Patient care is the reason many of us medical professionals dedicate ourselves to the field. We desire to see lives improved through the science and advancement of healthcare. We explicitly recognize that quality of life hinges on the extent of the well-being experienced in that individual’s life, and medicine houses the resources needed to improve it for all who have access to proper and sufficient care. It has been telling over the last decade that there is one technology quickly elevating the impact the medical field has on personal health, our communities, and the providers who are constantly expanding their toolbox.
Point-of-care ultrasound (POCUS) is changing the face of medicine and redefining patient’s expectations. This modality has entered the scene full force, implementing new requirements on behalf of those who seek the attention of healthcare professionals. The unique advantages of POCUS include rapid assessment of critically ill patients presenting a variety of symptoms, such as chest pain, shortness of breath, or undifferentiated hypotension. Due to this speed of diagnosis and its precise accuracy, POCUS is setting new patient standards, challenging us as providers each innovative step of the way.
There may be a few of us still uncertain and wondering if POCUS is truly worth the investment to learn and perfect. Could we actually see this pocket-sized device replace the stethoscope and become the go-to method for diagnosing and crafting a treatment plan for our patients? Is POCUS the future of medicine? Let’s consider a few cases in which POCUS does come to the rescue in ways other modalities do not.
Chest Pain (trauma)
One of the most powerful tools available to the physician of emergency department (ED) patients presenting chest and thoracic trauma is bedside POCUS. It is the very core of the focused assessment with sonography for trauma or FAST examination. This form of evaluation has proven to be highly accurate, decreasing the time it takes to manage and develop an appropriate patient care plan. In turn, it is improving mortality and neurologic outcomes.
One major challenge for ED physicians is tending to patients with a chief complaint of dyspnea. Traditionally the attending physician would obtain a thorough patient history, administer a physical examination, and conduct a chest radiograph, with the understanding that each has significant limitations. Receiving a sufficient history at times is affected by confusion, anxiety, and respiratory distress. The physical examination could be restricted by body habitus or respiratory effort. A portable machine and a radiologist are required to obtain a chest radiograph, which may delay achieving a prognosis.
POCUS eliminates these barriers for patients who suffer from dyspnea. It provides a faster and more accurate analysis of the patient’s condition while removing the limitations that can impede care. Clinicians receive immediate answers, empowering them to administer the most appropriate therapy more promptly. It is also repeatable to help demonstrate the improvement of the disease, and it’s also free of radiation.
Patients with symptoms of shock are in high-risk situations. They face a high chance of mortality, and the differentials are broad. Rapid diagnosis of the cause is paramount; however, restricted because of the failure to complete history and perform a physical examination. With POCUS, the healthcare provider can rule out several possible diagnoses immediately. Within minutes, vital information to identify various categories of shock is available and used to guide further treatment, order additional diagnostic imaging, and used for consultation.
POCUS evaluation of pelvic pain drastically reduces prognosis time and length of hospital stay. Due to this, ultrasonography is a primary diagnostic modality used to assess pelvic pain in the ED. For example, POCUS is used to rule out ectopic pregnancy in pregnant patients with pelvic pain. Having the ability to exclude ectopic pregnancy from consideration is a priority of early symptomatic pregnancy evaluation. Historically, physical examination findings are unreliable in making the diagnosis. POCUS has become one of the most dependable and safest ways to do so.
Cellulitis, abscesses, hematoma, and arthritis are examples of conditions that cause joint swelling and pain. Conducting a thorough evaluation and treatment helps to prevent complications and improve outcomes. However, a swollen, painful joint diagnosis is compounded because signs and symptoms aren’t sensitive or specific for identifying a joint effusion. Additionally, administering a physical examination is limited by pain, soft tissue swelling, and patient compliance.
Traditionally, aspiration is performed to determine a joint effusion that may subject patients to unnecessary invasive procedures if this is not the accurate underlying condition present. Additionally, aspirating small joint effusions with the blind technique is extremely difficult. The complication can lead to multiple attempts and potentially misdiagnosis.
Conducting a musculoskeletal ultrasound is a better alternative. It is a rapid and sensitive technique for detecting the presence of joint effusions. Once confirmed by imaging, the clinician can make informed decisions about the need for aspiration, decide if additional diagnostic imaging is needed, or choose to manage with other measures.
Real-time POCUS guidance has been beneficial for both the healthcare provider performing the procedure and the patient receiving it. It has been shown to increase the user’s confidence and decrease attempts, complications, and anesthetic used. Using POCUS for emergent procedures provides a faster prognosis and immediate feedback, improving clinical practice and the patient’s experience and care. Ideally, the patient’s overall satisfaction is improved along with their condition.
In each example provided, there’s no doubt that POCUS gives us the power to remove the limits set on time. Through this modality, we reach answers faster, remove the mystery by having access to see the internal anatomy more clearly, and most importantly, help our patients in ways we could not before. Medicine has been changed forever. POCUS completely redefines the accuracy of our work and the effectiveness of our ability.
Today is the day to consider this addition to our toolbox. POCUS is rewriting medical history as we speak. Let’s help author the story it is guiding us through. Learn more about POCUS training and education and the future this modality is creating for our field.