The Role of Point-of-Care Ultrasonography in Medicine
While traditional methods of performing a physical examination are of critical importance, healthcare practitioners that become skilled in the use of point-of-care ultrasonography become uniquely empowered. Conditions such as cardiac valvular disorders that are inferred by auscultation can be visualized and quantified by ultrasound. Time-sensitive definitive diagnoses, such as ruptured abdominal aortic aneurysms, are made in minutes rather than hours. The differential diagnosis of undifferentiated shock is narrowed in a matter of minutes through the use of ultrasound to evaluate cardiac ejection fraction, noninvasive estimation of central venous pressures by visualizing the diameter and variation in the inferior vena cava, and assessing for right heart overload, pericardial effusion, and intracorporal blood loss in major body cavities.
The range of clinical applications that point-of-care ultrasound is being utilized for is rapidly expanding on a continuous basis. A variety of clinical care efficiencies have been reported. (Table 1) (Bassler) Examples include patients with flank pain or hematuria, where the kidneys can be evaluated for the presence of hydronephrosis, renal cysts, or distortion of the renal architecture consistent with a renal mass. In addition, the bladder can be assessed with ultrasound to estimate the volume and confirm ureteric expulsion of urine into the bladder using Doppler. The presence of these bladder jets confirms patency of the ureters, avoiding an unnecessary computed tomography (CT) scan.
The intimal-medial thickness of the carotid artery can be measured as a screening for atherosclerosis. Ultrasound has 100% sensitivity for the diagnosis of abdominal aortic aneurysms. In patients with a swollen arm or leg, a deep vein thrombosis can easily be screened for at the bedside without having to anticoagulate the patient while waiting for an ultrasound. Differentiating simple cellulitis from the need to surgically drain an abscess has been shown to be superior with ultrasound. Long-bone fractures can be diagnosed and reduced under ultrasound guidance. Many times foreign bodies can be localized and removed without the need for fluoroscopic guidance. Needle-based procedures can be made safer and timelier when done under ultrasound guidance. This includes paracentesis, thoracentesis, arthrocentesis, pericardiocentesis, lumbar puncture, regional anesthesia, and vascular access.
Portable ultrasound technology at the bedside means that this virtually risk-free technology is immediately accessible throughout the hospital and community clinics. This will decrease reliance on CT scans as initial imaging tests, and reduce the exposure of patients to ionizing radiation. Ultrasound is of critical importance in pediatric care, as children are particularly susceptible to the long-term risks of ionizing radiation. (Chen, Levy, Brenner) By conducting an initial assessment of the patient with ultrasound, physicians will be inclined to use focused rather than full-body CT scans. It will also lead to early detection of certain pathologic conditions that might not otherwise be possible, and provide cost-effective healthcare.
|Table 1: Clinical Benefits of Point-of-Care Ultrasonography|
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