Point-of-care ultrasound in internal and emergency medicine: from basics to training and implementation
Creators: name: Grosgurin, Olivier
Publisher: name: Université de Genève
Year: 2021
Subjects: info:eu-repo/classification/ddc/616
info:eu-repo/classification/ddc/617
Point of care Ultrasound
Bedside Ultrasonography

description: Growing doubts regarding history and physician examination (HPE) value, coupled with recent advances in ultrasound technology and miniaturization offered conditions promoting the gradual advent of point of care ultrasound (POCUS). POCUS is meant to answer specific, basic and usually binary clinical questions to address specific hypotheses in a timely manner in order to immediately guide treatment and/or orientation at bedside. In internal and emergency medicine, POCUS is used for simple diagnostic purposes. Indeed, in complement to HPE, POCUS allows identification of cardiac, pleuro-pulmonary, abdominal and vessel abnormalities leading to a straightforward diagnosis. In addition, multimodal POCUS examination is performed in acute distress syndromes (e.g. acute respiratory and/or circulatory failure, cardiac arrest, multiple trauma) where it narrows differential diagnosis and shortens time to diagnosis and/or treatment according to recent evidence. Moreover, insertion of POCUS guided central and peripheral venous catheters has been extensively proven to be safer than historical non US guided procedures. Other semi-invasive procedures such as ascites and pleural fluid punctures, and more recently lumbar puncture have also shown to be safer with US guidance. The added clinical value of POCUS intimately depends on the quality of POCUS training and implementation. Usual training structure comprises three distinct steps: POCUS initiation, POCUS practical training and POCUS certification. POCUS initiation consists in theory acquisition through didactic lessons or growing more efficient Web-based content and practical ultrasound “hands on” sessions (healthy volunteers and/or patients), aiming at proper image acquisition. This initiation should be as early and as accessible as possible, automatically integrated in regular Emergency Medicine and Internal Medicine postgraduate education. POCUS supervised practical training follows; it is very demanding for trainers and trainees, but stands as a determinant factor to concretely build competency and to rigorously anchor POCUS in bedside evaluation. Successful POCUS implementation needs overt and regularly repeated clarification of its scope of practice, thus offering a delineated frame of practice to its users and a reassuring message to other institutional ultrasound providers. Besides that, current developments towards improved device simplicity and maneuverability contribute to POCUS efficient implementation. In addition, it is crucial to rely on enough well-trained referents in the process of POCUS integration. They are essential to promote, teach and honestly assume POCUS activity. Material, teaching, supporting and supervising resources are progressively available to ground POCUS as an additional truly reliable pillar of HPE. Its humble though determined implementation, alongside HPE and other imaging procedures, should be supported without restriction.