Cardiac Limited Ultrasound Examination Techniques to Augment the Bedside Cardiac Physical Examination

SONOSIM SUMMARY:

The Cardiac Limited Ultrasound Examination (CLUE) is a rapid look for specific cardiovascular ultrasound “signs” to augment conventional bedside assessment. As with traditional physical examinations, the accuracy of CLUE depends on physician skill, which is why ease of training and efficiency of performance were kept in mind during CLUE’s creation.

CLUE focuses on six areas of common physical findings and utilizes two or three views per imaging window for ease of image acquisition and an efficient flow to the examination. The quick two-dimensional scan searches for signs of left ventricular systolic dysfunction, right ventricular enlargement, pulmonary edema, pleural and pericardial effusion, and elevation of central venous pressure. CLUE addresses significant cardiopulmonary findings while only taking about two minutes to complete.

CLUE intends to improve patient care by bridging point-of-care ultrasound with the traditional physical examination. Because CLUE enhances detection of pathologies typically assessed for during physical examination and requires only basic ultrasound skills and equipment, it can be easily integrated into physical exam training within medical education or into existing exam routines of practicing physicians.

Abstract

The current practice of physical diagnosis is dependent on physician skills and biases, inductive reasoning, and time efficiency. Although the clinical utility of echocardiography is well known, few data exist on how to integrate 2-dimensional screening “quick-look” ultrasound applications into a novel, modernized cardiac physical examination. We discuss the evidence basis behind ultrasound “signs” pertinent to the cardiovascular system and elemental in synthesis of bedside diagnoses and propose the application of a brief cardiac limited ultrasound examination based on these signs. An ultrasound-augmented cardiac physical examination can be taught in traditional medical education and has the potential to improve bedside diagnosis and patient care.

To read the article, visit the Journal of Ultrasound in Medicine website.