Pulmonary and cardiac evaluation with bedside focused ultrasonography in the management of patients presenting to the emergency medicine clinic with dyspnea

Dyspnea is a frequent symptom in the emergency department. Rapid identification of the underlying cause improves the prognosis. Imaging is often required for diagnosis. Therefore, we investigated the value of using bedside-focused ultrasonography in diagnosing patients presenting with dyspnea. 77 patients were studied prospectively in Gaziantep University Emergency Department. The investigator performed focused cardiac ultrasonography and bedside lung ultrasonography. Laboratory and imaging studies were performed if requested by the referring physician. The final diagnosis of the patients was determined without being influenced by the attending physician. When the definitive diagnoses were compared with the data obtained from ultrasonography, the systolic functions of patients with acute heart failure (AHF) were found to be significantly depleted (p = 0,001). Inferior vena cava inspiratory and expiratory diameters were found to be significantly higher (p = 0,004 and p = 0,024). The caval index was found to be significantly lower (p = 0,001). According to the BLUE-protocol (Bedside Lung Ultrasound in Emergency) algorithm, the sensitivities and specificities of the BLUE-protocol are, respectively, 96.8% and 95.7% for pulmonary edema, 87.5% and 97.8% for pneumonia. Troponin I and NT proBNP levels were significantly higher in the AHF group (p= 0,001). The mean duration of ultrasonography was significantly lower than those of direct radiography and computed tomography which were consistent with the data in the literature. Bedside-focused ultrasonography can be safely performed with high diagnostic accuracy in patients with dyspnea.