What Is Point-Of-Care Ultrasound (PoCUS)?
Point-of-care ultrasound (PoCUS) is an advanced diagnostic procedure performed and interpreted by the attending clinician as a bedside test to help guide the evaluation and management of the patient. This is an increasingly growing field performed right at the bedside, which means it can happen in an emergency room, hospital bed, medical office, or pre-surgical area.
This procedure is usually performed by a skilled medical provider, which helps to investigate unclear findings and diagnose numerous medical conditions ranging from internal bleeding, blood clots, acute appendicitis, airway compromise, traumatic injury assessment, gallstones, and lung or heart problems. PoCUS’s relatively fast use has made it more popular and a potential option when a normal radiological investigation delays the diagnosis.
What Are the Benefits of Point-Of-Care Ultrasound?
There are many benefits to incorporating PoCUS in daily clinical practice, like
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Integrating sonographic findings with clinical examination and history at the patient's bedside, if the primary clinician does PoCUS, the need to incorporate a second clinician can be avoided, as can the need for patient transfer to a separate ultrasonography room.
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It is a cost-effective approach to reducing healthcare expenses.
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The time taken to reach diagnosis can be reduced by incorporating PoCUS into clinical practice.
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Patient safety and diagnostic accuracy can be improved.
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The complication rate can also be decreased.
How Does PoCUS Help to Diagnose Medical Issues?
Point-of-care ultrasound consists of a screen and a transducer, which help show images of different body parts. The transducer transmits sound waves that bounce off the body's tissues and return to the transducer. The sound waves bounce off various body tissues in different ways; these waves are collected by the machine, which uses the waves to create an image.
PoCUS can image various body parts and show the body in motion, such as the blood flow, the lungs expanding, and the heart pumping. Therefore, physicians take images of internal organs and body tissues, including the heart, liver, lungs, kidney, uterus, muscles, tissues, veins, and arteries.
According to the patient's history and physical examination, physicians get an idea about the cause of the condition. But in certain cases, medical conditions may have similar symptoms, making identification of the medical condition difficult. Physicians can diagnose quickly and efficiently by visualizing the organs and tissues and their working. Studies show that PoCUS examination during a doctor’s visit has significantly affected the diagnosis or management of 50 % of patients. Additionally, it has reduced the need for specialist referrals.
What Are the Indications of Point-Of-Care Ultrasound?
PoCUS use in clinical practice has been evolving effectively in recent times. So, it is indicated in many situations, such as
1. Cardiovascular - The use of POCUS helps to determine left ventricular ejection fraction (LVEF) (a measure of left ventricular systolic function), right ventricular ejection fraction (RVEF) (a measure of right ventricular systolic function), the filing status of the patient, pericardial fluid (collection of extra fluid between the heart and the pericardium), wall motion abnormalities (WMA) (abnormalities in the cardiac wall motion during the cardiac cycle), and pressure overload (a pathological state where the cardiac muscle contracts while experiencing an excessive afterload). With the help of PoCUS, it is helpful to find out if LVEF and RVEF are normal, moderated, reduced, or severely reduced. Hyperdynamic volume depletions or volume overloads of the ventricles can also be estimated as present. The WMAs can also be detected to some extent.
2. Lung - POCUS is equivalent to or more accurate in diagnosing pulmonary conditions than laboratory markers in diagnosing some pulmonary conditions. POCUS can identify the cause of shortness of breath and the correct intervention required for patients with unclear diagnoses. Moreover, it is an efficient tool to differentiate between pulmonary and non-pulmonary causes of shortness of breath, which is vital for physicians to proceed further.
3. Abdominal - Using PoCUS, various medical conditions in the abdominal region can be identified and diagnosed. PoCUS makes it possible to instantly identify what is happening inside the abdomen, rather than relying on physical examination and other tests.
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PoCUS can quickly diagnose kidney stones, bowel obstructions, appendicitis, and other time-sensitive developments faster than scheduling a CT scan, X-ray, or MRI would accommodate.
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Evaluation of the size, shape, and contents of the gallbladder and bile duct is also possible using PoCUS.
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An abdominal aortic aneurysm can be detected on ultrasound using a longitudinal evaluation of the abdominal aorta, checking for a diameter of more than three centimeters.
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When performing an abdominal sweep, acute intestinal obstruction can be detected by spotting multiple loops of the bowel measuring more than three centimeters in diameter. Obstruction’s severity can also be categorized by identifying the extra-luminal fluid, the presence or absence of peristalsis, luminal air, and bowel wall thickening.
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PoCUS is effective in patient recovery. For instance, bladder volume measurement with an ultrasound scan is a less invasive technique in a post-procedure setting. It can be done at the bedside of the recovering patient after surgery.
4. Pregnancy - PoCUS is also widely used for obstetrical indications in detecting suspicious ectopic pregnancy by confirming an empty uterus. It helps evaluate early pregnancy, which may decrease the overall hospital stay length. Also, PoCUS is accurate in diagnosing fetal heart activity at any stage. Hence, it helps check for threatened and missed abortions. It is also very beneficial for determining the fetal position in the third trimester of pregnancy.
5. Trauma - For a few decades, the role of ultrasound in abdominal and thoracic trauma patients has been a topic of considerable change and debate. PoCUS in trauma is mainly used to detect pericardial tamponade (compression of the heart caused when the pericardium fills with fluid), hemothorax (presence of blood in the space between the lungs and chest wall), pneumothorax (presence of air in the space between the lungs and chest wall), and intraperitoneal hemorrhage (pooling of blood in the peritoneal cavity). The FAST (focused assessment with sonography in trauma) examination is a preferred traditional method of detecting bleeding in blunt and penetrating trauma. Ultrasound is commonly used to detect the above-mentioned condition, as it is more effective than chest X-rays.
Conclusion:
Point-of-care ultrasound is a diagnostic test that makes physicians make better diagnoses providing improved outcomes. PoCUS is easy, fast, safe, and painless, and it can be used in a clinical environment or an emergency department, so it is getting more popular. POCUS is a useful tool for making quick and timely diagnoses and preventing unnecessary tests and referrals.
