Part 1: Why are physicians beginning to use ultrasound increasingly at the bedside?

by James Mateer MD RDMS

The initial interest in point of care ultrasound (POC US) exams has been driven by the rapid advancements in ultrasound technology over the past 15-20 years.  These advancements have largely paralleled the development of advances in computer technology.

The 80’s advanced portable real-time imaging options.

The 90’s brought improvements in image quality and more compact portable console units.

This is an example of a hand-carried ultrasound unit. (provided by GE)
This is an example of a hand-carried ultrasound unit.
(provided by GE)

After 2000, a number of compact, hand-carried units were introduced.

Today, the improved image quality, price point and portability for both compact console and hand- carried units have focused the attention of clinicians on utilization of bedside ultrasound.

During this period of technological advancement, physicians have published numerous studies demonstrating conclusively that POC- US improves diagnostic efficiency and patient outcome.

This has led many specialties to incorporate POC US training into their residency or fellowship programs.   We now have a growing number of clinicians who realize the value of the POC US exam for improved diagnosis and treatment.

Currently, several medical schools have initiated POC US training for medical students as they progress through their clinical rotations. These physicians of the future will determine how extensively POC US is utilized for physical diagnosis, disease screening and therapeutic intervention.

As ultrasound advances, there will be continued improvements in portability, image resolution, ease of use and digital interface with the electronic medical record systems.

All of these past and continued technological developments will be a driving force for further utilization of point of care ultrasonography.

Coming up…

Part 2: How a renewed emphasis on the cost effective practice of medicine and patient safety issues will influence the future of POC US.

Learn more from Dr. Mateer at Introduction and Advanced Emergency Medicine and Critical Care Ultrasound Training Courses at Gulfcoast Ultrasound Institute.

Esophageal rupture diagnosed with bedside ultrasound

By Derr C, Drake JM. University of South Florida, FL, USA.

Abstract

A 69-year-old man presented to the emergency department with hematemesis, hypotension, tachycardia, and hypothermia. The emergency physician performed a bedside ultrasound of the chest, heart, and abdomen. The heart was unable to be visualized in the parasternal, apical, or subxiphoid windows, and free fluid and particulate matter were visualized in the chest and abdomen. The inability to visualize the heart in the normal cardiac windows suggested a diagnosis of pneumopericardium. Based upon the patient’s presenting symptoms and ultrasound findings, an esophageal perforation was suspected. Esophageal perforation is a medical emergency. Deterioration and death due to sepsis can occur within hours of presentation [6]. Although there is a great deal of literature discussing the diagnosis of esophageal perforation by chest radiograph, computed tomography (CT), and esophagography, there are no articles on the role of ultrasound. Esophageal perforation may result in the communication of air between the esophagus and pericardium and the leakage of gastric contents into the chest and peritoneal cavity. The presence of air in the pericardial sac results in nonvisualization of the heart on ultrasound. Fluid in the chest and abdomen may be visualized in the posterior upper abdominal windows. Although these ultrasound findings alone are not entirely specific for esophageal perforation, when coupled with a high index of suspicion due to the patient presentation, ultrasound can be one of the most portable, readily available, low-cost, and minimally invasive techniques to make the diagnosis of esophageal perforation.

Derr, C. & Drake, J. Esophageal rupture diagnosed with bedside ultrasound. The American journal of emergency medicine 30, 2093.e1–3 (2012).

or check out the full article on pubmed.gov

It’s time to think Ultrasound for all the right reasons.

Ultrasound FirstFor appropriate clinical conditions, ultrasound offers clear safety and economic advantages over radiographic exams, and yet evidence suggests that ultrasound is underutilized. Many clinicians are unaware of the range of conditions for which ultrasound first is an established guideline, and the gap only grows larger as research extends ultrasound’s diagnostic value.

What is Ultrasound First?

Ultrasound First is an endeavor devoted to education and increasing awareness of the effectiveness of ultrasound in enhancing patient care.

Objectives

  • Raise awareness of the value and benefits of ultrasound among patients, health care providers, and insurers
  • Provide ultrasound education and evidence-based guidelines for health care providers
  • Educate insurers about the cost savings and patient benefits associated with performing an ultrasound study when scientific evidence supports its potential effectiveness compared to other imaging modalities
  • Educate patients about the benefits of ultrasound as the appropriate imaging modality for their care
  • Encourage the incorporation of ultrasound into medical education

For more information about this initiative visit: www.ultrasoundfirst.org