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Welcome to POCUS25

POUCUS25 is a community-based effort to try to define and bring clarity—initially to entry-level POCUS users—to the POCUS movement and also to be a “one stop” resource for education and learning content covering the POCUS25 topics.

Below is an initial core list of 25 point-of-care ultrasound (POCUS) procedures or protocols that the POCUS community would recommend based on their potential significance to improve global health. This list is in development and is now open for feedback from the community. We would love to hear from all of you with the goal of refining and republishing before the end of 2019 with as many voices as possible.

 

# Help us build POCUS25 here
1 Deep Vein Thrombosis (DVT)—Lower extremity 2 zone compression test using B-mode only—saphenofemoral junction region and popliteal
2 Focused Cardiac Ultrasound (FoCUS)*—PLAX, PSAX, A4C, A4C—ASE recommendation
3 Gross estimation of LV and RV systolic function—EPSS, contractility of LV and RV extremes of volume status
4 Pericardial effusion and cardiac tamponade detection and differentiation from pleural effusion, assess IVC to support cardiac tamponade findings
5 Extremes of volume status—hypovolemia and hypervolemia using IVC diameter and response to respiration and LV cavity diameter
6 Detection of chronic heart disease (LVH—symmetrical and asymmetrical LVH, RVH and LAE)
7 Normal lung ultrasound—A-lines, etc., lung sliding, lung edge, pleura and rib shadows, pneumonia/consolidation, air bronchogram, dynamic air bronchogram, spine sign
8 Pneumothorax—B-mode and M-mode
9 Pneumonia/consolidation, air bronchogram, dynamic air bronchogram, spine sign, pleural effusion, simple effusion, complex loculated effusion, anechoic and hyperechoic effusion
10 Protocol—EFAST exam
11 Detection of fracture of long bones on B-mode/2D ultrasound or cortical disruption of bones example: rib fracture
12 Knee ultrasound—basic views and detection of knee effusion, ultrasound-guided knee injection and aspiration, anisotropy artifact
13 Liver ultrasound—liver span in the right mid-clavicular plane, fatty liver, liver cyst, liver mass detection, liver abscess
14 Gallbladder ultrasound—gallstones, SIN sign, gallbladder mass, acute cholecystitis and chronic cholecystitis and gangrenous cholecystitis, ultrasound Murphy’s sign, CBD diameter measurement and gross detection of CBD dilatation
15 Pancreas ultrasound, detection of pancreatitis, pancreatic mass, obstruction of CBD by a mass in the region of the head of pancreas or CBD calculus
16 Spleen ultrasound, spleen span measurement, detection of splenic mass and peri splenic fluid
17 AAA screening, technique to measure diameter of abdominal aorta and aortic aneurysm, aortic aneurysm detection, thrombus in an aortic aneurysm and aortic dissection
18 IVC assessment for approximate CVP and volume status
19 KUB ultrasound, renal length measurement, renal calculi, hydronephrosis detection and grading, renal mass, ureteric obstruction, bladder volume, bladder mass
20 Basic practical ultrasound physics and knobology. Modes of ultrasound—B-mode/2D mode, M-mode, color Doppler, power Doppler, spectral Doppler, depth, gain, TGC/DGC, common artifacts
21 Skin and soft tissue ultrasound—normal appearance, edema, cellulitis, abscess
22 Basic female pelvic exam (TAS)—uterus, cervix, ovaries, adnexa, pouch of Douglas/cul de sac
23 Transabdominal female pelvic exam—adnexal mass, ovarian cyst, free fluid in the POD, hydrosalpinx
24 Basic first trimester ultrasound (TAS)—fetal number, fetal cardiac activity, amniotic fluid, intrauterine and extrauterine pregnancy, molar pregnancy, low lying placenta or placenta previa. TVS recommended for ectopic pregnancy if not detectable by TAS
25 MSK—shoulder exam, basic view, ultrasound guided aspiration and injection, anisotropy artifact

POCUS25 FAQ's

POCUS stands for point-of-care ultrasound and the POCUS25 will be essentially be a core list of the top 25 point-of-care-ultrasound procedures or protocols that the POCUS community would recommend  based on their potential significance to improve global health. This is intended for everyone interested in using, learning about and implementing POCUS in their medical practices. The POCUS25 page is designed to evolve beyond just a list and become a “one-stop” resource for education and training of the top 25 ultrasound procedures or protocols that should be learned by individuals practicing POCUS or those considering adding point-of-care ultrasound to assist with patient care. Conceptually, the POCUS25 was inspired by the Stanford Medicine 25. The POCUS25 is designed to evolve with time to keep pace with ever-changing trends in technology and to always remain relevant. The POCUS25 supports the aim to promote POCUS to all healthcare providers.

Our vision is that the POCUS25 becomes the “one-stop” resource for healthcare providers around the world using handheld ultrasound. Everyone, who wants to learn or use point-of-care ultrasound will simply need to go to the POCUS25 website, where they will have everything available that they need to know. They have a question in mind, they have a patient and they are not so sure about it, they can go there and use it as an online reference guide. It is designed to solve all your POCUS problems or questions or queries that you might have around the core POCUS25 ultrasound procedures or protocols. Our vision is to collaborate with the global POCUS community to expand and build this resource which hopefully will help make healthcare better and help every patient that potentially could be scanned or have some clinical question answered using point-of-care ultrasound.

Healthcare practitioners who want to quickly evaluate a patient would benefit from the POCUS25—it could be a physician, a physician assistant, a nurse practitioner, or any healthcare worker who is evaluating or assessing a patient at the point-of-care setting, trying to clinically assess or manage a patient or even triage a patient. That means patient needing medical assistance could be on the roadside or a beach, in the hospital or a rescue helicopter, or even on a space station. The patient may be sick or have an injury. A point-of-care ultrasound exam could possibly help to assess the pathophysiological state of the patient or even help to simply answer a binary question. For example, does the patient have a cardiac tamponade? While a POCUS exam is not the answer for all clinical conditions, it is important that it should be diagnosable with diagnostic imaging ultrasound.

The decision to learn and become proficient in one, several or all of the POCUS25 varies based on each individual healthcare provider’s needs. For instance, if the physician, nurse practitioner or physician assistant is only seeing patients with cardiac problems then they may restrict their training to only cardiac POCUS. However, primary care physicians, who is primarily involved in obstetrics and gynecology, the POCUS25 OB/GYN section would be very relevant and recommended to master for the basic POCUS OB/GY evaluation. Yet, for those not seeing OB Gyn patients, then the Ob/Gyn ultrasound procedures within the P25 would not be of any help or little help for the individual’s practice but would still be a recommended core skill to have for future use.

The POCUS25 will be a living document that is intended to be a focal point of engagement for the POCUS community. Our goal is to provide an open forum for feedback on the POCUS25 and update it periodically based on the general consensus of this feedback. With that said, we envision that some items on the list will consistently remain among the most highly ranked on the POCUS25, while other procedures or protocols may be removed and replaced by new ones, or simply change in the rankings. Through ongoing research and consultation with POCUS users and POCUS-subject-matter experts (SMEs) around the world, the POCUS25 will continue to be refined.

The POCUS25 was created because there was a lack of clarity and uniformity in the global medical community as to what point-0f-care ultrasound is, how it is used and it’s future. For example, if you keep expanding the assessment of a patient’s heart with point-of-care ultrasound, you can go into the territory of a full echocardiography exam. There is a need for some clarity and definition because as individuals learn POCUS, there is really no clarity as to how much ultrasound procedure should be learned by the individuals within the scope of POCUS. We took this initiative to help define POCUS and bring clarity to the community as to what exactly should be in the basic POCUS25 curriculum. POCUS25 aims to become a guiding beacon for the entire global POCUS community. POCUS25 aims to bring more uniformity/standardization and more credibility to the POCUS movement.

This initial POCUS25 list was developed by the POCUS Certification Academy™ internal team of clinicians in consultation with about 20 subject matter experts in the field of diagnostic ultrasound. We also looked at published manuscripts, society guidelines and recommendations for precisely what should be included on the initial list. The process for the broader community to provide feedback and consultation is now open. Our goal is to continue to refine the current list and publish a consensus document before the end of 2019 with the voices of all those that participate in the process.

We reviewed published research, manuscripts, society guidelines and recommendations for point-of-care ultrasound. We also took in consideration feedback from subject matter experts in the field of diagnostic ultrasound and point-of-care ultrasound. We provide these references to validate our process and to give credit to those upon whose knowledge and expertise the POCUS25 was developed. POCUS25 will evolve and we will continue to edit the POCUS25 list as get feedback from experts in the field of POCUS.

Below are initial references used:

 

References:

1) Focused Cardiac Ultrasound: Recommendations from the American Society of Echocardiography Kirk T. Spencer, MD, FASE, Bruce J. Kimura, MD, Claudia E. Korcarz, DVM, RDCS, FASE, Patricia A. Pellikka, MD, FASE, Peter S. Rahko, MD, FASE, and Robert J. Siegel, MD, FASE, Chicago, Illinois; San Diego and Los Angeles, California; Madison, Wisconsin; Rochester, Minnesota (J Am Soc Echocardiography 2013; 26:567-81.)

2) Ma IWY, Arishenkoff S, Wiseman J, Desy J, Ailon J, Martin L, Otremba M, Halman S, Willemot P, Blouw M, Canadian Internal Medicine Ultrasound (CIMUS) Group (2017) Internal medicine point-of-care ultrasound curriculum: consensus recommendations from the Canadian internal medicine ultrasound (CIMUS) group. J Gen Intern Med 32(9):10527

3) Hoppmann RA, Rao VV, Bell F, et al. The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience. Critical Ultrasound Journal. 2015; 7:18

4) Schnobrich DJ, Gladding S, Olsen AP, Duran-Nelson A (2013) Point-of- Care ultrasound in internal medicine: a national survey of educational leadership. J Grad Med Educ. 5(3):498–502

5)  American College of Emergency Physicians (2017) Ultrasound guidelines: emergency, point-of-care and clinical ultrasound guidelines in medicine. Ann Emergency Med 69(5): e27–e54

6) Klem DJ, Ratelle JT, Azeem N, Bonnes SL, Halvorsen AJ, Oxentenko AS et al (2015) Longitudinal ultrasound curriculum improves long- term retention among internal medicine residents. J Grad Med Educ. 7(3):454–457

7) Kimura BJ, Amundson SA, Phan JN, Agan DL, Shaw DJ (2012) Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination. J Hosp Med. 7(7):537–542  https://caep.ca/wp-content/uploads/2018/11/CAEP-PoCUS-Position-Statement-Full-Text-2018-V7-draft.pdf

8) Recommendations for the Use of Point-of-Care, Ultrasound (PoCUS) by Emergency Physicians in Canada David Lewis, MBBS; Louise Rang, MD; Daniel Kim, MD; Laurie Robichaud, MD; Charisse Kwan, MD; Chau Pham, MD; Allan Shefrin, MD; Brandon Ritcey, MD; Paul Atkinson, MBBChBAO, MA; Michael Woo, MD; Tomislav Jelic, MD; Genevieve Dallaire, MD; Ryan Henneberry, MD; Joel Turner, MD; Rafiq Andani, MBBS; Roisin Demsey, MD; Paul Olszynski, MD, MEd

The POCUS25 will be further refined and improved through collecting the opinions and feedback of experts in the field of ultrasound and point-of-care ultrasound. After compiling this initial list with a first review of manuscripts and consultations with 20 subject matter experts in POCUS, the next step is to solicit feedback of the much broader audience via a survey. This will involve us reaching out to thousands of POCUS experts and users, including physicians, POCUS users, nurse practitioners, sonographers, and other healthcare professionals actively using point-of-care-ultrasound. Based on the feedback, we will publish a white paper with the updated POCUS25 list. The POCUS community movement is still in its infancy and is predicated to further develop and grow over the coming years.

First, we would appreciate it if you took a few minutes to complete the POCUS25 survey.

Everyone is encouraged and welcomed to the POCUS Certification Academy community and to contribute to the POCUS25 movement. We ask you to share your feedback and provide comments to our team and/or donate POCUS videos and cases with positive findings and even normal videos or pictures for us to share with the POCUS community. Additionally, we would like to acknowledge each individual’s contribution, so that anyone providing feedback and wants to be cited on the movement will have their name added to the POCUS25 reference list as a contributor. Please feel free to contact our POCUS25 team at POCUS@apca.org.

POCUS25

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