PEARLS for an Ultrasound Physical and Its Routine Use as Part of the Clinical Examination

Michael Wagner, MD; Janice Boughton, MD

Disclosures

South Med J. 2018;111(7):389-394. 

In This Article

Abstract and Introduction

Abstract

At present, there is no consensus on what a routine examination that uses ultrasound (US) should look like. Point-of-care US (POCUS) is poised to be as important a clinical skill as palpation and auscultation; however, the expansive list of potential applications can be intimidating to the beginner. In this article we propose using a PEARLS (Parasternal, Epigastric, Anterior Lung [and/or Apical], Right upper quadrant, Left upper quadrant, and Suprapubic) mnemonic as an approach to a core physical examination augmented with POCUS for routine use. Numerous US protocols for trauma, shock, and respiratory failure have been published, and it is no coincidence that many have evolved overlapping views. These views have numerous uses and applications and should not be confined to only critically ill patients. The PEARLS examination is for both primary care and inpatient settings and is scalable for POCUS beginners and advanced users. From the generalist's perspective, we describe our philosophy on the initial foundation and provide a framework to grow one's POCUS skills.

Introduction

Since the 1980s clinicians have been using ultrasound (US) to enhance their bedside examinations in caring for their sickest patients, first in trauma bays and emergency departments, and then in critical care units. A number of conditions that are difficult to detect using traditional examination techniques are diagnosed readily with pocket-sized US devices at the bedside. With an expanding list of applications from head to toe and numerous US protocols for different clinical scenarios, the use of point-of-care US (POCUS) is poised to be as important a clinical skill as palpation and auscultation.[1] At present, there is no consensus on what a routine examination with US should look like, although numerous publications and protocols have laid the groundwork for its design (Figure 1).[2–18]

Figure 1.

Timeline of selected publications highlighting the history and evolution of POCUS protocols andmultisystem ultrasound examinations. FAST, Focused Assessment with Sonography for Trauma. ATLS, Advanced Trauma Life Support; PEARLS, Parasternal, Epigastric, Anterior Lung (and/or Apical), Right upper quadrant, Left upper quadrant, and Suprapubic.

In this article, using a PEARLS (Parasternal, Epigastric, Anterior Lung, [and/or Apical], Right upper quadrant, Left upper quadrant, and Suprapubic) mnemonic, we describe our approach to a core physical examination augmented with POCUS for routine use by the generalist in both hospital and primary care settings.

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