FoCUS in PE

 Q: What are the two evaluations in the diagnosis of pulmonary embolism (PE) with bedside focus cardiac ultrasound (FoCUS)? 

Answer: Point Of Care Ultrasound (POCUS) and Focus Cardiac Ultrasound (FoCUS) has now become a standard of care in ICU management.

If the following two are demonstrated simultaneously on a patient, it almost confirms the diagnosis of PE:

• ratio of the size of Right Ventricle (RV) and Left Ventricle (LV) more than 1:1 
• a floating thrombus in the RA, RV, or a clot in transit

FoCUS has a good negative value in the assessment of PE. Other parameters which are looked into assessing PE are McConnell's sign, septal flattening, tricuspid regurgitation (TR), and tricuspid annular plane systolic excursion. 

#FoCUS

#POCUS

#pulmonary

#cardiology

References:

1. Daley JI, Dwyer KH, Grunwald Z, Shaw DL, Stone MB, Schick A, Vrablik M, Kennedy Hall M, Hall J, Liteplo AS, Haney RM, Hun N, Liu R, Moore CL. Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs. Acad Emerg Med. 2019 Nov;26(11):1211-1220. doi: 10.1111/acem.13774. Epub 2019 Sep 27. PMID: 31562679.

2. Taylor RA, Davis J, Liu R, Gupta V, Dziura J, Moore CL. Point-of-care focused cardiac ultrasound for prediction of pulmonary embolism adverse outcomes. J Emerg Med. 2013 Sep;45(3):392-9. doi: 10.1016/j.jemermed.2013.04.014. Epub 2013 Jul 2. PMID: 23827166.