What Does Point of Care Ultrasound Mean in Medical Terms?

12-15-2020

With budgets remaining stagnant and patient volumes increasing, clinicians turn to ultrasound for a more cost-effective, real-time, non-invasive alternative to CT or MRI scans.

Point of care ultrasound refers to the use of ultrasound at a patient’s bedside for diagnostic or therapeutic purposes. A clinician uses point of care ultrasound (POCUS) to guide the evaluation and diagnosis in conjunction with a traditional medical examination.

While the technology is certainly not new, its use has increased due to its clinical utility as more medical providers have embraced ultrasound for frontline care. Why is this happening? What are the benefits of using this technology over traditional methods?

The Basics: What is a Point of Care Ultrasound Exam?

A point of care ultrasound exam involves using ultrasound to answer specific clinical questions or guide a procedure at the “point of care,” whether in a hospital or a remote setting. It provides a quick, non-invasive way to speed the diagnosis and treat the patient more effectively.

POCUS v. Bedside Ultrasound

POCUS is similar to “bedside ultrasound,” but there are some key differences. A bedside ultrasound is a traditional term that uses a sonographic assessment of the patient when they cannot move from their bed to another location for scanning.

POCUS encompasses a bedside ultrasound but is usually performed by a physician and provides much more flexibility. While traditional ultrasonography certainly still has its place, POCUS allows the physician to review and interpret images and make critical decisions at the point of care.

POCUS v. Comprehensive Ultrasound Examinations

Unlike a more comprehensive ultrasound examination, POCUS focuses on answering a very specific question. It examines only a particular area of the body or organ. They are also generally performed by the same clinician who has asked the specific question.

POCUS Uses in the Emergency Setting

POCUS can be used in virtually any care setting. However, because of its ease of use and speed of diagnosis, it has proven invaluable in Emergency Medicine. This technology can also combine with other assessment tools to assist with a quick diagnosis. Below are a few examples of how POCUS can assist in emergencies.

Undifferentiated Shock

POCUS can be used in an undifferentiated shock patient to discern between the major shock types, including distributive, hypovolemic, and obstructive. According to one study, despite only spending an average of six minutes in assessment time, a physician could narrow the differential diagnosis and increase overall diagnostic precision by using POCUS.

Cardiac Arrest

Cardiac arrest requires quick action. POCUS is regularly used during cardiac resuscitation, often combined with rhythm strip data. It can also help determine anatomic causes of pulseless electrical activity, including pulmonary embolism, cardiac tamponade, and tension pneumothorax.

Trauma

Ultrasound is often used to detect intraperitoneal hemorrhage, pericardial tamponade, and hemothorax/pneumothorax – using an extended focused assessment with sonography for trauma or FAST. While POCUS of the abdomen may not allow isolating the source of the bleed, it can be helpful to determine if a bleed has occurred, which gets them into the operating room faster in many cases.

Benefits of Care Using POCUS

Ultrasound continues to offer many advantages over its imaging counterparts (CT/MR/X-Ray) because it is relatively less expensive to acquire, easier to disinfect, and radiation-free. But its uses extend far beyond some of the more traditional practices. Some of the benefits of incorporating POCUS include things like:

Significantly decreased time to diagnose, including time-sensitive, critical conditions
Minimizing delays in care, such as time to get antibiotics or time to move into surgery
Decreasing procedural complications
Generally improving patient safety and decreasing complication rates
Increasing the accuracy and reliability of patient monitoring
Increased success rates of invasive bedside procedures
Exams performed at the bedside to minimize the risk of contamination

A portable ultrasound can go virtually anywhere, from bedside to on-site care in some situations. As a result, they are ideal for emergency situations or where medical attention must be administered outside of the traditional hospital setting.

New technology and artificial intelligence (AI) have significantly simplified POCUS. Scans are faster and more accurate, which increases confidence in the diagnosis and use of portable ultrasound machines as a whole. For example, Mindray’s TE7 Ultrasound System delivers unparalleled image quality and is equipped with AI-powered Smart Tools to assess patients quickly and reliably in fast-paced, emergency environments. It can even be used with hands-free scanning, decreasing the potential for contamination.

There is also a demand for laptop POCUS systems due to their mobility. Mindray’s M9 and ME8 Ultrasound Systems define the new standard for intelligent performance in mobile, laptop designs delivering clarity and advanced capabilities previously only available on larger, cart-based systems. With today’s technology, point of care physicians do not have to sacrifice quality for mobility, and can be confident from room to room, patient to patient.

The Landscape Around POCUS Technology is Improving and Changing

As of January 2, 2019, organizations like the Society of Hospital Medicine have explicitly stated that POCUS has many benefits, including cutting down complication rates and increasing success rates of bedside procedures. Use is only expected to increase as medical professionals realize the many benefits of embracing this technology, as many have done during the novel coronavirus.

The Society of Hospital Medicine has recommended additional education and training for POCUS and proper use of this technology. Because these tools are being used regularly and might be used to replace or supplement the traditional sonogram, the right training in usage and analysis is vital.

In response, some companies are further innovating their technology to ensure that these systems are easy to use and responsive. For example, the Z.One PRO Ultrasound System Emerald Edition 2.0 from Mindray is a cart-based system with an optional simplified user interface that has 38% fewer buttons compared to its other models.

Point of care ultrasound technology is not going away. If anything, it will become more prevalent in the years to come. We are still just scratching the surface of this technology’s overall usefulness.