Advancing Point-of-Care Ultrasound Enables CRNAs to Provide Game-Changing Care
It’s clear to see that point-of-care ultrasound (POCUS) is shifting the way we engage in medical practice. The ultrasound (US) machine found its inception in the 1950s, then quickly moving into becoming a widely available tool in the 1960s. The limitations of these early US machines were its size, the requirements for use such as patient immersion into the water for image retrieval, as well as barriers to image interpretation and limited capabilities.
Fast forward to the 1990s, and we find that research and development have vastly advanced to enable US machines to become portable, faster, and smaller. Technological developments such as the color Doppler, multifrequency probes, and the transvaginal transducer had made it so that clinicians could utilize the US right at the bedside, hence the birth of POCUS. In our 21st century, the welcomed addition of artificial intelligence (AI) has advanced POCUS to even higher ground.
Perioperative care is a field of medicine that is reaping the benefits of this technology that continues to evolve and save lives. According to the American Society of Regional Anesthesia and Pain Medicine (ASRA), “Ultrasound -guidance has transformed regional anesthesia from the practice of relatively few academic experts to an “everyday” tool widely utilized by most anesthesiologists. US imaging is now used in virtually every anesthesiology practice in the United States…” Furthermore, ASRA takes the stance that, “Point-of-care applications of ultrasound relevant to anesthesia practice are in many cases more accurate than traditional imaging modalities and clinical assessment models for a variety of diagnosis.”
Recently, our Focus on POCUS™ podcast had the pleasure of interviewing Thomas Baribeault, CRNA and Founder and President of the Society of Opioid-Free Anesthesia (SOFA). Baribeault currently practices in Atlanta, Georgia, and is responsible for implementing opioid-free anesthesia and post-operative pain protocols. He received his bachelor’s degree in nursing from Ohio State University, a master’s of science in nursing and anesthesia residency from Case Western Reserve University, and a doctorate in nursing practice and pain management fellowship from the University of South Florida.
In this episode, Baribeault walks us through his personal evolution of how he learned about the benefits of POCUS for his field. He was initially trained in the standard curriculum for vascular access and peripheral nerve blocks. From there, he advanced to lung scans for pneumothorax and scanning patients’ abdomen for gastric contents and NPO status. Along Baribeault ‘s educational journey, he had an instructor who was compelled to teach him about basic transthoracic echo. He cites this as being a game-changing moment for his CRNA capabilities.
Due to POCUS’s ability to quickly analyze the patient’s body habitus, this tool streamlines his ability to perform a focused scan right at the bedside, essentially delivering a “reconnaissance scan,” as he cleverly calls it. He can skip jumping through hoops, so to speak, to get rapid answers, which upgrade his delivery of exceptional CRNA care.
Baribeault notes that the reduction in size and mobility is the major component of POCUS technology that has taken its evolution from good to exceptional. The elimination of the traditional large, wheeled cart was a pivotal moment for providers everywhere. The simplicity of being able to plug your transducer into an iPhone or tablet allows a level of effortlessness that streamlines care in an unmatched way. Incorporating AI technology to provide guided image interpretation, assist with injection fractions, and auto calculation of fluid volumes is phenomenal.
While Baribeault praises the advancements of AI technology in POCUS, he also warns listeners to proceed carefully before becoming dependent on AI to interpret everything. There is still a need to increase basic education standards for everyone that incorporates POCUS into their practice. The POCUS Certification Academy™ is founded on this premise and believes this is the only way to continue the evolution of POCUS to its greatest potential.
- Kendall, John L., Hoffenburg, Stephen R., & Smith, R. Stephen. (2007). History of emergency and critical care ultrasound: The evolution of a new imaging paradigm. Critical Care Medicine, 35 (5). 10.1097/01.CCM.0000260623.38982.83. Retrieved on April 28th, 2020, from https://www.academia.edu/18477390/History_of_emergency_and_critical_care_ultrasound_The_evolution_of_a_new_imaging_paradigm.
- (n.d.) American Society of Regional Anasthesia and Pain Medicine: Why PoCUS?. Retrieved April 28th, 2020, from https://www.asra.com/page/310/why-pocus.
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