Ultrasound imaging has been a staple of healthcare for decades, but as medical technology continues to evolve to meet patient needs, ultrasound has progressively been used in new ways across diverse areas of medicine: emergency care, procedural guidance, post-op, sports medicine, and much more. The rise of bedside ultrasound, or at the point of care, has also expanded the use of ultrasound, as healthcare professionals have sought new ways to accommodate patients wherever they are and at every stage along the care continuum—from early diagnosis to treatment, from injury to recovery. As a result, point-of-care ultrasound (POCUS), a subcategory of ultrasound, has seen rapid growth across the clinical spectrum, from hospitals to clinics to the front lines and rural communities.

What is POCUS?

Today, point-of-care ultrasound, commonly referred to as POCUS, is a growing practice that empowers medical practitioners to treat patients wherever they are, rather than needing them to be at a specific location and at a specific time. This emphasis on portability creates more dynamic healthcare along the entire care continuum, one in which professionals can use ultrasound to assist in medical procedures or quickly diagnose patients for clinical treatment — whether it be in an ambulance, in a city or rural hospital, a senior living center, a sports event, rehabilitation center, primary care office, or elsewhere.

“If we use POCUS to screen patients for symptoms of an illness or condition sooner, we can hopefully reduce morbidity and mortality,” says Arun Nagdev, M.D., Exo’s Senior Director of Clinical Education.

Dr. Nagdev shares an example story of how he has used POCUS in an emergency: “I had a patient in the middle of our COVID wave who came in with shortness of breath; everyone thought it was COVID. He was in the ambulance bay, waiting to be triaged because we had so many patients. I took one of our POCUS devices outside and I looked at his heart. He had a very enlarged right ventricle that looked like it was being strained. This simple point-of-care test made me realize that he could be having a large pulmonary embolism and he needed treatment immediately. The patient was a 45-year-old man that could have sat in the ambulance bay and decompensated very easily if it was not for the early identification with POCUS.”

As a health information and devices company, Exo believes everyone should have access to high-quality, affordable, and easy-to-use medical imaging. A fierce advocate for improving patient care, Dr. Nagdev’s goal is to educate as many providers as possible on the uses of POCUS, and its immense value in modernized medicine.

Point-of-care ultrasound has proven to be indispensable in the world of emergency medicine. Physicians can use ultrasound to provide a quick diagnosis when needed, and also for procedural guidance to access a vein or inject anesthetic medication in the correct location. Physicians can adopt POCUS into many of their fields of specialties, and more and more medical school are integrating this powerful imaging from the first day of education for young students.

5 Uses for POCUS Ultrasound

POCUS technology can be used across different specialties to make life-changing diagnoses and improve patient outcomes. Some of these focused areas where POCUS can make a big difference include cardiac, lung, abdominal and musculoskeletal (MSK) ultrasound. POCUS also makes a big difference in guiding procedures more safely such as when performing vascular access and nerve blocks.

1. Cardiac Ultrasound

Cardiac disease continues to be a major contributor to death in the United States. Point-of-care ultrasound cardiac evaluations of patients with chest pain, difficulty breathing, and low blood pressure are becoming more common in the emergency department. Using an abbreviated cardiac examination, clinicians are able to define the presence of various disease states (congestive heart failure, pericardial effusion, pulmonary embolism, etc.) earlier and initiate optimal medical care . Also, protocolizing and integrating cardiac POCUS in the resuscitation of a patient can assist in the effectiveness of CPR.

“The heart is a complex organ, making it difficult to assess a patient in the emergency room with chest pain. Physicians need objective data to make a diagnosis, which depending on the scenario, must happen at the bedside. Looking into the body to examine what’s going on is the fastest way to achieve answers,” says Dr. Nagdev. “Cardiac ultrasound can easily reshape the landscape of EM, speeding up the time it takes to triage a patient. It saves lives by simply saving minutes.”

2. Lung Ultrasound

At a time when the world is still reeling from the COVID-19 pandemic, healthcare professionals may be particularly keen to diagnose patients experiencing pulmonary issues in the ED rapidly. But there are differences between a patient with COVID-19 and a patient with another pulmonary issue. For this reason, a lung ultrasound is especially useful when diagnosing COVID-19, as it can also detect interstitial lung congestion, consolidation, pneumothorax, and/or pleural effusion . “A lung infected with COVID-19 appears different in an ultrasound from a lung suffering from a classic bacterial pneumonia,” says Dr. Nagdev. “POCUS can be a tool to differentiate and pulmonary versus non-pulmonary cause of shortness of breath, which provides the physician with crucial information for next steps.”

According to the American College of Cardiology, POCUS can be used to improve diagnostic specificity when using POCUS to evaluate a patient with difficulty breathing . POCUS can identify the cause of shortness of breath, and define the correct intervention (and further imaging) needed for an undifferentiated patient.

3. Abdominal Ultrasound

There is a slew of diagnoses that ultrasound can help identify in the abdominal region. POCUS can be used to quickly diagnose appendicitis, kidney stones, bowel obstructions, and other time-sensitive developments—all faster than scheduling an MRI, CT scan or X-ray would accommodate.

“We’re going from examining an abdomen with our hands to surveying it on a screen,” says Dr. Nagdev. “We’re opening up new ideas in healthcare and making it better for everyone to practice medicine.” For example, the use of ultrasound makes it possible to see what’s going on inside the abdomen instantly, rather than relying upon palpation. POCUS often leads to increased diagnostic accuracy.

Point-of-care ultrasound has uses in patient recovery as well. For example, measuring bladder volume with an ultrasound scan is a less invasive way to track patient recovery in a post-procedure setting, allowing objective measures of urinary retention at the bedside in patients who are still recovering from surgery.

4. Vascular Access Ultrasound

Ultrasound guidance for central venous cannulation (CVC) has become the standard in clinical care. This technique of locating the vein as well as guiding the needle safely, has reduced complications and increased success.

Dr. Nagdev describes the problem with using anatomy as the landmark for the placement of central lines in patients’ necks: “In most patients, the internal jugular lies lateral to the carotid artery. The problem is that without looking with ultrasound, you don’t know if this ‘classic’ positioning is present in your patient. If we use standard landmarks, we risk hitting various objects in the neck (artery, thyroid, and even the lung). Ultrasound allows clear and easy visualization to make an often-complicated procedure, simple.”

5. Musculoskeletal Ultrasound (MSK)

POCUS can identify fractured bones, torn ligaments, the presence or absence of an abscess, and even the presence of a joint effusion. This simple non-ionizing tool can help clinicians determine the need for further testing and define the patient’s pathology.

In rheumatology, for example, POCUS can identify inflamed joints and plantar fascia enlargement. Instant results and a screen nearby to share with the patient can prove to be a powerful tool in illustrating why a patient is experiencing pain. It also helps as a visual aid for the physician to strategize possible pathways to treatment in conversation with the patient.

“Assessing bone and muscular anomalies with ultrasound is just another avenue to achieve reduced radiation—or entirely radiation-free—care for all patients in an area of medicine that traditionally has relied heavily upon other methods of diagnosis,” says Dr. Nagdev.

The Big Picture for POCUS

Point-of-care ultrasound technology enables physicians to make better diagnoses and improve outcomes which sometimes ends up saving the patient’s life.
“I think if we get point-of-care ultrasound probes for every physician and clinician in the medical field, innovation will grow,” says Dr. Nagdev. “We’re already seeing a progression and incentive to see what more POCUS can do for patients.”
Whether in a clinical environment or in an emergency department, POCUS is an incredibly useful tool to make quick and timely diagnoses based on real information.

Read more on POCUS: A Beginner’s Guide to POCUS, What Is POCUS Used For?, Is POCUS Cost Effective?, What Is a POCUS Device?, How to Make the Case for a New POCUS Workflow.

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Exo is a health information and devices company modernizing medical imaging starting with making ultrasound simple and affordable for all. Exo just released Exo Works™, an intelligent and intuitive point-of-care ultrasound workflow solution that lets medical practitioners document exams in seconds and easily manage QA from anywhere. Learn more about Exo Works.