Author: February 25, 2022

Point-of-care ultrasonography (POCUS) is very a useful imaging technique for emergency medicine (EM) physicians. Comprehensive training in POCUS is presently a compulsory part of EM training in many parts of the world and is used extensively by some EM teams in many parts of Europe. Know more from Dr. Oscar John Ma.

Consultative ultrasonography vs POCUS:

Standard consultative ultrasonography requires the top-shelf EM physician to order the examination and to be dependent on the cardiologist or radiologist to perform it in a clinically relevant and timely manner.

In using POCUS, the EM physician performs all image acquisition and interpretation at the point of care and uses the information immediately to address specific hypotheses and to guide ongoing therapy. This requires that the EM physician has skill at image acquisition, image interpretation, and the cognitive elements required for immediate application of the results of the examination. The top-notch EM clinician has full knowledge of the case and is able to instant integrate the results of the POCUS examination into the management plan, whereas the traditional consultative model involves a delay in performance of the study, delay in its interpretation, and delay in transmission of the results to the clinical team. In addition, the cardiology or radiology consultant is not fully aware of the clinical facts of the case. The use of POCUS may be limited by time and staffing constraints in the busy emergency department. However, unlike the standard workflow of traditional consultative ultrasonography, the EM POCUS examination may be limited in scope and goal-directed; or, depending on the available time, clinical situation, and mainly the skill of the operator it may be as comprehensive as the standard consultative examination.

Scope of practice EM POCUS:

The EM physician is tasked and challenged with the primary evaluation and management of the patient with cardiopulmonary failure. Use of EM POCUS is an important tool in this process, just as it is for the intensivist who provides follow-through care. The EM physician and intensivist share the same skill set as defined in the American College of Chest Physicians/La Societe de Reanimation de Langue Francaise (ACCP/SRLF) Statement on Competence in extremely Critical Care Ultrasonography.

The only difference between the two specialties is that the intensivist uses CCUS for following management in the ICU, whereas the EM physician uses it for initial management in the emergency department. The key components of CCUS are discussed as follows.

Ultrasonography for procedure guidance:

Dr. O. John Ma explains that Ultrasonography is used by the EM physician for guidance of many varieties of procedures that are required for treatment of critical illness or routine management of the disease process. Ultrasonography increases the success rate and reduces the complication rate of a wide variety of procedures that are performed by EM physicians and intensivists, such as thoracentesis (both diagnostic and therapeutic requiring chest tube insertion), regional anesthesia, paracentesis, lumbar puncture, central venous catheter insertion (at all sites, difficult peripheral arterial and venous catheter insertion, incision and drain.

Conclusion:

Ultrasonography has become a fundamental part of EM more than the past two decades. Some aforementioned applications of ultrasonography are well established, confirmed, and practiced routinely, while more research is necessary to advance the use of ultrasonography in other areas.