Point-of-Care Ultrasound (POCUS) has gained a strong foothold in point-of-care delivery. Its increasing appeal in critical care and other emergency settings lies in it being a rapid, safe, accurate, and highly accessible diagnostic tool. It has had far-reaching implications so far in diagnostics and therapy and is expected to make deeper inroads in healthcare in the coming years.
Here we discuss the broad meaning of point-of-care ultrasound, the role it has adopted in urgent care, its increasing range of applications, and evolving trends.
What is Point-of-Care Ultrasound?
Point-of-care ultrasound represents the use of ultrasound machines for diagnostic and therapeutic applications, wherever the patient is located, for instance, at the bedside, in an ambulance, hospital emergency room, or in remote locations such as, villages or distant towns.
Role of Point-of-Care Ultrasound in Emergency
Point-of-care ultrasound enables quick and accurate diagnoses of medical conditions in emergency settings, resulting in immediate treatment decisions and initiation of therapy. Making diagnostic and therapeutic applications available to critically ill, injured, or immobile patients, no matter where they are, is crucial in saving lives.
This is primarily because removing patients from closely monitored settings or even causing them any type of movement can be not only discomforting but also risky in some cases. POCUS preempts the need to visit another imaging facility or to wait for reports, further reducing the time to action. Furthermore, using other imaging modalities such as radiology would subject critically ill patients to harmful ionizing rays and/or intravenous contrast agents, which is certainly not advisable. Thus, POCUS has proven to be comparatively more viable at point-of-care locations than its counterparts.
Point-of-care ultrasound has revolutionized overall patient care, especially in emergency settings, positively impacting operational efficiencies and patient outcomes by reducing pain and suffering. It’s used in various scenarios ranging from monitoring therapy in an intensive care unit and ruling out pathological findings in emergency rooms to examining patients in the trauma bay or simply narrowing the differential diagnosis in patient evaluation.
Furthermore, as rapid advancements in ultrasound technology lead to improved image quality, higher accuracy, increasingly smaller and portable devices, faster scanning, ease of use, and improved workflow, point-of-care ultrasound machines will also experience more progress, further improving patient satisfaction.
Next, we look at how POCUS has shaped delivery in urgent care.
POCUS in Urgent Care
Use of point-of-care ultrasound in urgent care wasn’t common previously. However, availability of increasingly portable and cheaper devices is leading to increased adoption of point-of-care ultrasound machines in urgent care. Most importantly, accurate and faster diagnoses significantly reduce mortality and morbidity in critically ill patients, leading to increased patient satisfaction.
Examples of POCUS in Urgent Care
- In urgent care, POCUS can possibly extend the physical exam, expanding assessment of the urgent care patient. It can cater to the high-acuity patient population in urgent care, allowing screening of complex comorbidities, among other things.
- For instance, the hand-held scanner has been useful in examining shortness of breath, pneumothorax, and pleural effusion.
- Point-of-care ultrasound has been useful in detecting musculoskeletal abnormalities too. For instance, acutely injured patients and even children are unable to lend themselves to physical exams, making ultrasound more suitable. Ultrasound is not only non-invasive and free of harmful ionization, but it also allows a gentler evaluation of tender joints. Therefore, ultrasound is particularly useful in evaluating and closely examining suspected fractures in children and critically ill patients.
- It has shown improved outcomes of diagnostic homonyms such as asthmatic bronchitis vs. cardiac asthma.
- It is also said to have improved therapeutic interventions like joint injections and abscess drainage.
- It helps in the diagnoses of pneumothorax and urinary retention. Being extremely convenient, accurate, and fast, POCUS provides speedy diagnosis, enabling prompt treatment of urinary retention, thereby avoiding unnecessary embarrassment to patients.
The accuracy and quality of ultrasound testing are superior to those of traditional physical exams. In a study conducted by Colli A et. al., it was found that POCUS use can increase sensitivity and specificity values to 96% and 97% respectively, with a positive likelihood ratio of 32. This is in comparison to sensitivity and specificity of 65-70% of a physical exam to detect Deep Vein Thrombosis (DVT).
The increasing popularity of point-of-care ultrasound in urgent care is also due to the operational ease of the technology. There is a range of POCUS hand-held and laptop-based devices available in the market today, with varying degrees of portability and resolution, catering to different needs and budgets. Advances in technology may broaden the range of available choices of portable ultrasound devices for institutes and private practice.
Other POCUS Applications
Point-of-care ultrasound has become so paramount in emergency care that it has been described as the “third hand of emergency physicians and surgeons”. POCUS can be used in combination with a physical examination for further investigation of unclear findings, such as, the presence or absence of specific pathological results in patients.
As point-of-care ultrasound continues to be used in all scenarios that require better and faster decisions concerning further tests and/or treatment choices in clinical settings, its scope increases.
Ultrasound is useful in the resuscitation process to identify some of the following conditions:
- Pulmonary embolism – Echocardiography can be used to detect abnormalities of the right side of the heart.
- Hypothermia – Echocardiography may be used in combination with ultrasound with Doppler to evaluate peripheral blood flow or cardiac output
- Haemoperitoneum, Haemo- or Pneumothorax and Cardiac Tamponade
- Hypovolemia – Used as an additional diagnostic test for hypovolemic cardiac arrest
Symptom or Sign-Based
Ultrasound can be used to conduct further investigation in case of symptoms like shortness of breath, swelling, pain, and many others.
Ultrasound has achieved an indispensable role in guiding complex medical procedures in the emergency department so as to minimize complications. Some procedures which are assisted by ultrasound are:
- Foreign Body Removal
- Lumbar Puncture
- Thoracentesis, Paracentesis, and Pericardiocentesis
- Joint Aspiration
- Regional Anesthesia
- Placement of Temporary Pacemaker
Ultrasound use in central venous catheter insertion is now established as the standard of care.
Therapeutic and Monitoring
Point-of-care ultrasound finds broad applications in therapeutic care and monitoring of patients, based on the ultrasound category. An example of therapeutic application in critical care is physiotherapy for accident victims. Monitoring applications include monitoring of patients in the intensive care unit or in an operating room for patient safety.
The basic cardiac ultrasound is conducted to examine patients that show signs of hypotension, dyspnea, possible pericardial effusion, cardiac arrest, cardiac trauma, and chest pain.
It aims to ascertain whether there is cardiac activity, pericardial effusion or signs of tamponade, or right ventricle strain. In the case of right ventricle train, it’s used to detect or rule out pulmonary embolism. Cardiac ultrasound can also be used to examine the global left ventricular systolic function.
Abdominal ultrasound is used to test patients in emergency departments for abdominal, flank, or back pain. It is crucial to conduct an abdominal ultrasound in such cases to detect or rule out abdominal aortic aneurysm (AAA). Other uses of the abdominal ultrasound include evaluation of urinary tract abnormalities like kidney cysts, kidney stones, bladder fullness, and overflow incontinence. It is also used to assess the diameter and size of the spleen and size, shape, and contents of the gallbladder and common bile duct.
Lung and Thorax
The lung and thorax ultrasound are used to examine patients with undifferentiated chest pain, shortness of breath, or respiratory distress. Lung ultrasound is used to detect pneumothorax, pleural effusion, and pulmonary edema. Ultrasound is shown to be superior to say, a chest radiography as it has a higher sensitivity, providing more accuracy.
Skin and soft tissue are common types of infection in the emergency department. And ultrasound scores over physical examinations in order to differentiate between different infections like cellulitis, abscess, and necrotizing fasciitis, among others. Soft tissues are easily visible with ultrasound technology and a soft tissue ultrasound is one of the easiest exams to conduct.
Point-of-care ultrasound is used to diagnose musculoskeletal complaints, which are very common in the emergency department. Some examples include diagnoses of joint effusion, long bone fractures, tendon injury, retained foreign body, and masses and free fluid around joints.
POCUS is also increasingly being used for examining a common cause of acute abdomen – small bowel obstruction. POCUS is preferred over other imaging modalities such as, abdominal X-ray and CT with contrast, which has a high radiation and cost.
Ocular emergencies in the emergency department range from simple eye infections like conjunctivitis to serious diseases that can rob a patient’s eyesight. However, limited equipment, lack of physician training, and unavailability of ophthalmology consultation in many settings, make rapid diagnoses difficult. Therefore, ocular ultrasound can prove to be of immense help in diagnosing eye conditions like retinal detachment, vitreous hemorrhage/detachment, globe rupture, and lens dislocation.
Point-of-Care Ultrasound – Future Trends
Ultrasound machine trends have naturally mirrored an increasing demand for smaller, cheaper, and increasingly portable devices that will widen the scope of POCUS applications. Consequently, the demand for trained ultrasound technicians will increase to fulfill the growing use of point-of-care ultrasound. The expected increase in scope is also attributed to a burgeoning population of senior citizens who will need point-of-care delivery.
According to the World Population Prospects: 2017 Revision, the number of persons aged 60 or above is expected to more than double by 2050, rising from 962 million globally in 2017 to 2.1 billion in 2050. And the diagnostic devices segment that held more than 65% revenue share in 2018 is estimated to grow at a significant rate by 2025. These statistics show that point-of-care ultrasound is poised to grow worldwide in the near future.
To help equip your institute or private practice with the latest ultrasound technology, National Ultrasound offers an extensive lineup of new and used ultrasound equipment from major manufacturers. Contact a National Ultrasound professional today by clicking the “Get a Quick Quote” button at the top of this page for a customized quote on our portable ultrasounds or any of our other products and services.
 Frazzetta G, Faraci C, Mancuso SI, Fragati G, Di Giovani S, Costanzo L. Emergency Ultrasound in Critical Patients: The “Bedside Ultrasonography” as the “Third Hand” of Emergency Surgeon. Austin J Emergency & Crit Care Med 2015;2:1-4