title: The "5Es" of emergency physician-performed focused cardiac ultrasound: a protocol for rapid identification of effusion, ejection, equality, exit, and entrance.
abstract: Emergency physician (EP)-performed focused cardiac ultrasound (EP FOCUS) has been increasingly recognized as a crucial tool to help clinicians diagnose and treat potentially life-threatening conditions. The existing literature demonstrates a variety of EP FOCUS applications and protocols; however, EP FOCUS is not taught, practiced, or interpreted consistently between institutions. Drawing on over 12 years of experience in a large-volume, high-acuity academic emergency department, we have developed a protocol for teaching and performing EP FOCUS known as "The 5Es," where each E represents a specific assessment for immediately relevant clinical information. These include pericardial effusion, qualitative left ventricular ejection, ventricular equality, exit (aortic root diameter), and entrance (inferior vena cava diameter and respirophasic variation). Each of these assessments has been well described in the emergency medicine literature and is within the scope of EP-performed echocardiography. This approach provides a reliable and easily recalled framework for assessing, teaching, and communicating EP FOCUS findings that are essential in caring for the patient in the emergency setting.
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: M
authors.initials: M
authors.lastname: Kennedy Hall
authors.affiliation: Department of Emergency Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX.
authors.forename: E C
authors.initials: EC
authors.lastname: Coffey
authors.affiliation: Department of Emergency Medicine, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT.
authors.forename: Meghan
authors.initials: M
authors.lastname: Herbst
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Rachel
authors.initials: R
authors.lastname: Liu
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Pare
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: R
authors.initials: R
authors.lastname: Andrew Taylor
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Sheeja
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Chris L
authors.initials: CL
authors.lastname: Moore
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004452:Echocardiography / Q000379:methods / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D010490:Pericardial Effusion / Q000000981:diagnostic imaging; D019095:Point-of-Care Systems / Q000592:standards*; D014481:United States; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging