Lung ultrasound by emergency nursing as an aid for rapid triage of dyspneic patients: a pilot study

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Introduction

Dyspnea is a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity (Zimmermann et al., 1994). Patients suffering from dyspnea or shortness of breath commonly seek care in the emergency department (ED) (West, 1985). Anticipating the dangerous diagnoses that cause this complaint and preventing the associated morbidity and mortality from such conditions has been the primary focus of emergency medicine. Differential diagnosis of dyspnea is an important issue for emergency physicians (EPs) to guide the appropriate treatment of patients. Treatment decisions and evaluation of the dyspneic patients must be conducted at the same time. The indiscriminate use of bronchodilatator treatment in patients who do not have a history of chronic obstructive pulmonary disease (COPD) is associated with a greater need for ‘aggressive interventions’, including mechanical ventilation and the need for intravenous vasodilators (Singer et al., 2008). Bedside lung ultrasonography (BLUS) has become an increasingly valuable diagnostic tool in various pulmonary and cardiac diseases, especially in emergency conditions (Copetti, 2008, Kirkpatrick, 2004, Lichtenstein, Mezière, 2008, Ünlüer, Kara, 2013, Ünlüer, 2012, Ünlüer, 2013a, Ünlüer, 2013b). There is a growing body of evidence that shows that patient care is improved when BLUS is included in the diagnostic workup of such patients. Use of ultrasonography (USG) in pre-hospital care and in EDs could potentially provide critical information about dyspneic patients and could thereby optimize the early treatment of patients with dyspnea. The portability, accuracy, and non-invasiveness of the USG give it potential as an effective imaging modality to provide diagnostic information in an emergency setting. In addition, the traditional physical examination often has significant limitations in the diagnosis of cardiopulmonary pathology (Johnson, Carpenter, 1986, Liang, Schnittger, 2003, Mangione, Nieman, 1997).

Our objective was to evaluate the accuracy of emergency nurse (EN)-performed BLUS for diagnosing dyspnea as having a cardiac or a non-cardiac cause in patients admitted to the ED.

Section snippets

Setting

This study was a prospective, cross-sectional cohort study that was conducted from 1 to 30 May 2013 at an academic, adult tertiary care center ED of a university hospital in Turkey. In our ED, at least two emergency medicine specialists with eight residents of emergency medicine work in each shift. No patients have been discharged from the ED without establishing a final diagnosis by eight emergency medicine specialists or ten consultant physicians. The local Ethics Committee approved the study

Results

Patients were enrolled in the study from 1 to 30 may 2013. During the study period, 106 patients with dyspnea were admitted to the ED. Ten of them were excluded from the study: two were aged under 18, four had acute chest pain, two were pregnant, one was hypotensive, and one had had previous thoracic surgery. The remaining 96 patients, who gave informed consent, were included in the study. Six of them were excluded from the final statistical analysis: three patients had severe anemia and three

Discussion

ENs have started to perform various procedures in the emergency care setting, including fluorescein staining, the removal of foreign bodies from the eye, the interpretation of radiographic images, the simple closure of lacerations, splinting extremities, and microscopy of blood, urine, and other tissue samples (Cole and Ramirez, 2000). In addition, several studies have found that the overall patient comfort and satisfaction was comparable when they were treated by either a physician or

Limitations

One of the limitations of our study was only two operators were included in the study. The other limitation was that the ENs were not blinded to the study. Since the ENs knew that they were being evaluated, they were more motivated to enhance their performance in the criteria being studied. As no standards exist for training nurses in USG, we cannot assume that our training program was adequate. However, it was designed on the basis of the training program used to train our emergency residents

Conclusion

Emergency USG has the promising ability to assist in making appropriate triage decisions for dyspneic patients. Our study shows that ENs can perform BLUS in hospital EDs with a high degree of accuracy to dyspneic patients.

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