RESUMO
Dyspnoea can be defined as an unpleasant or uncomfortable sensation of difficult breathing experienced by an individual. The differential diagnosis includes acute heart failure (AHF), acute coronary syndrome (ACS) and pulmonary embolism (PE) as the main diseases to be excluded for their potential acute severity and mortality. NT-pro BNP is a sensitive and specific marker of ventricular dysfunction. Materials & Methods : Observational cross sectional study was done from October 2016 to October 2017 with 70 patients of acute dyspnoea presenting to emergency department. An automated immuno-analytical test for NT-pro BNP was carried out. Data was analyzed using appropriate statistical tests. Observation : Out of 70 cases of breathlessness, 48 patients were diagnosed with cardiovascular disease, 17 had Respiratory disease and 5 were of other causes (non respiratory, non cardiac). In Cardiovascular causes of breathlessness (n=48) the mean NT-pro BNP level was 2234 pg/ml, and in Non cardiovascular causes of breathlessness (n=22) the mean NT-pro BNP level was 677 pg/ml. Thus, there was a significant difference in the levels of mean NT-pro BNP. Conclusion : The statistically significant difference was observed when plasma NT-pro BNP levels of cardiovascular disease were compared to non cardiovascular disease (in respiratory causes levels were significantly lower) .Thus it supports the ability of NT pro BNP to provide specific information about the cardiac involvement in acute dyspnoea
RESUMO
Introduction: Hemorrhagic shock is the leading etiology in most cases of trauma and can be rapidly fatal. Thus adequate fluid resuscitation is required to improve the outcome of patients. CVP is usually used to guide resuscitation. Point-of-care sonography in emergency medicine provides non-invasive assessment of intravascular volume status. Measurement of inferior vena cava does not require special preparation as it can be done along with FAST examination. Materials & Methods : This observational study was conducted on patients with history of trauma presenting to Emergency Department. The patients were divided into two groups: a hypotension group with hypotension on presentation and a normotensive group with normal blood pressure. The diameters of IVC both during inspiration (IVCi) and expiration (IVCe) were measured by M-mode ultrasound using a 3-5 MHz Phased Array Transducer. Results: Both IVCe and IVCi were significantly smaller in hypotension group as compared to normotension group of patients, while collapsibility index was increased in hypotensive group. The mean IVCe diameter was 7.8 mm in hypotension group. There was positive correlation of IVC parameters to blood pressure, and shock index. Post-resuscitation there was increase in diameters of IVC, decrease in collapsibility of IVC, and significant improvement in the vital parameters. Conclusion: The study showed that the measurement of IVC diameter can be used as a reliable tool to guide resuscitation in trauma patients and can help to predict significant hypovolemia, in patients having normal blood pressure