Point Of Care UltrasoundDaniel Nash CRNA DNAP

The point of care use of Ultrasound by a clinician as a diagnostic or procedural

tool to

assist in the evaluation and management of patients.

POCUS

Characteristics of POCUS exam

• Well-defined purpose for improved patient outcomes

• Focused and goal oriented

• Findings are easily recognizable

• Easily learned

• Quickly performed

• Performed at bedside-clinic, ER, Pre-op etc.

POCUS has the ability to save BILLIONS of dollars on an annual basis

“Stethoscope of the future”

Healthcare providers, facilities, and health systems that strategically incorporate POCUS

Into clinical practice will rapidly distinguish themselves from those who refrain from

Incorporating this HIGHLY VALUABLE MODALITY

Utilization for Assessment

Cardiac• LV/RV function

• Volume status

• Wall motion abnormalities

• Valvular function

• Pericardial effusion

• Cardiac tamponade

Pulmonary• Interstitial fluid “Pulmonary Edema”

• Pleural effusion

• Pneumothorax• CXR sensitivity 76%

• US sensitivity 95-100%

• Lung consolidation “pneumonia”

• Lung mass

Abdominal• Aortic aneurysm

• Liver mass or bleeding

• Gallbladder size and contents

• Volume status-Vena Cava size

• Kidney-stones

• Spleen

DVT assessment

Emergency – eFAST (extended Focused

Sonography with Ultrasound in Trauma)

• Trauma

• Pneumo thorax

• Free fluid-bleeding

• Liver and spleen damage

• Bladder

• Cardiac function and volume

Gastric Evaluation• Volume

• Differentiate solid vs liquids

• Trauma

Cardiac• LV/RV function

• Volume status

• Wall motion abnormalities

• Valvular function

• Pericardial effusion

• Cardiac tamponade

Parasternal Long Axis

Parasternal Long Axis

Parasternal Short Axis

Parasternal Short Axis

Apical

Apical

Subcostal

Subcostal

Pulmonary• Interstitial fluid “Pulmonary Edema”

• Pleural effusion

• Pneumothorax

• Lung consolidation “pneumonia”

• Lung mass

Walk probe laterally along chest

Until Diaphragm reached

Sliding Lung Sign

Seashore Pattern

Power/Color

Doppler

Normal Edema

Abdominal• Aortic aneurysm

• Liver mass or bleeding

• Gallbladder size and contents

• Volume status-Vena Cava size

• Kidney-stones

• Spleen

Abdominal Aortic Aneurysm

Gallbladder

Cystic Duct

Subcostal IVC

Left Upper Quadrant

Emergency – eFAST (extended Focused

Sonography with Ultrasound in Trauma)

• Trauma

• Pneumo thorax

• Free fluid-bleeding

• Liver and spleen damage

• Bladder

• Cardiac function and volume

103 PE per hour in USA!!!SonoSim Module on DVT

Gastric Content Assessment

Hypoechoic Liquid Volume

Hyperechoic Solid Food Volume

How should we all learn this new Assessment

Strategy ???

????

• POCUS involves the bedside use of US to answer specific diagnostic

questions and to asses real-time physiologic responses to treatment.

• Benefits to POCUS include improving sensitivity and specificity of the

physical examination to help guide treatment.

• We support its incorporation into anesthesiology curricula and training

programs and the continuing professional development of POCUS

related activities at a national level.

• Most curricula have in common, a step wise approach that consists of a

foundation of knowledge and skills and competency building through

practice.

• A significant variety of didactic modalities have been described, and on-

line learning and simulation offer clear advantages.

• What constitutes the minimum number of studies necessary to achieve

competence is still debated as are the most appropriate tools to assess

competence.

While duty-hour restrictions have reduced the amount of time available

for educators to teach and the sheer volume of material and information

we expect our students and residents to master has increased,

effective, time-efficient education represents a daunting charge to those

in medical education. Prober and Heath suggest that we must find ways

to “make our lessons stickier” and introduce the concept of the flipped

classroom as a preferred approach.

The “flipped classroom” is a novel approach to learning where

students watch lectures online and at their own pace, typically at

home. Class is then reserved for active learning exercises and

interactive activities, which illustrate important

concepts.

• Conclusion: We were unable to demonstrate the achievement of

competence in POCUS of medical learners engaged in our combined

self-directed and simulation-based training program

• Feedback from faculty, curriculum integration and alignment with clinical

experience may be beneficial.

What to look for in a training program

• Online content and Skills lab combination-Flipped classroom

• Step by step: knowledge-skills-practice