Bedside echo for chest pain: an algorithm for education and assessment

Figures & data

Figure 1 Undifferentiated chest pain sonographic algorithm.

Abbreviations: DVT, deep vein thrombosis; LV, left ventricle; RV, right ventricle; IVC, inferior vena cava.

Table 1 Skills station descriptions

Focused cardiac ultrasound
Sonographic skills station	Learning objectives
The undifferentiated chest pain ultrasound algorithm: case-based review (30 minutes)	How to approach the undifferentiated chest pain patient using the ultrasound algorithm.  In this station, residents were provided clinical scenarios with focused cardiac ultrasound images and clips. These cases demonstrated a variety of findings such as right ventricular dilatation, decreased cardiac function, wall motion abnormality, inferior vena cava evaluation, etc. While reviewing clinical images with the residents, the instructor described how the different components of the ultrasound algorithm can help improve patient care and decrease the time to a clinical diagnosis and disposition.
Focused cardiac ultrasound: hands-on station (30 minutes)	How to perform a focused cardiac ultrasound as it pertains to the goal-oriented undifferentiated chest pain algorithm.  In this live model station, residents were given hands-on instruction on performing a focused cardiac ultrasound to help guide the management and diagnosis of undifferentiated chest pain. They were taught the methods necessary to obtain basic echo views, including subxiphoid, parasternal long, parasternal short, and apical four chamber. These views were then used to teach recognition and interpretation of IVC collapsibility, wall motion abnormalities, global ventricular function, pericardial effusion, tamponade physiology, and right ventricular dilatation.
Focused thoracic ultrasound: hands-on station (30 minutes)	How to perform a focused thoracic and lower extremity ultrasound, as it pertains to the goal-oriented undifferentiated chest pain algorithm.  In this station, residents were taught to perform focused thoracic ultrasound on a model. This included identification of basic anatomy and lung sliding as well as identification of pneumothorax, pulmonary edema, focal pneumonia, and pleural effusion. Residents were also taught how to perform lower extremity ultrasound to evaluate for deep vein thrombosis at the level of the common femoral vein, saphenofemoral junction, and popliteal vein.
Undifferentiated chest pain ultrasound algorithm: objective standardized clinical examination (30 minutes)	Evaluation of resident performance on a focused cardiac ultrasound.  In this station, the residents were required to perform a focused ultrasound for one of the three different clinical scenarios. One example was: “55-year-old male presents to the ER complaining of chest pain for 30 minutes. Patient is diaphoretic and mildly short of breath.” Residents were allowed to perform a focused cardiac, thoracic, or lower extremity ultrasound, as it pertained to the ultrasound algorithm. Ultrasound videos and images pertinent to the case scenario were shown to the residents. The residents provided their final diagnosis at the end of the case to complete this station.

Abbreviations: ER, emergency room; IVC, inferior vena cava.

Figure S1 Questionnaire

Abbreviations: BP, blood pressure; MI, myocardial infarction; IVC, inferior vena cava; CP, chest pain SOB, shortness of breath; PT, patient; CT, computed tomography; RUQ, right upper quadrant.

Figure S2 Undifferentiated chest pain objective standardized clinical exam

Notes: Not performed =0; performed =1.

Figure S3 Follow-up survey