Point-of-Care Ultrasound

Point-of-care ultrasonography improves healthcare. While traditional methods of performing a physical examination are of critical importance, healthcare practitioners that become skilled in the use of point-of-care ultrasonography become uniquely empowered to better care for patients. Point-of-care ultrasound has been proven to improve patient outcomes and experiences including, but not limited to: Providing faster diagnosis of time-sensitive critical conditions (e.g., leaking AAA, ruptured ectopic pregnancy), Minimizing delays in care (e.g., time to IV antibiotic administration due to lack of IV access), Diminishing procedural complications (e.g., iatrogenic pneumothorax following CVL placement or thoracentesis).

Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. POCUS confirmation of intrauterine pregnancy rules out an ectopic pregnancy. In the third trimester of high-risk pregnancies, umbilical artery Doppler ultrasonography can improve perinatal outcomes. Musculoskeletal POCUS is used to diagnose and guide treatment of many joint and soft tissue conditions. It is as accurate as magnetic resonance imaging in the diagnosis of complete rotator cuff tears. Ultrasound guidance improves outcomes in the placement of central venous catheters and fluid drainage from body cavities and lumbar punctures. Ultrasonography can reduce the use of CT for diagnosis of appendicitis; however, negative scan results do not rule out disease. POCUS can accurately diagnose and rule out gallbladder pathology, and is effective for diagnosing urolithiasis. Focused cardiac ultrasonography can detect pericardial effusion and decreased systolic function, but is less accurate than lung ultrasonography at diagnosing acute heart failure. Limited evidence demonstrates a benefit of diagnosing testicular and gynecologic conditions. Point-of-care ultrasonography (POCUS) is an evolving outpatient, inpatient, and urgent care diagnostic tool. Diagnostic timing decreases, and accuracy increases when POCUS augments the clinical examination and procedures. The use of POCUS in primary care is increasing because it reduces cost, radiation exposure, and imaging delays, and increases patient satisfaction.