Tricuspid Annular Plane Systolic Excursion (TAPSE) for Risk Stratifying Patients with Pulmonary Embolism
- Aug 16th, 2018
- Sean Hickey
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Pericardial tamponade occurs when fluid within the pericardial sac impairs filling of the right-sided chambers, leading to a decrease in cardiac output and hemodynamic compromise. It is neither a clinical nor an echocardiographic diagnosis alone. Rather, the echocardiogram carries diagnostic value and should be performed when there is an elevated pre-test probability for tamponade based on the history and physical exam. Here, we will illustrate the core echocardiographic findings of pericardial tamponade.
EPSS is a simple, easy to learn tool that allows a quick estimation of left ventricular function. The value of EPSS lies in its objective findings that do not require specialized training for interpretation and utilization, as shown by numerous studies. In patients without mitral or aortic valvular pathology, EPSS can be obtained from a single echocardiography view, providing quantifiable information on heart function within minutes. EPSS > 7mm is typically cited as the cut-off for abnormal ejection fraction (<50%). It offers a further tool for inexperienced emergency physicians that can be used to complement the overall assessment and risk stratification of patients with congestive heart failure.
After taking all the time and resources for conscious sedation, you find yourself unsure whether the shoulder dislocation has been reduced. You have two options: 1) Wait for sedation to wear off. Send patient around corner to x-ray. a) If reduced, great. b) If not reduced, then your team must repeat the whole process. 2) ULTRASOUND!