Submitted by Dr. Daniel Lichtenstein
One night, I received in the intensive care unit a patient with a complex history, and mainly, this patient with likely an extensive pneumonia was put under prompt mechanical ventilation, and the right lung was fully white on X-rays.
My physical examination did not enable me to see what it was about. The circulatory function was impaired. It was after midnight, and I rushed in the radiology department, took one ultrasound machine with me (this was fully forbidden but there was nobody). Ultrasound promptly revealed a huge pleural effusion, and my first reflex was to withdraw this obstacle which, maybe, prevented the venous return. I had the feeling that the circulatory function worked better after this procedure. Then I brought more quietly the machine where I had found it.
This diagnosis and procedure may appear common nowadays, simple routine. I do not know who used critical ultrasound first (people now use the term POCUS), the idea was rather simple, and likely the patient had shorter length-of-stay, or maybe just a life saved more easily, thanks to this visual medicine.
This simple story occurred in March 1985, in the hospital where, very young, I had to take my first responsibilities in these scary nights, all alone. We were far from the “pocket machines”. By the way, what was forbidden at these remote times has now become standard of care. Since this day, I thank ultrasound every day, and am so glad to see the patients of a whole life of critical care, maybe saved, maybe just benefiting from a more elegant approach (I don’t enumerate the advantages of ultrasound).
Has POCUS impacted the care you provided to a patient? Has it altered the course of treatment or helped you to diagnose?
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