-3)
We have just recently released a very helpful tutorial produced by Danny Peterson, MD (a PGY5 in our EM program) on the interpretation of various, broad categories of LV function to assist in managing your patient in shock (See below). If you are interested in learning more about how to perform and interpret point of care echo, consider enrolling in our critical care ultrasound course to be held this August.
1. Moore, Christopher L., et al. “Determination of left ventricular function by emergency physician echocardiography of hypotensive patients.” Academic emergency medicine 9.3 (2002): 186-193.
2. Melamed, Roman, et al. “Assessment of left ventricular function by intensivists using hand-held echocardiography.” CHEST Journal 135.6 (2009): 1416-1420.
3. Randazzo, Marco R., et al. “Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography.” Academic emergency medicine 10.9 (2003): 973-977.