Ultrassonography at Bedside in Emergency ICU: a powerful diagnostic tool

Background

Ultrasonography (USG), since the creation at 1954, is contributing as a great diagnostic tool in many medical specialties. Ultrasound has become an integral part of the practice of emergency medicine and trauma care. In this study we report 5 cases, in which USG was fundamental to diagnose and led further decisions in treatment in the Intensive Care Unit.

Objective

Identify and cases report in which USG was fundamental to diagnose and support the therapeutic choice.

Patients and methods

Observational prospective study of the patients attended at a public emergency hospital ICU, submitted to the protocol FAST extended (FAST-E), from February until June 2012.

Results

Five patients were enrolled

Case 1: A 31 year-old woman (ys), with urinary sepsis and mean arterial pressure (MAP)=60 mmHg. USG evidenced hypokinesia of left ventricle, diagnosing cardiogenic shock. Dobutamine was initiated.

Case 2: 34ys man, with severe brain trauma, in mechanical ventilation and O2= 100%, MAP=70 mmHg. USG, at ER, evidenced free fluid in the hepatorenal space, and the surgery was indicated.

Case 3: 50ys woman, with respiratory insufficiency. USG diagnosed an hypertensive pneumothorax. Drainage was perfomed.

Case 4: 66ys man, victim of a spinal trauma, MAP=75 mmHg and inferior vena cava diameter=28 mm, collapsibility <50%. FAST-E protocol evidenced neurogenic shock. Norepinephrine was initiated.

Case 5: 52ys woman, related subclavian vein thrombosis treatment 2 months ago, and was referred to ER with brawny edema of the and arms. USG showed a superior vena cava thrombus and absence of line A in the left pulmonary apex, featuring superior vena cava syndrome (thoracic CT, after USG, demonstrated pulmonary artery e superior vena cava thrombus and occlusive apex tumor). Anticoagulation with LWMH was initiated.

Conclusion

The reported cases with severe diseases were diagnosed by USG examination at the ICU. The incorporation of this technology, as a routine in the ICU, demonstrated efficacy, empowered diagnostic decisions, and allowed reliably treatment.