Contemporary Application of Point-of-Care Echocardiography in the Emergency Department

Point-of-care echocardiography is revolutionizing the management of patients presenting with undifferentiated shock and cardiac arrest in the emergency department (ED). Its primary purpose is to aid the clinician in rapidly ruling in and ruling out life-threatening diagnoses at the bedside. In addition, it has become an important component of the clinical examination for stable patients seen in the ED with nonspecific signs and symptoms such as shortness of breath or syncope. Although first described to facilitate the diagnosis of pericardial effusions and cardiac standstill, ED echocardiography has since evolved and is now widely used by emergency physicians to help diagnose other important cardiovascular pathologic conditions that may be contributing to undifferentiated shock, such as left ventricular failure and right ventricular dilatation resulting from pulmonary embolism. The use of echocardiography in the ED continues to expand, with advanced applications that include valvular assessment, diastolic dysfunction, and regional wall motion abnormalities, as well as the use of point-ofcare transesophageal echocardiography. As the diffusion of these new skills continues and becomes routine, it will alter the practice of emergency medicine and the interaction with consulting cardiologists.