Abstract
Background: In the last years, ultrasound technology has entered clinical practice as a tank and today, it has also allowed no-cardiologists to extend their medical examination without needing to call the consultant and having a good profile of diagnostic accuracy.
The ultrasound bedside does not replace the consultant, but it allows not to perform inappropriate consultations with more savings for hospitals.
Objective: The aim was to review the recently published literature to inform the clinician about the most up to date management of use bedside echography in the emergency setting. In this short review, we focused on two types of syndromes, no traumatic- hypotension and dyspnea, common to the three holistic disciplines of medicine, showing the main and basic questions and answers that ultrasound can give us for rapid identification of the problems.
Methods: We conducted a systematic review using Pubmed/Medline, Ovid/Willey and Cochrane Library, combining key terms such as “cardiac ultrasound, “cardiac diseases”, “emergency medicine”, “pocus”, “dyspnea”, “ hypotension”. We selected the most relevant clinical trials and review articles (excluding case reports) published in the last 19 years and in our opinion, 59 publications appeared to be the best choice according to the PRISMA statement. In additional papers identified from individual article reference lists were also included.
Conclusion: Recent studies have shown a promise in establishing best practices for evaluation of heart, lung abdomen and deep vessels At the moment, bedside US is widely used in an integrated ultrasound vision just like the holistic view have internal medicine, intensive care and emergency medicine and many medical schools in Europe and the USA are inserting ultrasonography into the core curriculum, but we still have to find a standard method for the training program for minimum competence acquisition.
Keywords: Cardiac ultrasound, cardiac diseases, emergency medicine, pocus, dyspnea, hypotension.
Graphical Abstract
[1]
Laennec RTH. De l’auscultation médiate, ou, Traité du diagnostic des maladies des poumons et du coeur: Fondé principalement sur ce nouveau moyen d’exploration 1819.
[2]
Guidelines U. Ultrasound guidelines: Emergency, Point-of-Care and clinical ultrasound guidelines in medicine. Ann Emerg Med 2017; 69(5): e27-54.
[http://dx.doi.org/10.1016/j.annemergmed.2016.08.457] [PMID: 28442101]
[http://dx.doi.org/10.1016/j.annemergmed.2016.08.457] [PMID: 28442101]
[3]
Kellett J, Deane B. The diagnoses and co-morbidity encountered in the hospital practice of acute internal medicine. Eur J Intern Med 2007; 18(6): 467-73.
[http://dx.doi.org/10.1016/j.ejim.2007.02.019] [PMID: 17822658]
[http://dx.doi.org/10.1016/j.ejim.2007.02.019] [PMID: 17822658]
[4]
Duckitt R, Palsson R, Bosanska L, Dagna L, Durusu TM, Vardi M. CDIME group. Common diagnoses in internal medicine in Europe 2009: A pan-European, multi-centre survey. Eur J Intern Med 2010; 21(5): 449-52.
[http://dx.doi.org/10.1016/j.ejim.2010.06.012] [PMID: 20816603]
[http://dx.doi.org/10.1016/j.ejim.2010.06.012] [PMID: 20816603]
[5]
Di Lenarda A, Scherillo M, Maggioni AP, et al. TEMISTOCLE Investigators. Current presentation and management of heart failure in cardiology and internal medicine hospital units: A tale of two worlds--the TEMISTOCLE study. Am Heart J 2003; 146(4)E12
[http://dx.doi.org/10.1016/S0002-8703(03)00315-6] [PMID: 14564335]
[http://dx.doi.org/10.1016/S0002-8703(03)00315-6] [PMID: 14564335]
[6]
Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26(6): 567-81.
[http://dx.doi.org/10.1016/j.echo.2013.04.001] [PMID: 23711341]
[http://dx.doi.org/10.1016/j.echo.2013.04.001] [PMID: 23711341]
[7]
Giannotti G, Mondillo S, Galderisi M, et al. Hand-held echocardiography: Added value in clinical cardiological assessment. Cardiovasc Ultrasound 2005; 3: 7.
[http://dx.doi.org/10.1186/1476-7120-3-7] [PMID: 15790409]
[http://dx.doi.org/10.1186/1476-7120-3-7] [PMID: 15790409]
[8]
Galderisi M, Santoro A, Versiero M, et al. Improved cardiovascular diagnostic accuracy by pocket size imaging device in non-cardiologic outpatients: The NaUSiCa (Naples Ultrasound Stethoscope in Cardiology) study. Cardiovasc Ultrasound 2010; 8: 51.
[http://dx.doi.org/10.1186/1476-7120-8-51] [PMID: 21110840]
[http://dx.doi.org/10.1186/1476-7120-8-51] [PMID: 21110840]
[9]
Cardim N, Fernandez Golfin C, Ferreira D, et al. Usefulness of a new miniaturized echocardiographic system in outpatient cardiology consultations as an extension of physical examination. J Am Soc Echocardiogr 2011; 24(2): 117-24.
[http://dx.doi.org/10.1016/j.echo.2010.09.017] [PMID: 21074362]
[http://dx.doi.org/10.1016/j.echo.2010.09.017] [PMID: 21074362]
[10]
Via G, Hussain A, Wells M, et al. International Liaison Committee on Focused Cardiac UltraSound (ILC-FoCUS); International Conference on Focused Cardiac UltraSound (IC-FoCUS). International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr 2014; 27(7): 683.e1-683.e33.
[http://dx.doi.org/10.1016/j.echo.2014.05.001] [PMID: 24951446]
[http://dx.doi.org/10.1016/j.echo.2014.05.001] [PMID: 24951446]
[11]
Levitt MA, Jan BA. The effect of real time 2-D-echocardiography on medical decision-making in the emergency department. J Emerg Med 2002; 22(3): 229-33.
[http://dx.doi.org/10.1016/S0736-4679(01)00479-6] [PMID: 11932083]
[http://dx.doi.org/10.1016/S0736-4679(01)00479-6] [PMID: 11932083]
[12]
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28(1): 1-39.e14.
[http://dx.doi.org/10.1016/j.echo.2014.10.003] [PMID: 25559473]
[http://dx.doi.org/10.1016/j.echo.2014.10.003] [PMID: 25559473]
[13]
Labovitz AJ, Noble VE, Bierig M, et al. Focused cardiac ultrasound in the emergent setting: A consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr 2010; 23(12): 1225-30.
[http://dx.doi.org/10.1016/j.echo.2010.10.005] [PMID: 21111923]
[http://dx.doi.org/10.1016/j.echo.2010.10.005] [PMID: 21111923]
[14]
Arienti V, Camaggi V. Clinical applications of bedside ultrasonography in internal and emergency medicine. Intern Emerg Med 2011; 6(3): 195-201.
[http://dx.doi.org/10.1007/s11739-010-0424-3] [PMID: 20680519]
[http://dx.doi.org/10.1007/s11739-010-0424-3] [PMID: 20680519]
[15]
Prinz C, Voigt JU. Diagnostic accuracy of a hand-held ultrasound scanner in routine patients referred for echocardiography. J Am Soc Echocardiogr 2011; 24(2): 111-6.
[http://dx.doi.org/10.1016/j.echo.2010.10.017] [PMID: 21126857]
[http://dx.doi.org/10.1016/j.echo.2010.10.017] [PMID: 21126857]
[16]
Andersen GN, Haugen BO, Graven T, Salvesen O, Mjølstad OC, Dalen H. Feasibility and reliability of point-of-care pocket-sized echocardiography. Eur J Echocardiogr 2011; 12(9): 665-70.
[PMID: 21810825]
[PMID: 21810825]
[17]
Kobal SL, Trento L, Baharami S, et al. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. Am J Cardiol 2005; 96(7): 1002-6.
[http://dx.doi.org/10.1016/j.amjcard.2005.05.060] [PMID: 16188532]
[http://dx.doi.org/10.1016/j.amjcard.2005.05.060] [PMID: 16188532]
[18]
Stokke TM, Ruddox V, Sarvari SI, Otterstad JE, Aune E, Edvardsen T. Brief group training of medical students in focused cardiac ultrasound may improve diagnostic accuracy of physical examination. J Am Soc Echocardiogr 2014; 27(11): 1238-46.
[http://dx.doi.org/10.1016/j.echo.2014.08.001] [PMID: 25216765]
[http://dx.doi.org/10.1016/j.echo.2014.08.001] [PMID: 25216765]
[19]
Hellmann DB, Whiting-O’Keefe Q, Shapiro EP, Martin LD, Martire C, Ziegelstein RC. The rate at which residents learn to use hand-held echocardiography at the bedside. Am J Med 2005; 118(9): 1010-8.
[http://dx.doi.org/10.1016/j.amjmed.2005.05.030] [PMID: 16164888]
[http://dx.doi.org/10.1016/j.amjmed.2005.05.030] [PMID: 16164888]
[20]
Lang RM, Bierig M, Devereux RB, et al. Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18(12): 1440-63.
[http://dx.doi.org/10.1016/j.echo.2005.10.005] [PMID: 16376782]
[http://dx.doi.org/10.1016/j.echo.2005.10.005] [PMID: 16376782]
[21]
dski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American society of Echocardiography. J Am Soc Echocardiogr 2010; 23: 685-713..
[22]
Brennan JM, Blair JE, Goonewardena S, et al. Reappraisal of the use of inferior vena cava for estimating right atrial pressure. J Am Soc Echocardiogr 2007; 20(7): 857-61.
[http://dx.doi.org/10.1016/j.echo.2007.01.005] [PMID: 17617312]
[http://dx.doi.org/10.1016/j.echo.2007.01.005] [PMID: 17617312]
[23]
Kimura BJ, Amundson SA, Willis CL, Gilpin EA, DeMaria AN. Usefulness of a hand-held ultrasound device for bedside examination of left ventricular function. Am J Cardiol 2002; 90(9): 1038-9.
[http://dx.doi.org/10.1016/S0002-9149(02)02699-1] [PMID: 12398984]
[http://dx.doi.org/10.1016/S0002-9149(02)02699-1] [PMID: 12398984]
[24]
Melamed R, Sprenkle MD, Ulstad VK, Herzog CA, Leatherman JW. Assessment of left ventricular function by intensivists using hand-held echocardiography. Chest 2009; 135(6): 1416-20.
[http://dx.doi.org/10.1378/chest.08-2440] [PMID: 19225055]
[http://dx.doi.org/10.1378/chest.08-2440] [PMID: 19225055]
[25]
Mark DG, Ku BS, Carr BG, et al. Directed bedside transthoracic echocardiography: Preferred cardiac window for left ventricular ejection fraction estimation in critically ill patients. Am J Emerg Med 2007; 25(8): 894-900.
[http://dx.doi.org/10.1016/j.ajem.2007.01.023] [PMID: 17920973]
[http://dx.doi.org/10.1016/j.ajem.2007.01.023] [PMID: 17920973]
[26]
Abe Y, Ito M, Tanaka C, et al. A novel and simple method using pocket-sized echocardiography to screen for aortic stenosis. J Am Soc Echocardiogr 2013; 26(6): 589-96.
[http://dx.doi.org/10.1016/j.echo.2013.03.008] [PMID: 23602166]
[http://dx.doi.org/10.1016/j.echo.2013.03.008] [PMID: 23602166]
[27]
Shmueli H, Burstein Y, Sagy I, et al. Briefly trained medical students can effectively identify rheumatic mitral valve injury using a hand-carried ultrasound. Echocardiography 2013; 30(6): 621-6.
[http://dx.doi.org/10.1111/echo.12122] [PMID: 23347259]
[http://dx.doi.org/10.1111/echo.12122] [PMID: 23347259]
[28]
Klein AL, Abbara S, Agler DA, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: Endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2013; 26(9): 965-1012.e15.
[http://dx.doi.org/10.1016/j.echo.2013.06.023] [PMID: 23998693]
[http://dx.doi.org/10.1016/j.echo.2013.06.023] [PMID: 23998693]
[29]
Torres MAR, Texeira TF, Camarozano AC, et al. Stress Echo 2020 study group of the Italian Society of Cardiovascular Imaging. The value of a simplified approach to end-systolic volume measurement for assessment of left ventricular contractile reserve during stress-echocardiography. Int J Cardiovasc Imaging 2019; 35(6): 1019-26.
[http://dx.doi.org/10.1007/s10554-019-01599-5] [PMID: 30977036]
[http://dx.doi.org/10.1007/s10554-019-01599-5] [PMID: 30977036]
[30]
Michalski B, Kasprzak JD, Szymczyk E, Lipiec P. Diagnostic utility and clinical usefulness of the pocket echocardiographic device. Echocardiography 2012; 29(1): 1-6.
[http://dx.doi.org/10.1111/j.1540-8175.2011.01553.x] [PMID: 22044766]
[http://dx.doi.org/10.1111/j.1540-8175.2011.01553.x] [PMID: 22044766]
[31]
Razi R, Estrada JR, Doll J, Spencer KT. Bedside hand-carried ultrasound by internal medicine residents versus traditional clinical assessment for the identification of systolic dysfunction in patients admitted with decompensated heart failure. J Am Soc Echocardiogr 2011; 24(12): 1319-24.
[http://dx.doi.org/10.1016/j.echo.2011.07.013] [PMID: 21885245]
[http://dx.doi.org/10.1016/j.echo.2011.07.013] [PMID: 21885245]
[32]
Laursen CB, Sloth E, Lambrechtsen J, et al. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms. Chest 2013; 144(6): 1868-75.
[http://dx.doi.org/10.1378/chest.13-0882] [PMID: 23948720]
[http://dx.doi.org/10.1378/chest.13-0882] [PMID: 23948720]
[33]
Volpicelli G, Elbarbary M, Blaivas M, et al. International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS). International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38(4): 577-91.
[http://dx.doi.org/10.1007/s00134-012-2513-4] [PMID: 22392031]
[http://dx.doi.org/10.1007/s00134-012-2513-4] [PMID: 22392031]
[34]
Zong H-F, Guo G, Liu J, Bao L-L, Yang C-Z. Using lung ultrasound to quantitatively evaluate pulmonary water content. Pediatr Pulmonol 2020; 55(3): 729-39.
[http://dx.doi.org/10.1002/ppul.24635] [PMID: 31917899]
[http://dx.doi.org/10.1002/ppul.24635] [PMID: 31917899]
[35]
Cibinel GA, Casoli G, Elia F, et al. Diagnostic accuracy and reproducibility of pleural and lung ultrasound in discriminating cardiogenic causes of acute dyspnea in the emergency department. Intern Emerg Med 2012; 7(1): 65-70.
[http://dx.doi.org/10.1007/s11739-011-0709-1] [PMID: 22033792]
[http://dx.doi.org/10.1007/s11739-011-0709-1] [PMID: 22033792]
[36]
Roy PM, Colombet I, Durieux P, Chatellier G, Sors H, Meyer G. Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. BMJ 2005; 331(7511): 259.
[http://dx.doi.org/10.1136/bmj.331.7511.259] [PMID: 16052017]
[http://dx.doi.org/10.1136/bmj.331.7511.259] [PMID: 16052017]
[37]
Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: Pathophysiology, clinical importance, and management of right ventricular failure. Circulation 2008; 117(13): 1717-31.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.107.653584] [PMID: 18378625]
[http://dx.doi.org/10.1161/CIRCULATIONAHA.107.653584] [PMID: 18378625]
[38]
Le Gal G, Righini M, Sanchez O, et al. A positive compression ultrasonography of the lower limb veins is highly predictive of pulmonary embolism on computed tomography in suspected patients. Thromb Haemost 2006; 95(6): 963-6.
[http://dx.doi.org/10.1160/TH06-03-0158] [PMID: 16732375]
[http://dx.doi.org/10.1160/TH06-03-0158] [PMID: 16732375]
[39]
Mansencal N, Vieillard-Baron A, Beauchet A, et al. Triage patients with suspected pulmonary embolism in the emergency department using a portable ultrasound device. Echocardiography 2008; 25(5): 451-6.
[http://dx.doi.org/10.1111/j.1540-8175.2007.00623.x] [PMID: 18452470]
[http://dx.doi.org/10.1111/j.1540-8175.2007.00623.x] [PMID: 18452470]
[40]
Haydar SA, Moore ET, Higgins GL III, Irish CB, Owens WB, Strout TD. Effect of bedside ultrasonography on the certainty of physician clinical decisionmaking for septic patients in the emergency department. Ann Emerg Med 2012; 60(3): 346-58.e4.
[http://dx.doi.org/10.1016/j.annemergmed.2012.01.006] [PMID: 22633342]
[http://dx.doi.org/10.1016/j.annemergmed.2012.01.006] [PMID: 22633342]
[41]
Mandavia DP, Hoffner RJ, Mahaney K, Henderson SO. Bedside echocardiography by emergency physicians. Ann Emerg Med 2001; 38(4): 377-82.
[http://dx.doi.org/10.1067/mem.2001.118224] [PMID: 11574793]
[http://dx.doi.org/10.1067/mem.2001.118224] [PMID: 11574793]
[42]
Tayal VS, Kline JA. Emergency echocardiography to detect pericardial effusion in patients in PEA and near-PEA states. Resuscitation 2003; 59(3): 315-8.
[http://dx.doi.org/10.1016/S0300-9572(03)00245-4] [PMID: 14659600]
[http://dx.doi.org/10.1016/S0300-9572(03)00245-4] [PMID: 14659600]
[43]
Kucher N, Luder CM, Dörnhöfer T, Windecker S, Meier B, Hess OM. Novel management strategy for patients with suspected pulmonary embolism. Eur Heart J 2003; 24(4): 366-76.
[http://dx.doi.org/10.1016/S0195-668X(02)00476-1] [PMID: 12581684]
[http://dx.doi.org/10.1016/S0195-668X(02)00476-1] [PMID: 12581684]
[44]
Meredith EL, Masani ND. Echocardiography in the emergency assessment of acute aortic syndromes. Eur J Echocardiogr 2009; 10(1): i31-9.
[http://dx.doi.org/10.1093/ejechocard/jen251] [PMID: 19131497]
[http://dx.doi.org/10.1093/ejechocard/jen251] [PMID: 19131497]
[45]
Nazerian P, Vanni S, Castelli M, et al. Diagnostic performance of emergency transthoracic focus cardiac ultrasound in suspected acute type A aortic dissection. Intern Emerg Med 2014; 9(6): 665-70.
[http://dx.doi.org/10.1007/s11739-014-1080-9] [PMID: 24871637]
[http://dx.doi.org/10.1007/s11739-014-1080-9] [PMID: 24871637]
[46]
Lichtenstein D. FALLS-protocol: Lung ultrasound in hemodynamic assessment of shock. Heart Lung Vessel 2013; 5(3): 142-7.
[PMID: 24364005]
[PMID: 24364005]
[47]
Antonucci E, Fiaccadori E, Donadello K, Taccone FS, Franchi F, Scolletta S. Myocardial depression in sepsis: From pathogenesis to clinical manifestations and treatment. J Crit Care 2014; 29(4): 500-11.
[http://dx.doi.org/10.1016/j.jcrc.2014.03.028] [PMID: 24794044]
[http://dx.doi.org/10.1016/j.jcrc.2014.03.028] [PMID: 24794044]
[48]
Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri NG. Occult traumatic pneumothorax: Diagnostic accuracy of lung ultrasonography in the emergency department. Chest 2008; 133(1): 204-11.
[http://dx.doi.org/10.1378/chest.07-1595] [PMID: 17925411]
[http://dx.doi.org/10.1378/chest.07-1595] [PMID: 17925411]
[49]
Solomon SD, Saldana F. Point-of-care ultrasound in medical education-stop listening and look. N Engl J Med 2014; 370(12): 1083-5.
[http://dx.doi.org/10.1056/NEJMp1311944] [PMID: 24645940]
[http://dx.doi.org/10.1056/NEJMp1311944] [PMID: 24645940]
[50]
Scalea TM, Rodriguez A, Chiu WC, et al. Focused assessment with sonography for trauma (FAST): Results from an international consensus conference 1999.
[51]
Efremov SM, Kuzkov VV, Fot EV, et al. Lung ultrasonography and cardiac surgery: A narrative review. J Cardiothorac Vasc Anesth 2020 23; S1053-0770(20): 30093-8.
[52]
Ultrasound Guidelines: emergency, point-of-care and clinical ultrasound guidelines in medicine Ann Emerg Med 2017; 69(5): e27-54.
[53]
Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: The BLUE protocol. Chest 2008; 134(1): 117-25.
[http://dx.doi.org/10.1378/chest.07-2800] [PMID: 18403664]
[http://dx.doi.org/10.1378/chest.07-2800] [PMID: 18403664]
[54]
Bekgoz B, Kilicaslan I, Bildik F, et al. BLUE protocol ultrasonography in Emergency Department patients presenting with acute dyspnea. Am J Emerg Med 2019; 37(11): 2020-7.
[http://dx.doi.org/10.1016/j.ajem.2019.02.028] [PMID: 30819579]
[http://dx.doi.org/10.1016/j.ajem.2019.02.028] [PMID: 30819579]
[55]
Jones AE, Tayal VS, Sullivan DM, Kline JA. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med 2004; 32(8): 1703-8.
[http://dx.doi.org/10.1097/01.CCM.0000133017.34137.82] [PMID: 15286547]
[http://dx.doi.org/10.1097/01.CCM.0000133017.34137.82] [PMID: 15286547]
[56]
Shokoohi H, Boniface KS, Pourmand A, et al. Bedside ultrasound reduces diagnostic uncertainty and guides resuscitation in patients with undifferentiated hypotension. Crit Care Med 2015; 43(12): 2562-9.
[http://dx.doi.org/10.1097/CCM.0000000000001285] [PMID: 26575653]
[http://dx.doi.org/10.1097/CCM.0000000000001285] [PMID: 26575653]
[57]
Atkinson PR, Milne J, Diegelmann L, et al. Does pointof-care ultrasonography improve clinical outcomes in emergency department patients with undifferentiated hypotension? An international randomized controlled trial from the SHoC-ED investigators. Ann Emerg Med 2018; 72(4): 478-89.
[http://dx.doi.org/10.1016/j.annemergmed.2018.04.002] [PMID: 29866583]
[http://dx.doi.org/10.1016/j.annemergmed.2018.04.002] [PMID: 29866583]
[58]
Kimura BJ, Sliman SM, Waalen J, Amundson SA, Shaw DJ. Retention of ultrasound skills and training in “point-of-care” cardiac ultrasound. J Am Soc Echocardiogr 2016; 29(10): 992-7.
[http://dx.doi.org/10.1016/j.echo.2016.05.013] [PMID: 27372559]
[http://dx.doi.org/10.1016/j.echo.2016.05.013] [PMID: 27372559]
[59]
Leidi A, Rouyer F, Marti C, Reny J-L, Grosgurin O. Point of care ultrasonography from the emergency department to the internal medicine ward: Current trends and perspectives. Intern Emerg Med 2020; 15(3): 395-408.
[http://dx.doi.org/10.1007/s11739-020-02284-5] [PMID: 32034674]
[http://dx.doi.org/10.1007/s11739-020-02284-5] [PMID: 32034674]
Related Journals
Applied Drug Research, Clinical Trials and Regulatory Affairs
Article Metrics
9