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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, January 20, 2015

Ultrasonido: EPOC o ICC

Posted by Jacob avila on 2015, 01, 19
"Differentiating COPD and CHF in an acutely dyspneic patient is an important task that must be done quickly and often with minimal time and minimal resources. Unfortunately, we often make the wrong initial choice. A study by Collins and colleagues [26] found that in a sample of 173 patients that were subsequently diagnosed with heart failure, 33% were misdiagnosed in the ED. The most common factors associated with missed acute decompensated heart failure are a previous history of COPD, no previous history of CHF, and a BNP below 500 [24]. Making the wrong initial diagnosis can be detrimental to these patients, as giving beta agonists to patients with CHF exacerbations has been shown to lead to adverse outcomes, including death [3].
Ultrasound is a fast bedside test which some studies show has immense diagnostic utility. Even with the great +LR of LUS, like any other test or physical exam maneuver we have in medicine, LUS should not be performed and interpreted in a vacuum. It should be used in conjunction with the rest of your history, physical exam and tests. B-lines also are present in a multitude of other pulmonary pathologies including pulmonary contusion, pulmonary infarction, pneumonia, pneumonitis, atelectasis, pulmonary fibrosis, and ARDS."