When patient care can't wait, Point of Care Ultrasound (POCUS) gives physicians a safe, accurate, and affordable tool that provides answers to help with clinical decision making.
POCUS has a broad array of uses in hospital settings. Beyond securing a role in emergency medicine and critical care, this portable technology has found uses among pediatricians, neonatologists, orthopedics, sports medicine, and anesthesiologists.
Here's a look at the benefits of bedside ultrasound in a variety of clinical settings.
Tracing the Benefits of Bedside Ultrasound
Ultrasound is not a replacement for other radiological studies; instead, it's a tool for getting prompt answers that help eliminate or confirm diagnoses and determine next steps for patients. POCUS allows a clinician to obtain and interpret images and apply the findings when making care decisions. In emergency and critical care settings, this direct line of action translates to speed—patients don't have to wait for sonographers and radiologists before getting answers and a treatment plan. Those time savings can make a meaningful difference in patients' length of stay and clinical outcomes.
Ultrasound is easy to obtain, repeatable, and noninvasive. In addition to being less expensive than many other imaging modalities, it doesn't expose patients to radiation.1
POCUS also requires training and skill from the clinician. Most emergency medicine professional societies in the United States and abroad require ultrasound training as part of residency or specialty training. Training includes cardiac, lung, abdominal, soft tissue, ocular, and musculoskeletal ultrasound, as well as ultrasound-guided procedures, assessing trauma, and identifying deep vein thrombosis for emergency and critical care POCUS.2,3
Newer ultrasound technology also continues to be more portable and incorporates clinical-decision support tools as well as the ability to share images easily for consultations. Manufacturer-provided resources can supplement residency training and help clinicians stay on top of technology advances. For example, GE Healthcare's Venue Video Tutorials provides webinars, white papers, and other materials to help clinicians master the ultrasound's platform and maximize their workflows by taking full advantage of the machine's capabilities.
Expanding Uses for POCUS Technology
A wide range of medical areas have strongly adopted the use of ultrasound to evaluate and manage patients, meaning the benefits of POCUS are shared across the care continuum.
Emergency Medicine
Emergency medicine physicians turn to POCUS for immediate answers to specific questions. The American College of Emergency Physicians uses five clinical categories to classify ultrasound: resuscitation, diagnostic, symptom- based, procedure guidance, and therapeutic and monitoring changes as an adjunct to therapy.4 These categories align with the European Society for Emergency Medicine curriculum for POCUS as well.3
Ultrasound in the emergency department has wide-ranging uses, including evaluating the causes of cardiac arrest or respiratory failure, looking for deep vein thrombosis or pulmonary embolism, and assessing kidney injury, urinary tract infection, and nephrolithiasis. Emergency ultrasound can help clinicians evaluate fractures or examine the lungs for pneumonia.5
Critical Care
Often, the ways clinicians in the ICU and emergency medicine use ultrasound tend to overlap. Critical care physicians rely on POCUS for ongoing management of patients as well as for assessing hemodynamic function, Venous Thrombosis, cardiopulmonary function, and trauma or resuscitation.3,6
Critical care physicians benefit from knowing how to perform lung ultrasonography, echocardiography, lower extremity deep vein thrombosis studies, and abdominal and retroperitoneal scans. Unlike in the emergency department, critical care teams may perform ultrasounds repeatedly during a patient's stay to monitor for life-threatening complications and respond immediately.6
Trauma
The Focused Assessment with Sonography in Trauma (FAST) is an international ultrasound protocol to quickly evaluate trauma patients for internal bleeding and injury and deliver appropriate treatment. Ultrasound is highly specific and sensitive, and the FAST protocol has been shown to reduce time to surgery as well as patients' length of stay. A well-trained physician can perform an assessment via bedside ultrasound in less than five minutes. The extended FAST (eFAST) protocol also looks for causes of shock, hypotension, and abdominal or thoracic trauma.1
Postanesthesia Care Unit (PACU)
Anesthesiologists may turn to ultrasound to monitor patients perioperatively for nearly all aspects of bedside assessment. Using POCUS for patients who have acute hypotension or hypoxia in the PACU has been shown to lead to a reduced length of stay and fewer suspected causes for the event.7 Being able to quickly narrow down a cause can help clinicians provide swifter care.
Although patients may still require additional radiological studies and consultations with radiologists, POCUS allows clinicians to make evaluations and care decisions in real time. With ongoing training and support—and innovations that enhance accuracy and portability—bedside ultrasound further enables clinicians in performing rapid point-of-care evaluations and improving patient outcomes.
References:
- Bloom B, Gibbons R. Focused assessment with sonography for trauma. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470479/. Accessed April 21, 2022.
- Goett H. Introduction to Bedside Ultrasound. Society for Academic Emergency Medicine. https://www.saem.org/about-saem/academies- interest-groups-affiliates2/cdem/for-students/online-education/m3- curriculum/bedside-ultrasonagraphy/introduction-to-bedside- ultrasound. Accessed April 21, 2022.
- European Society for Emergency Medicine. European Curriculum of Emergency Medicine. Eusem.org. https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201306- 203EDhttps://eusem.org/images/Curriculum_2.0_WEB.pdf. Accessed June 3, 2022.
- American College of Emergency Physicians. Emergency ultrasound guidelines. Ann Emerg Med. 2009 Apr;53(4):550-70. doi: 10.1016/j.annemergmed.2008.12.013. PMID: 19303521.
- Whitson M, Mayo P. Ultrasonography in the emergency department. Critical Care. Aug 2016;20(227). https://ccforum.biomedcentral.com/articles/10.1186/s13054-016- 1399-x
- Guevarra K, Greenstein Y. Ultrasonography in the critical care unit. Current Cardiology Reports. Sep 2020;22(145). https://link.springer.com/article/10.1007/s11886-020-01393-z
- Ramsingh D, Singh S, Canales C, et al. The evaluation point-of-care ultrasound in the post-anesthesia unit: a multicenter prospective observational study. Journal of Clinical Medicine. May 2021;10(11). https://www.mdpi.com/2077-0383/10/11/2389
Access webinars, white papers, and other POCUS resources at GE Healthcare's Video Tutorials:
https://www.gehealthcare.com/products/ultrasound/venue-family/video- tutorials
