The Impacts of Using Cardiac Ultrasonography in the Emergency Department (ED) for Clinical Decision-Making: Two Case Reports.

Bedside cardiac ultrasonography in emergency departments (ED) is used frequently, with the name of Focused Cardiac Ultra-sound (FOCUS) for certain indications. A 72 year old man with congestive heart failure, coronary artery disease and atrial fibrillation presented to the ED with the chief complaint of dyspnoea. Pulmonary hyertension and a left ventricular ejection fraction of 35-40% was determined by echocardiography one month previously. The emergency physician applied bedside FOCUS to the patient who was diagnosed to have pulmonary oedema after examination and chest x-ray. The patient was hospitalised as global hypokinaesia and a new atrial thrombus was determined. A 55 year old patient presented to the ED with soft tissue sarcoma in his left arm and leg. He had left hemiparaesis and pulses were not palpable in the right upper extremity. The head computerised tomography (CT) was normal. In the bedside ultrasonography, an aortic thrombus was determined. In the latter examination by computed tomographic pulmonary angiography and formal doppler evaluation, complete thrombus at the right subclavian artery and at the arteries of right upper extremity were detected with signs that were indicative of thrombus in the intracranial part of right internal carotid artery. The patient was hospitalised within the plan of peripheral vascular surgery. Dyspnoea is a well known indication for FOCUS. However, the use of bedside cardiac ultrasonography with patient-based decision can contribute to safe and fast service delivery in ED as in the second case. Thus, the wider use of FOCUS can be indicated in the future. [ABSTRACT FROM AUTHOR]