How POCUS Can Make You Look Like A Superstar On Your Clinical Rotations!

Did you know that point-of-care ultrasound (POCUS) can be performed quickly at your patient’s bedside? Performing a point-of-care ultrasound can provide you with important information you can use to help your patients. When you are on your clinical rotations, here are some cool POCUS tips and tricks that you can utilize to help your patient and your clinical team.

 

1. Is your patient a tough stick? Is everyone having a hard time getting vascular access? Use POCUS to help guide peripheral IV placement. Watch your needle enter the vessel in real-time using ultrasound guidance. Use ultrasound guidance to avoid puncturing through the back wall of the vessel and “blowing the vein.”

 

2. Does your patient have an area of redness or warmth that may be concerning for an infection? Perform a soft tissue POCUS to determine if the patient has cellulitis vs. a phlegmon or an abscess that requires drainage. Ultrasound can help you determine if an abscess is present, how deep it extends, and if there are any loculations present.

 

3. Does your female patient have abdominal pain? Perform a POCUS of her abdomen and pelvis to evaluate for intra-abdominal free fluid or pregnancy. You will know within seconds if your patient is pregnant or not and how you should tailor her management plan.

 

4. Does your patient have abdominal pain and a history of hypertension or hypercholesterolemia? Perform a POCUS to assess their abdominal aorta. Look for aneurysmal dilatation of the aorta (AAA) or the bright, white echogenic intraluminal flap that may be an aortic dissection. Don’t miss this ticking time bomb in your patients who present with abdominal pain!

 

5.  Did your patient have traumatic injuries to their abdomen? Perform a bedside FAST exam (focused assessment with sonography for trauma) and look for black, hypoechoic free fluid in the patient’s abdomen or around their heart. You can diagnose an intra-abdominal hemorrhage and a pericardial effusion at the patient’s bedside and initiate definitive treatment immediately.

 

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Image: Courtesy of Dr. Teresa Wu

 

6. Did your patient suffer thoracic trauma as well? Add thoracic views to your point-of-care ultrasound and you now have an EFAST scan (extended focused assessment with sonography for trauma). Scan through the patient’s chest to see if he/she has a hemothorax or pneumothorax. Often times, you can get the diagnosis before a chest-ray has been shot.

 

7. Are you giving your patient IV fluids? Assess their IVC with POCUS and determine if they require intravascular volume resuscitation. Patient’s who are intravascularly depleted will have an IVC that collapses >50% with inspiration.

 

8. Do you see a plump and distended IVC with walls that don’t move much with respirations? Think about volume overload, or downstream obstruction (i.e. cardiac tamponade, large pulmonary embolism, increased intra-thoracic pressures, etc.) Correlate your IVC findings with a POCUS of the heart and thorax.

 

9. Does your patient need a bedside procedure? POCUS can be used to guide multiple procedures including, but not limited to, central venous access, paracentesis, thoracentesis, lumbar puncture, abscess drainage, arthrocentesis, joint injections, etc.

 

10. Is your patient coding? Perform a CORE Scan (concentrated overview of resuscitative efforts) to help you figure out what is causing the patient’s deterioration. The CORE scan can help guide your resuscitation and save a patient’s life.

 

To learn more about how to perform Point-of-Care Ultrasounds in your clinical practice, check out the mobile app SonoSupport at www.SonoSupport.com. Use your POCUS powers to make you the best doctor you can be! Follow me on Twitter at @TeresaWuMD for more educational pearls and pitfalls.

 

Featured Image: Courtesy of Dr. Teresa Wu

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Teresa Wu, MD

Dr. Teresa Wu is a graduate of the Johns Hopkins School of Medicine and completed her Emergency Medicine residency at Stanford University. She completed both ultrasound and administrative & simulation fellowships at Stanford University following completion of her residency training. She is currently the Simulation Curriculum Director and an Associate Professor in Emergency Medicine at the University of Arizona, College of Medicine-Phoenix. Dr. Wu also works as an emergency medicine physician and is the Director of Emergency Ultrasound & Fellowships for the Banner University Medical Center-Phoenix. Over her career, Dr. Wu has developed and directed multiple ultrasound and simulation fellowships across the country, and she has served as an honored keynote speaker for numerous international conferences. Dr. Wu’s innovative research and publications have lead to advances in medical simulation, education, and emergency ultrasound. Her point of care ultrasound app, SonoSupport, has been used to develop ultrasound education and curricula throughout the world.