Point-of-care ultrasound (POCUS) is a revolutionary diagnostic method that helps enhance physical examination at the point of care, that is, the patient’s bedside. Clinicians can use this tool to quickly diagnose medical conditions and guide treatment or bedside procedures, including POCUS emergency medicine applications.
Its widespread uses and benefits have made it an increasingly popular approach in medical practice, especially in improving procedural safety.
Here, we delve into POCUS and its importance. We also share four common clinical uses of POCUS that every clinician must know about and master.
What Is POCUS and Why Is It Important?
POCUS is a clinical practice where trained healthcare providers use ultrasound to diagnose medical conditions. It is a novel approach that offers broad applications in medical diagnosis, procedures, and screening.
This life-saving bedside tool narrows down diagnoses and shortens the duration of hospital stays, especially during patients’ emergency visits. Its special focus on diagnostic precision enables the rapid and reliable assessment of functional and structural anomalies.
Its implementation and integration into primary care procedures also help patients receive suitable treatment and prevent misdiagnosis, which improves the quality of healthcare and patient safety.
In addition, POCUS plays a vital role in reducing morbidities, mortality, and medical bills, which makes it an advanced medical technology with impressive benefits.
Clinical Uses of POCUS for Emergency and Hospital Clinicians
Here are four important clinical uses of POCUS that are fairly easy to master:
1. Renal and Bladder Ultrasound
Patients with renal disease may have many comorbidities that a renal and bladder ultrasound can quickly detect. This tool helps determine if healthcare professionals need to conduct an intervention to help the kidneys or bladder.
It is also useful in cases of acute kidney injuries (AKIs) or acute renal failures (ARFs) in inpatient and outpatient settings. POCUS offers improved patient management outcomes in AKI cases. It helps determine the causes of the condition by revealing abscesses, stones, inflammation (pyelonephritis), or hydronephrosis.
An emergency POCUS also helps quickly and effectively diagnose urinary and renal tract obstructions as well as acute renal colic. It thus reduces the need for departmental ultrasounds.
POCUS can also be used in pediatric nephrology settings to answer various bedside clinical questions, including hemodynamic status and structural renal anomalies. It helps assess the urinary tract and fluids, helping determine necessary medical interventions that enable prompt diagnosis and treatment.
POCUS’ other successful applications include improved image acquisition and interpretation, integration of sonography with therapy, and effective communication for colleagues and patients.
2. Lung Ultrasound
A bedside lung ultrasound enables clinicians to diagnose thoracic diseases that arise from acute respiratory failures. It aids in the examination of pulmonary congestion and shortness of breath. It also helps interpret abnormalities and enables the evaluation of the extravascular or interstitial lung water’s fluid content.
Lung ultrasounds are also useful in diagnosing lung diseases such as pneumonia, pneumothorax, hemothorax, pulmonary edema, pleural effusion, and alveolar and interstitial lung diseases.
They offer a quick assessment of lung functioning and help clinicians address the root causes of certain complications, enabling timely treatment. They also provide valuable assistance in some procedures such as thoracentesis.
3. Soft Tissue Ultrasound for Abscess Assessment
Soft tissue ultrasound is another common clinical application of POCUS. The implementation of POCUS in the assessment of soft tissues helps the observation of soft tissue pathologies, including signs of infection such as abscess and cellulitis.
An emergency POCUS ultrasound helps identify abscesses in cases of skin and soft tissue infections (SSTI) among emergency department (ED) patients that would warrant incision and drainage. In cases of inconclusive physical examinations, a soft tissue ultrasound helps clinicians differentiate between cellulitis and abscess.
It also prevents the misdiagnosis of soft tissue pathologies and minimizes the need for needless sedations, invasive procedures, and return visits for antibiotic treatment failures.
4. Vascular Access Guidance
Vascular access guidance is another important clinical use of POCUS. Using POCUS for assessing access and guiding intravenous (IV) cannulation is commonplace in hemodialysis units.
This tool helps determine arteriovenous fistula (AVF) maturation and identifies anomalies and landmarks. It also helps assess possible sites for IV cannulations. It aids cannulations, including procedures involving stents. It also boosts cannulation accuracy and gives patients the option to perform self-cannulations.
Another benefit of vascular access guidance is it helps clinicians decide the most suitable dialysis vascular access for patients with chronic kidney disease (CKD) and chronic heart failure (HF).
Conclusion
POCUS is a powerful tool that is extremely relevant in medical settings. Its application in primary care helps narrow down diagnoses during primary care consultations.
Although any clinician can use it in their daily work, this novel technology needs formal training and regular practice. Lack of training among medical students, residents, and practicing healthcare professionals is a common challenge in the clinical application of POCUS.
The Accreditation Council for Graduate Medical Education (ACGME) has made POCUS training mandatory for the emergency medicine discipline. So, medical residents completing their residency in family medicine, internal medicine, surgery, or internal medicine are not routinely trained to use this tool. Ultimately, this can negatively impact patient outcomes.
Formal POCUS training maximizes the benefits of this tool as clinicians learn how to use and interpret results properly. Hence, proper instruction can prevent inconclusive findings and improve patient care.
If you’re interested in getting hands-on POCUS training, Hospital Procedures Consultants offer various ultrasound courses. These courses can help you gain the necessary knowledge to use POCUS in your practice so you can quickly and accurately diagnose and treat patients who require it.
Resources
Makris, K. Spanou, L. Acute Kidney Injury: Definition, Pathophysiology and Clinical Phenotypes. Clin Biochem Rev. 2016; 37(2): 85–98
Carrera, K. Hassen, G. Camacho- Leon, Genesis. Rossitto. Martinez, F. Dabele, T. The Benefits and Barriers of Using Point-of-Care Ultrasound in Primary Healthcare in the United States. Cureus. 2022; 14(8): e28373.
Nepal, S. Dachsel, M. Smallwood, N. Point-of-care ultrasound rapidly and reliably diagnoses renal tract obstruction in patients admitted with acute kidney injury. Clin Med. 2020; 20(6): 541–544
Sethi, S. Raina, R. Koratala. Hassanzadeh, A. Vahera, A. Badeli, H. Point-of-care ultrasound in pediatric nephrology. Pediatr Nephrol. 2023; 38(6): 1733–1751.
Subramaniam, S. Bober, J. Chao, J. Zehtabchi, S. Point-of-care Ultrasound for Diagnosis of Abscess in Skin and Soft Tissue Infections. Acad Emerg Med. 2016 Nov;23(11):1298-1306
Schoch, M. Bennett, P. Currey, J. Hutchinson, A. Point-of-care ultrasound use for vascular access assessment and cannulation in hemodialysis: A scoping review. Semin Dial. 2020 ;33(5):355-368.
Kumar, A. Kugler, J. Jensen, T. Evaluation of Trainee Competency with Point-of-Care Ultrasonography (POCUS): a Conceptual Framework and Review of Existing Assessments. J Gen Intern Med. 2019; 34(6): 1025–1031