scholarly journals P122: The evaluation of various point of care ultrasound features in Stanford type A aortic dissections

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S109-S109
Author(s):  
T. Chiang ◽  
G. Puri
Keyword(s):  
Emergency Department ◽  
Pericardial Effusion ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Chart Review ◽  
Point Of Care ◽  
Retrospective Chart Review ◽  
Type A ◽  
Point Of Care Ultrasound ◽  
D Dimer

Introduction: Type A aortic dissection(AD) is one of the most lethal diseases in medicine. Its mortality rate increases 1-2% per hour from the onset of symptoms to treatment. Timely diagnoses of ADs, therefore, are crucial to improve survival and decrease morbidity. There are various proposed clinical guidelines to help emergency physicians decide when a CTA is urgently needed with most widely quoted being the validated Aortic Dissection Detection Risk Score(ADD-RS) recommended by the American Heart Association. The addition of D-Dimer for further risk stratification has also been entertained. A recent article published in the American Journal of Emergency recommends using point of care ultrasound(POCUS) to expedite diagnosis. With the rising use of POCUS in the emergency department, it can be the missing link to timely AD diagnoses. This project aims to elucidate the prevalence of positive POCUS findings (pericardial effusion and dilated aortic root) in type A AD via a retrospective chart review. Methods: This study is a retrospective chart review of 200 patients with the diagnosis of AD treated at Southlake Regional Hospital. We included patients diagnosed with type A AD and excluded those diagnosed with type B AD. We collected data on their demographics, ADD-RS scores, investigation results, treatments, and clinical outcomes. The main focus of the chart review was on the presence of pericardial effusion or dilated aortic root on echocardiograms. Binomial statistical analysis was used to analyze the collected data. Results: We identified 126 patients with type A AD out of 200 charts reviewed. Thirteen (14% CI 8-23%, n = 93 p = 0.05) had wide mediastinum on their chest X-rays; twenty (95% CI 75-100%, n = 21 P = 0.05) had elevated D-dimer levels; and ninety-one (72% CI 64-80%, n = 126 p = 0.05) had positive ADD-RS. Only 88 out of 126 AD cases had documented echocardiograms. Sixty-eight (77% CI 67-86%, n = 88 p = 0.05) had either pericardial effusions or dilated aortic roots on their echocardiograms. Eighty-one (92% CI 84-95%, n = 88 p = 0.05) had either positive ADD-RS or positive echocardiogram findings, which is 20 (23% CI 14-33%, n = 88 P = 0.05) more cases than ADD-RS would have picked up alone. Conclusion: The absence of both pericardial effusion and dilated aortic root on echocardiogram in combination with a negative ADD-RS has a high sensitivity for ruling out type A AD. Our data support further research into the use of POCUS to expedite the diagnosis of type A AD in the emergency department.

scholarly journals Detection of Type B Aortic Dissection in the Emergency Department with Point-of-Care Ultrasound

2019 ◽  
Vol 3 (3) ◽  
pp. 202-207 ◽  
Author(s):  
Emily Earl-Royal ◽  
Phi Nguyen ◽  
Al’ai Alvarez ◽  
Laleh Gharahbaghian
Keyword(s):  
Emergency Department ◽  
Aortic Dissection ◽  
Point Of Care ◽  
Case Reports ◽  
Point Of Care Ultrasound ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Diagnostic Reliability ◽  
Multiple Case ◽  
Stanford Type B

Aortic dissection (AD) is a rare, time-sensitive, and potentially fatal condition that can present with subtle signs requiring timely diagnosis and intervention. Although definitive diagnosis is most accurately made through computed tomography angiography, this can be a time-consuming study and the patient may be unstable, thus preventing the study’s completion. Chest radiography (CXR) signs of AD are classically taught yet have poor diagnostic reliability. Point-of-care ultrasound (POCUS) is increasingly used by emergency physicians for the rapid diagnosis of emergent conditions, with multiple case reports illustrating the sonographic signs of AD. We present a case of Stanford type B AD diagnosed by POCUS in the emergency department in a patient with vague symptoms, normal CXR, and without aorta dilation. A subsequent review of CXR versus sonographic signs of AD is described.

scholarly journals Importance of Multiple-window Assessment for the Diagnosis of Ascending Aortic Dissection Using Point-of-care Ultrasound: Report of Three Cases

2019 ◽  
Vol 3 (4) ◽  
pp. 333-337
Author(s):  
Virginia Zarama ◽  
María Arango-Granados ◽  
Luis Bustamante Cristancho
Keyword(s):  
Mortality Rate ◽  
Aortic Dissection ◽  
High Mortality ◽  
Aortic Root ◽  
Point Of Care ◽  
Rapid Diagnosis ◽  
Point Of Care Ultrasound ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Axis View

Acute ascending aortic dissection has a high mortality rate and requires rapid diagnosis and treatment. Point-of-care ultrasound (POCUS) can aid in the diagnosis. The aortic root is usually evaluated in the parasternal long-axis view; however, a dissection flap is not always visible in this projection. We present three cases of acute, type A aortic dissection in which the dissection flap was only evident in the apical five-chamber and subxyphoid views. These cases suggest that POCUS may play a pivotal role in the initial diagnosis of acute ascending aortic dissection and highlight the importance of viewing multiple windows to fully evaluate this possibility.

scholarly journals Iatrogenic Aortic Dissection Presenting With Leg Pain Diagnosed With Point-of-care Ultrasound

2019 ◽  
Vol 3 (4) ◽  
pp. 376-379
Author(s):  
Matthew Friedman ◽  
Armin Gollogly ◽  
Enrique Pena ◽  
Jennifer Johnson ◽  
Tina Dulani
Keyword(s):  
Emergency Department ◽  
Aortic Dissection ◽  
Point Of Care ◽  
Rare Complication ◽  
Leg Pain ◽  
Point Of Care Ultrasound ◽  
Vein Thrombosis ◽  
Iatrogenic Aortic Dissection ◽  
Cardiac Catheterizations ◽  
Deep Vein

Iatrogenic aortic dissection (IAD) status-post-cardiac catheterization is a rare complication often isolated to the proximal aorta. This is a case of IAD isolated to the distal aorta in a 41-year-old female who presented to the emergency department with right leg pain after undergoing three cardiac catheterizations. The diagnosis of IAD was made upon discovery of an intimal flap in the distal aorta and femoral artery while performing a point-of-care ultrasound to evaluate for deep vein thrombosis.

Utilization of POCUS in a Specialist Palliative Care Setting: A Retrospective Chart Review.

2020 ◽  
Author(s):  
Amit Arya ◽  
John Roderick Davey ◽  
Achal Sharma ◽  
Naheed Dosani ◽  
Dilnoor Grewal ◽  
...  
Keyword(s):  
Palliative Care ◽  
Chart Review ◽  
Care Setting ◽  
Point Of Care ◽  
Symptom Burden ◽  
Retrospective Chart Review ◽  
Care Utilization ◽  
Point Of Care Ultrasound ◽  
Specialist Palliative Care ◽  
Palliative Care Setting

Abstract Background: The use of Point-Of-Care Ultrasound (POCUS) has increased rapidly across various medical disciplines due to technological advancements providing high quality POCUS units. POCUS can help clinicians at the bed side with information regarding patient management in real time. However, literature reveals scant evidence of POCUS use in Palliative Care. This study’s objective was to examine the use of POCUS in a specialist palliative care setting. Methods: A retrospective chart review was conducted from January 2018 to June 2019 to evaluate characteristics of patients for whom POCUS was utilized. These patients were identified through pre-existing logs and descriptive information was collected from the electronic health records. This included demographic information, life-limiting diagnosis, patient assessment location, diagnosis made with POCUS and, if applicable, volume of fluid drained.Results: We identified 126 uses of POCUS in 89 unique patients. 62 patients (69.7%) had a cancer diagnosis, with patients most commonly suffering from GI, Lung and Breast pathologies. 61 POCUS cases (48.4%) were in the outpatient setting. 81 POCUS cases (64.3%) revealed a diagnosis of ascites and 21 POCUS cases (16.7%) revealed a diagnosis of pleural effusion. Other diagnoses made with POCUS included bowel obstruction, pneumonia and congestive heart failure. During the study period, 52 paracentesis and 7 thoracentesis procedures were performed using POCUS guidance.Conclusion: We identified multiple indications in our specialist palliative care setting where POCUS aided in diagnosis/management of patients in both inpatient and outpatient settings. Further studies can be conducted to identify the potential benefits in symptom burden, patient & caregiver satisfaction and health care utilization in palliative care patients receiving POCUS.

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