Article Categories: Review

Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus 

Brandon Oto, PA-C FCCM; Robert Baeten, PA-C FCCP; Leon Chen, DNP AGACNP-BC FCCP FAANP FCCM; Puja Dalal, MD FAAFP; Ria Dancel, MD FACP SFHM FAAP; Steven Fox, MD; Carl William Lange IV, MSBS EM-CAQ PA-C; Cameron Baston, MD MSCE FACP; Paul Bornemann, MD RMSK RPVI; Siddharth Dugar, MD FCCM FASE FCCP; Andrew Goldsmith, MD MBA; Meghan Kelly Herbst, MD FACEP; James N. Kirkpatrick, MD FASE FACC; Abhilash Koratala, MD FASN; Michael J. Lanspa, MD; Viveta Lobo, MD FACEP; Jason T Nomura, MD FACEP FAAEM FACP FAHA; Aliaksei Pustavoitau, MD MHS FCCM; Mourad H. Senussi, MD MS; Vincent L. Sorrell, MD FACP (honorary) FACC FASE FSCCT FSCMR; Frances Mae West, MD MS FACP; Aarti Sarwal, MD FNCS FAAN FCCM FASN RPNI – Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice.

The Application of Point of Care Ultrasound to Screen for Pulmonary Hypertension: A Narrative Review 

Danny Yu Jia Ke, BSc; Melissa Tso, MB BCh BAO FRCPC; Amer M. Johri, MD MSc FRCPC FASE – Pulmonary Hypertension (PH) is a condition with several cardiopulmonary etiologies that has the potential of progressing to right heart failure without proper intervention. After a history, physical exam, and investigations, cases of suspected PH typically undergo imaging via a transthoracic echocardiogram (TTE). This is a resource-intensive procedure that is less accessible in remote communities. However, point of care ultrasound (POCUS), a portable ultrasound administered at the bedside, has potential to aid in the diagnostic process of PH.

Point of Care Ultrasound for Diagnosis and Management in Heart Failure: A Targeted Literature Review 

Sabina Yampolsky, BSE; Alan Kwan, MD; Susan Cheng, MD; Ilan Kedan, MD MPH – Cardiac point of care ultrasound (POCUS) has shown increasing utility as a tool for diagnosing and managing heart failure (HF). Within cardiology, intravascular volume assessment leveraging visualization of the inferior vena cava (IVC) is a central aspect of care, as IVC size correlates with central venous pressure. This targeted literature review aimed to examine the existing literature assessing the use of POCUS in diagnosis and management of HF patients utilizing POCUS-based IVC measurement either alone or in combination with secondary methods.

Exploring the Applicability of Pre-Anesthetic Cardiac POCUS in Unexpected Conditions: Could it be Helpful?

Rodolfo C. Sabogal – Formal preoperative echocardiography has traditionally been recommended when there is substantial cardiovascular disease without recent follow up, unexplained dyspnea, a functional class less than 4 METS or a Duke Activity Status Index less than 34. However, it is important to note that certain patients may present with a variety of cardiac abnormalities due to their preexisting condition or multiple treatments, and these individuals warrant consideration. The objective of pre-anesthetic cardiac POCUS is to provide clinical information in a timely manner.

POCUS for Diastolic Dysfunction: A Review of the Literature

Samantha A. King, MD; Alexis Salerno, MD; Jessica V. Downing, MD; Zachary R. Wynne, MD; Jordan T. Parker, MD; Taylor E. Miller, MD; Semhar Z. Tewelde, MD – Emergency and critical care physicians frequently encounter patients presenting with dyspnea and normal left ventricular systolic function who may benefit from early diastolic evaluation to determine acute patient management. The current American Society of Echocardiography Guidelines approach to diastolic evaluation is often impractical for point of care ultrasound (POCUS) evaluation, and few studies have evaluated the potential use of a simplified approach.

Pictorial Essay of Cervical Duplex Ultrasonography

Siddharth Bhattacharjee, MBBS, MRCP (UK); Richa D. Jain, MD; Lokesh Bathala, DM; Anuradha HK, DM; Vijay K. Sharma, MD – Cervical duplex ultrasonography (CDU) is a simple, non-invasive, portable technique, that provides valuable high-quality visual information about the integrity of the carotid and vertebral vessels, plaque morphology and flow hemodynamics.

Ultrasonography in Acute Kidney Injury

Andrew A. Moses, MD MA; Hilda E. Fernandez, MD – Advances in the use of ultrasonography can enhance our ability to better characterize acute kidney injury (AKI). AKI is a clinical syndrome characterized by a rapid decrease in kidney excretory function with the accumulation of products of nitrogen metabolism and other clinically unmeasured waste products, and may proceed to include clinical manifestations including decreased urine output, development of metabolic acidosis, and electrolyte abnormalities.

Focused Cardiac Assessment in Kidney Care

Vineet Veitla, MD; Bhavna Bhasin, MD – Point of care ultrasonography (POCUS) is considered to be a very useful and informative extension of the bedside physical exam. The information obtained from POCUS allows for real time assessment for expedited decision making to improve efficiency in patient care and management.

POCUS in Intensive Care Nephrology

Randi Connor-Schuler, MD; Jonathan Suarez, MD – Acute kidney injury (AKI) is a significant problem for patients admitted to the intensive care unit (ICU), both due to the high incidence and associated mortality with rates of AKI requiring renal replacement therapy (RRT) of over 5%, and mortality rates with AKI of over 60%.

Role of Point of Care Ultrasonography in Patients with COVID-19 Associated Acute Kidney Injury

Daniel W. Ross, MD; Zubair Hasan, MD – The severe acute respiratory virus covariate-2 (SARS CoV-2) that causes Corona Virus Disease 2019 (COVID-19) has affected more than 194 million people worldwide and has attributed to or caused more than 4 million deaths. Acute kidney injury (AKI) is a common complication of COVID-19. Point of care ultrasonography (POCUS) can be a useful tool for the nephrologist.