Point-of-Care Ultrasound in the Inpatient Setting: A Tale of Four Patients

Renee K. Dversdal, MD; KevinM. Piro, MD; Charles M. LoPresti, MD; Noelle M. Northcutt, MD; Daniel J. Schnobrich, MD

Disclosures

South Med J. 2018;111(7):382-388. 

In This Article

Abstract and Introduction

Abstract

Point of-care ultrasound (POCUS) has become a mainstream bedside tool for clinicians in several specialties and is gaining recognition in hospital medicine. There are many clinical applications in which the inpatient practitioner can use POCUS to improve his or her diagnosis, monitoring, and treatment of patients. POCUS is valuable in many clinical scenarios, including acute renal failure, increasing lower extremity edema, change in inpatient clinical status, and acute dyspnea. The medical literature has demonstrated the ability of nonradiologists to accurately detect conditions, including hydronephrosis; extremes of central venous pressure; deep venous thrombosis; pericardial effusion with tamponade; and several pulmonary pathologic states, including pulmonary edema, pleural effusion, consolidation, and pneumothorax. Further development of POCUS in hospital medicine is highly likely given increased awareness and exposure among medical trainees, a developing literature base, and growing engagement from specialty societies.

Introduction

Point-of-care ultrasound (also known as POCUS, bedside US, handheld US, and pocket-sized US) is emerging as a powerful tool for the bedside examination of hospitalized patients. With POCUS, the hospitalist determines a focused question, obtains and interprets appropriate images, and immediately integrates them into management during the bedside patient encounter. POCUS provides the hospitalist with information that is not available from the traditional history and physical examination, often with sensitivity and specificity that exceed the physical examination and roentgenography.[1] In our experience, US helps the physician return to the bedside, involves physical contact with patients, and allows increased decision making to occur with patient involvement, in contrast to the often computer-centered workflow of the modern hospitalist.

POCUS became a mainstream application in emergency medicine in the 1990s and 2000s, critical care in the 2000s and 2010s, and is now emerging in hospital medicine. Hospitalists increasingly are using this tool clinically while also working to confirm and translate the research base, educational methods, and quality assurance infrastructures from these disciplines.[2] Internal medicine (IM) professional societies have begun to engage in the development of guidelines[3] and other infrastructures that are important to ensure high-quality use. Concomitantly, there has been a swelling of enthusiasm among IM trainees and educators, with numerous IM training programs teaching POCUS skills, and many more reporting plans to begin training.[4–7]

This article, based on our case histories, demonstrates the application of POCUS to four common clinical situations encountered by hospital-based physicians and reviews the literature supporting these uses. Challenges and necessities to expand high-quality use also are discussed.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....