Objective
Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic parameter that serves as a prognostic indicator for the severity of chronic obstructive pulmonary disease (COPD) clinical course. This study, consisting of a systematic review and meta-analysis, evaluates the current literature to elucidate the relationship between TAPSE measurement in COPD patients versus control subjects to discern baseline evidence of right heart strain. Methods PubMed, Scopus, CINAHL, Web of Science, and Cochrane Library databases were searched from their beginnings through November 1, 2023, for eligible studies. Outcomes included the difference of TAPSE measurement and right ventricular (RV) wall thickness between COPD patients and control patients. The Newcastle-Ottawa Scale was applied to assess risk of bias, Q-statistics and I2 values were used to assess for heterogeneity, and Egger and Begg tests were used to assess publication bias. Results The search yielded 11 studies reporting TAPSE values involving 1,671 patients, 800 (47.9%) of which had COPD. The unadjusted mean TAPSE value for COPD patients was 18.9±4.0 mm, while the mean TAPSE value for control patients was 22.2±0.8 mm. The presence of COPD was significantly associated with decreased TAPSE values, with the meta-analysis reporting the mean difference in TAPSE value at –3.0 (95% confidence interval, –4.3 to –1.7; P=0.001) between COPD and control patients. Six studies reported the RV free wall thickness. The unadjusted mean RV free wall thickness for COPD patients was 4.9±1.2 mm, and for control patients was 3.4±0.7 mm. Conclusion This meta-analysis demonstrated statistically significant lower TAPSE values and thicker RV free wall among COPD patients as compared with control patients.

Extracorporeal membrane oxygenation (ECMO) has been increasingly employed in the emergency department for patients with a potentially reversible cause of cardiac arrest. We present the case of a young female patient with an in-hospital cardiac arrest who was found to have severe right heart strain on point-of-care ultrasound (POCUS), suggesting a massive pulmonary embolism. Rapid bedside diagnosis using ultrasound expedited bedside cannulation and initiation of ECMO as a bridge to surgical thrombectomy, and ultimately the patient survived with full neurologic function. With its ready availability and increasing acceptance by consultants, POCUS should be incorporated into cardiac arrest algorithms as the standard of care to rule in thrombotic and obstructive causes of cardiac arrest.

The current heightened international political climate is accompanied by increased risk of chemical or biological agent weaponization. Historical accounts of biochemical warfare are extensive, and considering the recent use of such agents for targeted attacks, clinicians need to recognize and manage these cases. However, agent properties such as the color, odor, ability to be aerosolized, and long incubation period can introduce difficulties in the diagnostic and management approach. We searched PubMed and Scopus for a colorless, odorless, aerosolized substance with an incubation period of at least 4 hours. Data from articles were summarized and reported by agent. Based on data from the available literature, we included agents such as nerve agents, ricin, botulinum toxin, anthrax, tularemia, and psittacosis in this review. We also highlighted potential chemical and biological agents that could be weaponized and the optimal strategies for the diagnosis and treatment of patients exposed to an unknown aerosolized biological or chemical bioterrorism agent.