Understanding point-of-care ultrasound basics

Point-of-care ultrasound (POCUS) can be used to aid diagnosis and the management of a patient's treatment plan. But when should POCUS be used and how? In this video, you'll learn about some common applications of POCUS and the one crucial thing you must know before performing it.

This video was taken from our POCUS Essentials course taught by Viveta Lobo, MD who is an attending emergency medicine physician and Associate Director, Emergency Ultrasound Fellowship at Stanford University Medical Center in California, USA.

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[00:00:00] In 1824, a new medical technology had emerged and it was getting a lot of mixed attention and apprehension. This was a quote that was directly said about it—like most new technology, there is a risk that new practitioners will make mistakes based on their erroneous interpretations. This technology, therefore, must be restricted. What do you think they were talking about? That's

[00:00:30] right. If you guessed the stethoscope, you are correct. Just imagine that for a second. The stethoscope, the universal symbol of a physician. Most of my medical students show up on day one already having purchased their stethoscope. But fast forward almost 200 years and as history tends to repeat itself, we once again, have another new technology that has emerged and received very similar attention. That's right,

[00:01:00] the ultrasound machine. More specifically, point-of-care ultrasound, also known as bedside ultrasound, also known as emergency ultrasound. In 1943, Austrian brothers, Karl and Friedrich Dussik were the first to use ultrasound as a medical diagnostic tool when they attempted to locate brain tumors. Over five decades later, we now have sophisticated portable ultrasound machines with over

[00:01:30] 100 applications to diagnose and manage patients right at the bedside. So, what is POCUS or point-of-care ultrasound? It's basically an ultrasound exam that is performed by a physician at the bedside in real-time while assessing or managing your patient. You may perform it to help with the diagnosis, with the treatment plan or to even assess your treatment plan. Let's look at an example. If you had a shortness of breath patient show up,

[00:02:00] you may decide to use ultrasound at the bedside to look at their heart and you may diagnose a pericardial effusion. You may then decide to use your ultrasound to guide your pericardiocentesis procedure. You may then use it again to reassess if that pericardial effusion has now resolved. Now, one of the most fundamental concepts you have to understand before you begin to use point-of-care ultrasound is your focused question. So, what is a focused question? Your focused question is the

[00:02:30] question you want answered when you use your point-of-care ultrasound. Before you perform any application, you need to know what you are looking for. We're not radiologists. We do not perform general assessments of organs. You need to know what your question is before you're performing your scan. Let's look at some examples. If you're performing a renal scan, your focused question will be—is there hydronephrosis? If you're going to perform an ultrasound on the gallbladder,

[00:03:00] your focused question will be—are there gallstones? For an abdominal aorta, your question is—is there an aneurysm? In this course, we will review all of the basic and core point-of-care ultrasound content. Now, mind you, this is an ever-changing list. What's advanced today may be basic tomorrow. However, I will go through all the most commonly used applications for a wide range of specialties. Now, if you've never picked up an ultrasound probe, the first time you place it on a patient,

[00:03:30] this is probably the image you're going to see. A whole lot of nothing but don't worry, by taking this course and practicing your skills, you soon will be able to get an image that looks, like this. Now, you still may say that you don't see a whole lot but you will start to recognize that, here, you have a liver, here, you have a kidney, and here, there's a diaphragm.