Emergency ultrasound

Emergency ultrasound or point-of-care ultrasound (POCUS) is the application of ultrasound at the point of care to make immediate patient-care decisions. It is performed by the health care professional caring for the injured or ill persons. This point-of-care use of ultrasound is often to evaluate an emergency medical condition, in settings such as an emergency department, critical care unit, ambulance, or combat zone. Emergency ultrasound or point-of-care ultrasound (POCUS) is the application of ultrasound at the point of care to make immediate patient-care decisions. It is performed by the health care professional caring for the injured or ill persons. This point-of-care use of ultrasound is often to evaluate an emergency medical condition, in settings such as an emergency department, critical care unit, ambulance, or combat zone. Emergency ultrasound is used to quickly diagnose a limited set of injuries or pathologic conditions, specifically those where conventional diagnostic methods would either take too long or would introduce greater risk to a person (either by transporting the person away from the most closely monitored setting, or exposing them to ionizing radiation and/or intravenous contrast agents). Point of care ultrasound has been used in a wide variety of specialties and has increased in use in the last decade as ultrasound machines have become more compact and portable. It is now used for a variety of exams in various clinical settings at the person's bedside. In the emergency setting, it is used to guide resuscitation and monitor critically ill persons, provide procedural guidance for improved safety and confirm clinical diagnosis. Point of care ultrasound is sometimes the only option in the evaluation of injured persons who are too ill for transport to other imaging modalities (i.e. computed tomography, or CT scan) or whose illness is so acute that medical decisions in their care need to be made in seconds to minutes. It is also increasingly used to guide and triage care in resource-limited situations, in rural or medically underserved areas. For people who present signs of traumatic injury, the focused assessment with sonography for trauma or FAST exam is used to assess hypotensive persons for occult bleeding. Traditionally used by emergency physicians and surgeons treating trauma persons, it has also been used by paramedics in combat zones, and for non-traumatic problems such as ruptured ectopic pregnancy. Similarly, emergency ultrasound can also evaluate the lungs for hemothorax (bleeding in the chest), and pneumothorax (a puncture resulting in air trapped in the chest and lung collapse). People presenting with hypotension of unknown cause, ultrasound has been utilized to determine the cause of shock. Evaluation of the heart and inferior vena cava (IVC) can help the clinician at the bedside choose important treatments and monitor the response to the interventions. A person who has hypotension and a bedside ultrasound showing hyperdynamic left heart with a flat, collapsible IVC indicates low blood volume. If the person also has a fever, the clinician may determine sepsis, or severe infection is causing the problem. If that same hypotensive person has back pain instead of a fever, the clinician may see an abdominal aortic aneurysm that is leaking or ruptured. Conversely, weak heart activity and a very full, non-collapsible IVC would indicate a cardiac cause for low blood pressure. For those presenting with acute shortness of breath, ultrasound assessment of the lung, heart, and IVC can evaluate for potentially life-threatening diseases, including pneumothorax, significant pleural effusions, congestive heart failure, pulmonary edema, pericardial effusion, and some large pulmonary emboli. With its increased availability, ultrasound is now frequently used more in code situations, in which a person have lost most or all signs of life. Practitioners may use the ultrasound to see if the heart is moving, beating in organized fashion or if it has a pericardial effusion or fluid around it. Pericardiocentesis, a procedure in which a needle is used to drain the effusion, can utilize ultrasound guidance of a needle to decrease the risk of hitting lungs, heart or other vital organs