BACKGROUND: Diagnosing pericardial effusion is critical for optimal patient care. Typically, clinicians use physical examination findings and historical features suggesting pericardial effusion to determine which patients require echocardiography. The diagnostic characteristics of these tools are not well described. The objective of this study is to determine the prevalence of historical features and sensitivity of clinical signs to inform clinicians when to proceed with echocardiogram. METHODS: A retrospective review of point-of-care echocardiograms performed over a two and a half year period in two emergency departments were reviewed for the presence of a pericardial effusion. Patient charts were reviewed and abstracted for presenting symptoms, historical features and clinical findings. The prevalence of presenting symptoms and historical features and the sensitivity of classic physical examination findings associated with pericardial effusion and tamponade were determined. RESULTS: One hundred and fifty-three patients with pericardial effusion were identified. Of these patients, the most common presenting complaint was chest pain and shortness of breath. Patients had no historical features that would suggest pericardial effusion in 37.5% of cases. None of the patients with pericardial effusion or pericardial tamponade had all of the elements of Beck's triad. The sensitivity of Beck's triad was found to be 0 (0%–19.4%). The sensitivity for one finding of Beck's triad to diagnose pericardial tamponade was 50% (28.0%–72.0%). CONCLUSION: History and physical examination findings perform poorly as tests for the diagnosis of pericardial effusion or pericardial tamponade. Clinicians must liberally evaluate patients suspected of having a pericardial effusion with echocardiography.

BACKGROUND: To evaluate the utilization of point-of-care ultrasound (POCUS) for the assessment of emergency department (ED) patients with musculoskeletal symptoms and the impact of musculoskeletal POCUS on medical decision-making and patient management in the ED. METHODS: This was a retrospective review of ED patients presenting with musculoskeletal symptoms who received a POCUS over a 3.5-year period. An ED POCUS database was reviewed for musculoskeletal POCUS examinations used for medical decision-making. Electronic medical records were then reviewed for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and impact of musculoskeletal POCUS on patient management in ED. RESULTS: A total of 264 subjects (92 females, 172 males) and 292 musculoskeletal POCUS examinations were included in the final analysis. Most common symptomatic sites were knee (31.8％) and ankle (16.3％). Joint effusion was the most common finding on musculoskeletal POCUS, noted in 33.7％ of the patients, and subcutaneous edema/cobblestoning was found in 10.2％ of the patients. Muscle or tendon rupture was found in 2.3％ of the patients, and 1.9％ of the patients had joint dislocation. Bursitis or bursa fluid was found in 3.4％ of patients, and tendonitis/tendinopathy was found in 2.3％. Twenty percent of them were ultrasound-guided musculoskeletal procedures, and most of them (73.3％) were arthrocentesis. Of the included studies, all except three either changed or helped guide patient management as documented in the patients' medical records. CONCLUSION: Our study findings illustrate the utility of POCUS in the evaluation of a variety of musculoskeletal pathologies in the ED.

BACKGROUND: Current point-of-care ultrasound protocols in the evaluation of lower extremity deep vein thrombosis (DVT) can miss isolated femoral vein clots. Extended compression ultrasound (ECUS) includes evaluation of the femoral vein from the femoral vein/deep femoral vein bifurcation to the adductor canal. Our objective is to determine if emergency physicians (EPs) can learn ECUS for lower extremity DVT evaluation after a focused training session. METHODS: Prospective study at an urban academic center. Participants with varied ultrasound experience received instruction in ECUS prior to evaluation. Two live models with varied levels of difficult sonographic anatomy were intentionally chosen for the evaluation. Each participant scanned both models. Pre- and post-study surveys were completed. RESULTS: A total of 96 ultrasound examinations were performed by 48 participants (11 attendings and 37 residents). Participants’ assessment scores averaged 95.8% (95% CI 93.3%–98.3%) on the easier anatomy live model and averaged 92.3% (95% CI 88.4%–96.2%) on the difficult anatomy model. There were no statistically significant differences between attendings and residents. On the model with easier anatomy, all but 1 participant identified and compressed the proximal femoral vein successfully, and all participants identified and compressed the mid and distal femoral vein. With the difficult anatomy, 97.9% (95% CI 93.8%–102%) identified and compressed the proximal femoral vein, whereas 93.8% (95% CI 86.9%–100.6%) identified and compressed the mid femoral vein, and 91.7% (95% CI 83.9%–99.5%) identified and compressed the distal femoral vein. CONCLUSION EPs at our institution were able to perform ECUS with good reproducibility after a focused training session.