Acute medicine trainees can chose to pursue a specialist interest as part of their training. I decided to train in echocardiography and I’m currently close to attaining the BSE Adult Transthoracic Echocardiography Accreditation. I have found echocardiography a useful tool to rapidly answer important clinical questions and aid management of the acutely unwell patient. For example, an 85 year old was admitted with acute shortness of breath, hypoxia despite high flow oxygen and a normal CXR. A bedside echocardiogram revealed thrombi in the right atrium with mild right ventricular strain. A CTPA confirmed a saddle embolus and she was admitted to CCU as a precaution in case thrombolysis was required. In another case, a 75 year old was admitted to the emergency department after successful DC cardioversion for VF arrest 10 days post primary PCI for anterior STEMI. The post arrest ECG did not show new acute ischaemia. He had 2 further VT arrests with successful DC cardioverison to sinus rhythm. An echocardiogram revealed an acutely dilated right ventricle and he was thrombolysed for a high risk pulmonary embolus.

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References

1. Fox, KA; Position Statement: Echocardiography in the Critically Ill. Acute Medicine 2008;7(2):95-96
2. Clare, S. British Society of Echocardiography Accreditation-The ‘Gold Standard’ For Acute Medicine. Acute Medicine 2008; 7(3):
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3. Moore, CL, Rose GA, Tayal VS, et al. Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med 2002; 9(3):186-93
4. Bustam A, Noor, AM, Singh VR, et al. Performance of emergency physicians in point-of-care echocardiography following limited training. Emerg Med J. 2014; 31:369-373.
5. Taylor RA, Moore CL. Accuracy of emergency physicianperformed limited echocardiography for right ventricular strain. Am J Emerg Med 2014; 32(4):371-4.
6. www.bsecho.co.uk