Page 41 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

amination will take only up to three minutes. The sensitivity and specificity were 94.3% and 91.9% for acute heart failure syndromes, compared to the traditional methods of differenti- ating between pulmonary and cardiac causes including electrocardiogram, chest X-ray and B-type natriuretic peptide (BNP).
A similar triple scan consisting of basic echocardiography, lung ultrasound, and assessment of inferior vena cava collapsibility was proposed by Mantuani et al.37 They included 57 pa- tients with acute dyspnea caused by acute decompensated heart failure (ADHF), chronic obstructive pulmonary disease (COPD), and pneumonia. After the triple scan, the accuracy of the diagnosis, based on history and physical examination, increased from 53% to 77%. Sen- sitivity and specificity of the triple scan for ADHF were 100% and 84%.
Lichtenstein’s bedside lung ultrasound in emergency (BLUE) protocol allows rapid diagnosis of acute respiratory failure and can be completed in under three minutes.38,39 Four standard- ized points on either side of the chest are assessed for ten signs indicative of normal lung surface, pleural effusions, lung consolidations, alveolar-interstitial syndrome, and pneumo- thorax. For simplicity, echocardiography is not included. Distinct profiles are recognized for the main causes of respiratory distress: pneumonia, congestive heart failure, COPD, asthma, pulmonary embolism, and pneumothorax as summarized in Table 2.1. It has a diagnostic accuracy of > 90%.40
ABCDE of prehospital ultrasonography 39
2