Point-of-care Ultrasound for the Evaluation of Acute Arterial Pathology in the Emergency Department: A Case Series.

Aaran Drake,Megan Hoffer,Nicholas Dreyer,Keith Boniface

doi:10.5811/cpcem.2021.11.54904

Aaran Drake, Megan Hoffer + Show 2 more

Open Access

https://doi.org/10.5811/cpcem.2021.11.54904

Copy DOI

Abstract

IntroductionThe use of point-of care ultrasound (POCUS) in the evaluation of vascular emergencies including abdominal aortic aneurysm and deep vein thrombosis is well established. However, no current guidelines exist to outline the use of POCUS in the management of acute peripheral arterial pathology.Case SeriesHere, we present a case series that illustrates the utility of POCUS in the assessment of both traumatic and nontraumatic peripheral arterial disease. Direct visualization of the vasculature via B-mode, color Doppler, and pulsed-wave Doppler assisted in the diagnosis of the following: 1) an acute, post-catheterization thrombus of the proximal radial artery; 2) a complete, traumatic radial artery transection; 3) a forearm hematoma with active arterial extravasation; 4) a traumatic arteriovenous fistula; 5) an acute thrombosis of an artery bypass graft; and 6) an infected pseudoaneurysm.ConclusionThe incorporation of POCUS into patient care allowed for rapid identification of significant peripheral arterial pathology and led to changes in clinical management, expedited patient care, and circumvented potentially harmful complications.

Highlights

The use of point-of care ultrasound (POCUS) in the evaluation of vascular emergencies including abdominal aortic aneurysm and deep vein thrombosis is well established
The incorporation of point-of-care ultrasound (POCUS) into patient care allowed for rapid identification of significant peripheral arterial pathology and led to changes in clinical management, expedited patient care, and circumvented potentially harmful complications.[Clin Pract Cases Emerg Med. 2022;6(1):1-7.]
We aim to demonstrate the value of POCUS in the early detection of acute peripheral arterial disease within the emergency department (ED)

Summary

Introduction

The use of point-of care ultrasound (POCUS) in the evaluation of vascular emergencies including abdominal aortic aneurysm and deep vein thrombosis is well established. The use of point-of-care ultrasound (POCUS) has expanded greatly since the introduction of the focused assessment with sonography for trauma exam.[1] The American College of Emergency Physicians’ Emergency Ultrasound Guidelines include indications for POCUS such as trauma, pregnancy, cardiac and hemodynamic assessment, soft tissue infection, musculoskeletal injury, hepatobiliary and gastrointestinal pathology, ocular assessment, genitourinary complaints, and procedural guidance.[2] Other well-established indications for POCUS include vascular emergencies such as abdominal aortic aneurysm (AAA) and deep vein thrombosis (DVT). Despite the efficacy of POCUS in these vascular emergencies, currently no published guidelines exist that outline the use of POCUS in the assessment and management of peripheral arterial pathology. Given the documented utility of POCUS in the real-time evaluation of other vascular pathology, hemodynamic assessment, and procedural guidance (eg, vascular access), it would likely prove to be extremely beneficial in the diagnosis of peripheral arterial emergencies as well

Objectives

Findings

Discussion

Conclusion