Care Right By The Bedside
\A pregnant mother in her third trimester enters your emergency room. She’s just collapsed in the parking lot, with her partner luckily by her side. She’s brought in out of breath and vitally unstable.
There are now two lives in need of your attention and immediate diagnosis in order to move forward with a treatment that is both safe and effective for both. This mother just wants to hear is her baby is not in any danger. She is looking to you for reassurance and any signal that all is okay.
Within minutes you are able to do just that. Right at mom’s bedside, you determine that the fetal heart rate and movements are both normal. Now that mom is comforted by the news, continuing your evaluation you learn that she has a clot in her leg. It has presumably gone to her chest which caused her to pass out and have shortness of breath.
You are now able to move forward with treatment for mom’s pulmonary embolism which was discovered without her having to leave her hospital room and while avoiding exposing mom and baby to radiation.
The foreknowledge of and access to Point-of-Care Ultrasound (POCUS) allowed for this quick assessment to take place. Dr. Dean Vlahaki attended to the patient and without delay, he was able to give her answers about her unborn child while pinpointing the cause of her condition. An added success is no radiation was required. Dr. Vlahaki was empowered to not only tend to the immediate needs of both his patients but did so in a manner that considered and preserved their long-term wellbeing.
In this case and many others that Dr. Vlahaki has seen and experienced, POCUS provided increased diagnostic certainty. This is something that Dr. Vlahaki says is never a bad thing.
“The amount of diagnostic certainty ultrasound adds to your clinical examination history is immense,” Dr. Vlahaki states. “So, I’m not sure that you can justify not using it in certain cases.”
“It’s interesting when you look at legal cases in Canada regarding Point-of-Care Ultrasound, and I believe this may be true in the United States as well. I don’t know that there’s ever been a case where a person who used Point-of-Care Ultrasound was found to be liable for something bad that happened as a result of using it. The only cases that I’ve found that have a settlement for the patient are when Point-of-Care Ultrasound has not been used.”
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At St. Joseph’s Healthcare Emergency Department, Dr. Vlahaki relies on POCUS quite heavily – particularly with workup of abdominal pain in assessing patients for cholecystitis or renal colic. Cardiac diagnoses, lung ultrasound, testicular torsion, and early pregnancy are other conditions that physicians at St. Joseph’s utilizes POCUS for regularly. Dr. Vlahaki shares that when it comes to all the basic and advanced applications that POCUS can be used for, he and his team use it.
The application of POCUS in the emergency room has increased in Dr. Vlahaki’s opinion. For example, the aging population is increasing, and when they visit the emergency room, they usually show up with notably complicated cases. Their conditions take time and rigor to diagnosis accurately. Dr. Vlahaki proclaims that “having a tool that can speed things up and provide efficient diagnosis is going to be the big game changer.” In this way, he agrees that POCUS is revolutionizing medicine.
If this is the way forward, how does one stay on top of this movement in healthcare? It is recommended by Dr. Vlahaki to take advantage of free, online medical education resources regarding POCUS. Through these courses and on the job application, he believes that many physicians could begin teaching themselves the basics to gain enough general knowledge to start implementing it in their practice.
“If you haven’t done an intro course, I would suggest that first. Certainly, the online access to medical education resources are immense, and I recommend tuning into those,” Dr. Vlahaki suggests.
There seems to be no better time than the present to ensure that a full understanding of POCUS is grasped and the technology is embraced. If we have the future that Dr. Vlahaki hopes for, then we should be prepared to see POCUS move from emergency medicine into other specialties.
“Emergency medicine has historically been the front-runner or leader in Point-of-Care Ultrasound development and initiation. My biggest hope going forward is that other specialties get on board” explains Dr. Vlahaki.
The POCUS Certification Academy couldn’t agree more. Bridging the gap between specialties and ensuring that healthcare professionals remain abreast of how Point-of-Care Ultrasound is changing the face of patient care is a priority.
Learn more about the POCUS Certification Academy’s Assessment Committee and see how you take part in moving patient care forward.
Learn more about POCUS Certification here.
Dean Vlahaki, MBBS, RDMS, FRCP, is a member of the POCUS Certification Academy’s Assessment Committee. Dr. Vlahaki graduated from the University of Queensland Medical school in Brisbane, Australia in 2011. He completed his Emergency Medicine residency training and POCUS specialty training at McMaster University in Hamilton, Canada in 2017. Vlahaki now practices at multiple sites in a network of academic tertiary care hospitals in Hamilton, Canada. He is also an Assistant Clinical Professor with McMaster University and a major contributor to the Emergency Medicine Point of Care Ultrasound Fellowship program at McMaster University.
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