Echos from the lion's den 2Over the past 3 weeks I’ve had the honor, the privilege and the … to hang out with the „big boys” in the lion’s den (a.k.a. the echocardiography lab). It’s been a lot of fun and quite a learning experience. I’ve discovered a fair number of their „dirty secrets” while playing the „eyeballing game” with the guys. Here are the rules:

Eyeball the Heart game 2

It is obviously not my goal to ridicule the art and the skill of an experienced cardiologist. Nevertheless the interaction prompted some questions which are likely to remain unanswered. To be honest I was fairly surprised by the level of subjectiveness governing the echocardiographic interpretation. A little more or a little less is just a matter of a slightly different caliper placement. Hence I am asking… Why do we care about the absolute numbers  if they’re a product of an estimation? Why do we allow those digits to guide important clinical decisions (e.g. AICD placement) if they’re a matter of comparative assessments and relative impressions? Furthermore, why would one argue against the value of a bedside echocardiographic evaluation by a trained non-cardiologist if that is enhanced with real-time clinical clues and patient’s historical data?

JASE-gateI am not sure if it’s money, pride, ego or all of the above, that drive hostility towards point-of-care echo evaluations by emergency physicians or critical care providers, as an example. There are no logical arguments in this debate and statements such as recent JASE gate (a.k.a. Focused Cardiac Ultrasound recommendations from the American Society of Echocardiography) are inconsistent with patient advocacy. Countless lives have been saved and even more outcomes have been improved thanks to bedside echocardiography. Let’s quit the dispute and focus on mutual education. Beyond any shadow of doubt we can learn a lot from our cardiology colleagues, while we can certainly teach them a trick or two…

Speaking of echo education. Below a few of the million interesting echo resources:

  1. Newest first! My most recent discovery is a fantastic article from January 2014 issue of Critical Care Clinics. Drs. Perera, Lobo, Willims and Gharahbaghian provide you with an exhaustive point-of-care echo review.
  2. Introduction to Bedside Ultrasound by Matt & Mike in 2 digital volumes.
  3. Intro to Bedside Echo by Joe Minardipart 1 and part 2. Created for medical students – great for anyone!
  4. Yale Echo Atlas
  5. Nice iASE app for the big boys/girls. Advanced echo recommendations, summaries and calculators from the ASE (American Society of Echocardiography).