Understanding POCUS in Emergency Medicine

Increasingly, the medical industry is looking for innovative ways to provide better care—and clinical outcomes—to their patients. One promising lead is through leveraging POCUS (point-of-care ultrasound) technology. In fact, according to the Annals of Translational Medicine point-of-care ultrasound should be considered “the next evolution of medical education.” POCUS ultrasound applications are proving to be particularly successful in emergency medicine.

In emergency medicine scenarios, swift and decisive action can often be the difference between life and death. When accidents occur outside of a hospital or medical facility, it can be more difficult to address the situation with the proper equipment. This is where POCUS enters the equation.

Conventionally, if a patient requires an ultrasound exam, they would have to go to a healthcare facility and undergo the scan in a room specifically outfitted for the examination. Point-of-care ultrasound technology emphasizes bringing medical equipment to a patient, rather than the other way around. With POCUS, medical personnel and patients alike have more flexibility while maintaining good outcomes overall. We will break down the specifics, as well as some other POCUS basics in the remainder of this article.

What Does POCUS Stand for in Ultrasound Medicine?

The POCUS medical acronym stands for point-of-care ultrasound. This terminology distinguishes between point-of-care ultrasound vs other ultrasound machines. This distinction is fairly important because portable ultrasounds and point-of-care devices can differ in several ways from traditional diagnostic ultrasound devices.

What Does POCUS Mean in Medical Terms?

Beyond just the literal difference in meaning, when someone asks what does POCUS mean in ultrasound technology, it might make sense to consider its capabilities. We go into this in more depth later, but simply put POCUS technology can contribute toward:

• Quicker diagnosis
• Improved medical outcomes
• Improved patient experience
• Cheaper treatment costs for providers and patients

When it comes to emergency medicine, the flexibility, accuracy, and timeliness of POCUS exams can truly be game-changing for all parties involved.

POCUS Uses in Medicine

In general, POCUS—like all diagnostic ultrasounds—are used as part of the diagnostic process. Ultrasounds use sound waves to generate images of the internal body. As such, it’s a handy tool for diagnosing causes of pain, swelling, and inflammation—in both emergency and non-emergency situations.

Perhaps most famously, ultrasounds are also used to examine fetuses in pregnant women. This can either be part of a routine appointment, or if there are emergency concerns for the fetus’s or mother’s health. Additionally, POCUS imaging can be used to evaluate the development of key organs and bodily structures in infants, such as the brain, hips, and spine.

Due to its noninvasive nature, ultrasounds can help with conditions relating to but not limited to:

• Guide biopsies
• Diagnose heart conditions
• Assess damage to the heart after cardiac arrest
• Heart and blood vessels
• Scrotum
• Liver
• Thyroid
• Gallbladder
• Eyes
• Spleen
• Uterus and ovaries
• Pancreas
• Bladder
• Kidneys

What Is a POCUS Procedure?

A POCUS procedure is an ultrasound imaging exam done at the point of patient care. It may be quite similar to other ultrasound techniques. The key differentiator however is that POCUS occurs where the patient already is, rather than in a dedicated hospital room.

In terms of what to expect during a POCUS procedure, typically the experience includes the following details:

1. The Technology: Point-of-care ultrasound technology generally consists of a transducer (the hand-held device that sends and receives sound signals), some sort of video monitor, and some sort of computer console. It’s important to note however that for POCUS exams, the monitor and console can be multimedia devices like smartphones, tablets, or laptops.
2. The Process: The patient will most likely be laying down with the area(s) of concern facing up. The trained professional performing the exam will apply a small amount of gel to the area under examination and place the transducer there. At this point, the images should be immediately visible on the monitor.
3. The Results: Following the procedure, a healthcare professional will review the result of the patient’s imaging and go over them with the patient. In some cases, this might be as quickly as right after the exam. In other situations, it may take a few days for a patient to get the results back. However, with POCUS workflows like Exo Works™, documentation of the results can take only minutes, leading to quicker diagnoses being shared with the patient.

What Is an Example of An Emergency Condition That POCUS Can Diagnose?

POCUS is able to accurately diagnose a plethora of emergency (and non-emergency) medical conditions, either on its own or as a complementary component of a comprehensive exam. According to an American Family Physician POCUS review article, common use cases for POCUS technology include the following:

1. Abdominal Aortic Aneurysm (AAA) Screening: This screening practice is recommended for men in their 60s and 70s who have smoked at least 100 cigarettes in their lifetime. Screening reduces aneurysm rupture mortality by 34%. With POCUS, screening is possible using less costly and radiation-free imaging techniques. With regards to AAA, POCUS studies have yielded 100% sensitivity and specificity. Furthermore, a meta-analysis of POCUS AAA studies reveals a 99% sensitivity rate and a 98% specificity rate for AAA diagnosis. What’s more, in one trial, a medical student was able to accurately diagnose 15 out of 16 aneurysms in 57 patients after merely three hours of training.
2. Deep Vein Thrombosis (DVT): POCUS use on common femoral and popliteal veins afflicted with DVT reveals a 96% sensitivity and a 97% specificity for DVT detection. Furthermore, after just two hours of training, primary care providers were able to diagnose DVT with 90% sensitivity and 97% specificity. These numbers approach 100% with repeated diagnostic examinations.
3. Procedural Guidance: POCUS is currently used for guidance in many procedures and has become part of some standard operating procedures. When it comes to venous catheter placement, POCUS reduces complications, time to completion, and arterial puncture, while simultaneously improving success rates. For thoracentesis and paracentesis, POCUS reduces the rate of dry taps, bleeding, and prevents failure in paracentesis as well as reducing traumatic lumbar punctures. It is also helpful in preventing failure of superficial skin abscess draining. Additionally regarding musculoskeletal procedures, POCUS reduces pain scores for joint and soft tissue aspirations, injections, and nerve blocks, while also reducing instances of failed treatments.
4. Respiratory Distress: POCUS of the lung is more sensitive than plain radiography when it comes to diagnosing conditions such as pleural effusion and pulmonary contusion. It also decreases the time it takes for emergency departments to diagnose these conditions by two hours on average when compared to regular radiography. Additionally, while POCUS is less accurate than a CT scan for detecting pulmonary embolisms, it can be a helpful first step in the diagnosis if the CT scan is unavailable.

What Else Can POCUS Diagnose?

According to the same American Family Physician article, other conditions that show strong or moderate evidence of consistent POCUS diagnosis include:

• Rotator cuff tear
• Skin and soft tissue infections
• Appendicitis
• Gallstones
• Bowel perforation
• Decreased cardiac ejection fraction
• Elevated intracranial pressure
• Internal bleeding in trauma
• OB/GYN conditions
• Pericardial effusion
• Hydronephrosis
• Retinal detachment

What Is POCUS in Cardiology?

As a bedside or portable device, POCUS can help monitor, evaluate, and diagnose cardiological conditions in both emergency and non-emergency medicine. In particular, according to the American College of Cardiology, POCUS can be used to:

• Identify significant EKG changes
• Assess left ventricular function
• Evaluate chest palpitations or pain
• Investigate dizziness and or shortness of breath
• Assess hypertension
• Identify new heart murmurs
• Assess for cardiac arrest

What Are Some Examples of Emergencies in the Medical Office Where POCUS Might Be Used?

One of the many point-of-care ultrasound benefits is that it can be used in a wide variety of situations. For example, some of the most common ER cases and examples of medical emergencies that brought people into the ER, according to 2021 International Classification of Disease data, include:

• Chest pain
• Shortness of breath
• Abdominal pain
• Cough
• Respiratory Infection
• Head injury
• Cardiac arrest

For any of these afflictions, POCUS can provide diagnostic imaging to help determine the extent of these issues as well as potential root causes. In many cases, POCUS offers a quicker and more timely diagnosis than other radiography.

It’s important to note that “point-of-care” doesn’t mean “at-home care.” For example, for many patients, point-of-care could simply be a room in the hospital or at a medical office building. Instead of having to go from one room to another for an ultrasound, a POCUS device allows medical personnel to tend to the patient where they are. This is more convenient, saves time and energy, and can help reduce risks associated with transferring from one room to another or waiting to perform diagnostic radiology.

What Are the Most Common Emergency Situations Outside of a Medical Office Where POCUS Can Be Used?

Since POCUS is a portable, point-of-care medical tool, it can be used in a variety of non-medical-office settings. For example, POCUS can be used for emergency medicine in at-home care settings, nursing homes, or even more remote locations, such as at the sidelines of sporting events and in the air inside a helicopter. With that being said, outside of a medical office, POCUS can be used for common health emergencies like:

• Heart or chest pain
• Shortness of breath
• Stomach pain
• Heart attack

Proper paramedic ultrasound training with POCUS devices can help provide quick and immediate diagnosis and care to patients suffering from a medical emergency, no matter where their “point-of-care” is.

Do Good with POCUS…Do More with Exo

POCUS exists to empower medical professionals and to help patients. Exo Works™ exists to accommodate better and more efficient workflows so that POCUS can do just that. From the initial ultrasound through the next steps, our workflow enables better documentation and review to ease the load on healthcare professionals without compromising patient outcomes. We help simplify documentation, reporting, billing, and reimbursement for POCUS exams. To find out more contact us or schedule a demo.