الفهرس 
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Abstract
The complexity of diagnosis for critically ill dyspnea presentations in the emergency department remains a challenge. Accurate and rapid recognition of associated life-threatening conditions is paramount for timely treatment. Point-of-care ultrasound (PoCUS) may be of greater diagnostic benefit in resource-limited settings.
The aim of the current observational cross-sectional study was to estimate the predictive value of POCUS in diagnosis of different causes of acute dyspnea in hemodialysis patients. In addition to compare between PoCUS and CT in differentiation the causes of acute dyspnea in those patients who maintained on regular hemodialysis equal to / more than 6 months and admitted to the Emergency Department and Intensive Care Unit of Internal Medicine Department, Assiut University Hospital. Our main hypothesis is that, using PoCUS in this field could improve the clinical endpoints in patients with acute onset dyspnea.
All adult patients (aged > 18 years old, from both sex) on regular hemodialysis equal to / more than 6 months who hospitalized with acute dyspnea and admitted to the Emergency Department and intensive care unit (ICU) of Internal Medicine Department, Assiut University in the period from September 2021 to August 2022 were enrolled in the current study.
All eligible participants were subjected to the following preliminary evaluation:
1. Full history taking: including name, age, occupation, address, underling comorbidities (diabetes mellitus, hypertension, and cardiovascular disease), positive family history of similar condition, type and duration of hemodialysis. In addition to: onset, course, duration, site (position), severity, aggravation factors, relieving factors and associated symptoms of dyspnea.
2. Laboratory investigation including:
• Complete blood count (CBC)
• Liver function tests (total protein, albumin level, Aspartate aminotransferase (AST, Alanine transaminase (AST), alkaline phosphatase (ALP), and Gamma-glutamyl transferase (GGT)).
• Blood Gases including lactic Acid.
• Coagulation profile including (prothombin time (PT), prothombin concentration (PC), international normalized ratio(INR), and Partial thromboplastin time (PTT))
• Inflammatory markers (ESR, and CRP).
• Serum electrolytes level including (sodium, potassium, magnesium, calcium, and phosphate).
• Cardiac enzymes (serial if needed).
• Serum Ferretin.
• D-dimer.
• COVID PCR if founded.
3. Examination:
• General examination including volume status assessment:
Mean Blood pressure.
Pulse and orthostatic tachycardia.
Capillary re-fill.
Jugular venous pressure and distension.
Ascites.
Lower limb edema.
• Full Chest Examination with focusing on chest auscultation for:
Reduced breath sounds and/or coarse or fine crackles.
Wheeze.
Pleural rub.
• Full Cardiac Examination with focusing on cardiac auscultation for:
Muffled heart sounds.
Pericardial rub
Murmurs
3rd or 4th heart sounds.
• Daily body weight.
4. Imaging including:
Patients included in this study were subjected to the following:
• X-ray chest: baseline and serial.
• CT Chest.
• POCUS (Point of Care POCUS Portable UltraSound (Us 9601 Machine)
• Rapid Echocardiography assessment by Invisor Echocardiography machine model 2002 3- 5 Hz for detection and assessment of:
Pericardial effusion.
IVC diameter and collapsibility.