亀田 徹

Toru KAMEDA

安曇野赤十字病院救急科

Department of Emergency Medicine, Red Cross Society Azumino Hospital

キーワード :

Ultrasound devices, which have steadily become more compact, higher quality, and less expensive, have recently come into widespread use at patient bedsides. That is, non-expert clinicians now have increasingly more opportunities to use these devices. Furthermore, a large amount of evidence supports the clinicians’use as a point of care, especially in the field of acute care. Realizing the benefits of echocardiography in the management of acute care, the clinician-performed application of this technology has also been developed as focused cardiac ultrasound（FoCUS）. The diagnostic approach of FoCUS is qualitative or semi-quantitative to facilitate the decision making process at bedside. The items that are suitable to be examined by FoCUS, such as the left ventricular systolic function, the right ventricular size, inferior vena cava diameter with respiratory variation, and pericardial effusion with or without tamponade physiology were identified based on the findings of comprehensive standard echocardiography. The assessment of the gross valvular findings without using Doppler techniques can be the part of the FoCUS examination. Clinical studies have demonstrated that FoCUS improves the diagnostic accuracy by visualizing the cardiac structure and function in comparison to only physical examination and electrocardiography. FoCUS in the acute care setting can be performed for triage, resuscitation, diagnosis, observation, monitoring and guidance for procedures that are carried out both in-hospital and out of hospital. As a result, FoCUS is therefore expected to become more important in the future for clinicians. It has to be kept in mind that FoCUS does not provide a complete diagnostic echocardiographic examination and therefore is also associated with some limitations. Further assessments using comprehensive echocardiography and consultation with cardiologists should be considered to avoid making an over- or under- diagnosis of serious heart diseases. Collaboration between clinicians as its users and the experts, guidelines based on clinical research, and the development of standard educational programs are needed to improve FoCUS as a visual stethoscope for proper clinical information-sharing and the improvement of patient care.