REVIEW   Open access

Italian Journal of Emergency Medicine 2022 December;11(3):135-61

DOI: 10.23736/S2532-1285.22.00161-6

Copyright © 2022 THE AUTHORS

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language: English

POCUS chest pain management: point-of-care ultrasound in the integrated management of chest pain

Gian A. CIBINEL ✉

Emergency Department, ASL Torino 3 - Regione Piemonte, Pinerolo, Turin, Italy

Chest pain is a very frequent symptom in the general population, and is the reason for presentation in approximately 5% of patients entering emergency departments. In the majority of cases the pain is caused by non-life-threatening dysfunctions, such as gastroesophageal reflux or musculoskeletal disorders, but it also recognizes among the causes lethal pathologies such as coronary syndromes and acute aortic syndromes, pulmonary embolism, fulminant myocarditis, tension pneumothorax, and esophageal rupture. The characteristics of the symptoms and the clinical evaluation do not allow in most cases to discriminate between the various causes, and even the basic tests that can be carried out at the point of care of the patients (point-of-care tests) often do not allow a diagnostic definition. The use of second-level instrumental investigations (CT, MRI) is increasingly frequent, with the primary objective of identifying/excluding lethal pathologies, but the diagnostic yield decreases and no significant improvements in the prognosis are observed for the lethal pathologies already mentioned; moreover, the use of ionizing radiation and contrast media involves significant risks for the health of individuals and the population. Point-of-care ultrasound (POCUS) is a concrete possibility to improve diagnostic accuracy, without relevant risks for patients and with significant planning advantages, in terms of cost reduction and process times. However, three conditions are necessary for an adequate use of the POCUS; the competence of the operators in obtaining and interpreting the images, the ability to integrate the POCUS with the other evaluation methods to obtain the best diagnostic-management paths and the continuous updating on the evidence that must guide the clinical activity. This review aims to take stock of the integrated POCUS approach in chest pain, regarding the validity and applicability of the method in the setting of hospital and pre-hospital emergency systems.

KEY WORDS: Point-of-care systems; Ultrasonography; Chest pain; Acute coronary syndrome; Acute aortic syndrome; Pulmonary embolism