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Point-of-Care Ultrasound (PoCUS)

Image - Photo of Stephen C. Haskins, MD
Stephen C. Haskins, MD

Assistant Attending Anesthesiologist, Hospital for Special Surgery
Clinical Assistant Professor of Anesthesiology, Weill Cornell Medical College

Point-of-care ultrasound (PoCUS) is the practice of using ultrasound technology to assess patients at the bedside. It has been shown to be beneficial in many clinical settings, including before, during and after surgery. In the past, a physician’s bedside examination often only involved a stethoscope to hear what was going on inside. Now with ultrasound, anesthesiologists can see inside and visualize patients’ relevant anatomy.

Prior to surgery, when combined with other imaging technologies (including X-ray, CT scan and MRI), PoCUS allows anesthesiologists to more efficiently determine which patients can be safely taken directly to the operating room and which patients may need more extensive testing before undergoing an operation.

During and after surgery, anesthesiologists are using ultrasound to better assess internal structures such as the heart, lungs and blood vessels to determine how best to manage patients with major health issues. PoCUS can also be used to establish a patient’s baseline function of the heart or lungs to help anesthesiologists improve monitoring and management during or after surgery. If a patient becomes unstable in or around the surgical process, anesthesiologists can use PoCUS to identify and rule out specific causes of the instability. This makes the diagnosis and treatment of patients faster and more efficient in acute care settings like the operating room or post-anesthesia care unit (PACU).

Types of PoCUS Exams

There are several PoCUS examinations that help physicians assess different parts of the body. One type is focus assessed transthoracic echocardiography (FATE). Anesthesiologists trained in FATE can better evaluate patients who may have potentially life-threatening heart conditions or lung pathology. Another potential PoCUS application is to identify which patients who undergo hip arthroscopy may have an increased risk of pain after the procedure. In such cases, the anesthesiologist uses a focused assessment with sonography for trauma (FAST) exam to visualize fluids that have tracked out of the hip joint and into the abdomen.

PoCUS is rapidly becoming a powerful tool for patient assessment, management and care for the anesthesiologist. Due to the wide availability of ultrasound machines, as well as the regular use of ultrasound for medical procedures in anesthesia, point-of-care ultrasound is poised to become a common medical practice for anesthesiologists and critical care physicians in the near future.

 

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