What is HM-POCUS?
Point of Care Ultrasonography is always, by definition, a focused study intended to answer a very specific question under a very specific clinical circumstances. It is performed and interpreted by a clinician, caring for the patient in real time by the bedside. At the center of the field is the appreciation that the same sonographic finding may mean completely different things, depending on the clinical context. For example, fluid in hepato-renal recess in a hypertensive trauma victim indicates presence of blood in the peritoneal cavity and such patient should undergo emergency laparotomy. The same exact finding in a stable medical patient indicates presence of a small ascites and is not a reason for any concern. In other words, clinical correlation is advised.
Hospital Medicine Point of Care Ultrasonography is a new and dynamic field. As of yet, there is no consensus regarding the exact scope of the field or even it’s minimum standards. We anticipate that our understanding of what should and should not be included will evolve rapidly in the next few years. For now we define diagnostic HM-POCUS as including, but not limited to, the following clinical settings:
- Shock/hypotension
- Dyspnea
- Acute kidney injury (AKI)
- Clinical syndrome suggestive of CHF
- Follow up of a patient with known LV failure
- Abdominal distention
- Suspected elevation of intracranial pressure
- Suspicion for soft tissue abscess
And the following areas:
- Focused trans-thoracic cardiac ultrasound
- Pericardial effusion and tamponade
- LV size and systolic function
- RV size and systolic function
- Estimation of RA pressure
- Major Valvular disease (qualitative only)
- LV diastolic function (advanced level)
- Lung Ultrasound
- interstitial syndrome
- posterolateral alveolar and/or pleural syndrome (PLAPS)
- anterior alveolar syndrome
- pneumothorax
- Renal Ultrasound
- moderate or large hydronephrosis
- Bladder US
- estimation of bladder volume
- Biliary and gallbladder US
- presence of GB stones
- size of common biliary duct
- Abdominal Aorta
- r/o AAA
- LE veins for DVT
- Abdominal US for Ascites
- Musculo-skeletal US
- distinction between uncomplicated cellulitis from cellulitis + abscess
- identification of effusion of major joints
- Ocular
- Optic Nerve Sheath Diameter (ONSD) estimation as a surrogate for ICP
In addition, of course, ultrasound is used for guidance of most bedside procedures.
Our Philosophy
Dr. Todd Cutler delivering Medicine grand Rounds at Cornell, 8/21/2019