Journal Article

Point-of-Care Ultrasonography

Carter, Rachel E., MD, Jonas, Christopher E., DO, Arnold, Michael J., MD

2020

Overview

Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. POCUS confirmation of intrauterine pregnancy rules out an ectopic pregnancy. In the third trimester of high-risk pregnancies, umbilical artery Doppler ultrasonography can improve perinatal outcomes. Musculoskeletal POCUS is used to diagnose and guide treatment of many joint and soft tissue conditions. It is as accurate as magnetic resonance imaging in the diagnosis of complete rotator cuff tears. Ultrasound guidance improves outcomes in the placement of central venous catheters and fluid drainage from body cavities and lumbar punctures. Ultrasonography can reduce the use of CT for diagnosis of appendicitis; however, negative scan results do not rule out disease. POCUS can accurately diagnose and rule out gallbladder pathology, and is effective for diagnosing urolithiasis. Focused cardiac ultrasonography can detect pericardial effusion and decreased systolic function, but is less accurate than lung ultrasonography at diagnosing acute heart failure. Limited evidence demonstrates a benefit of diagnosing testicular and gynecologic conditions. The American College of Emergency Physicians, the American Institute of Ultrasound in Medicine, the Society for Academic Emergency Medicine, the American College of Radiology, and others offer POCUS training. Training standards for POCUS have been defined for residency programs but are less established for credentialing. Illustration by Jonathan Dimes

• Publisher: American Academy of Family Physicians
• Subject: Abdomen / Abscess - diagnostic imaging / Abscesses / Accuracy / Aneurysms / Aortic Aneurysm, Abdominal - diagnostic imaging / Appendicitis - diagnostic imaging / Cellulitis - diagnostic imaging / Clinical Competence / Colic - diagnostic imaging / Coronary vessels / Family Medicine/General Medicine / Female / Fractures, Bone - diagnostic imaging / Hemorrhage - diagnostic imaging / Humans / Internal Medicine / Intestinal Perforation - diagnostic imaging / Intracranial Hypertension - diagnostic imaging / Lung - diagnostic imaging / Male / Meta-analysis / Pain / Patient satisfaction / Pericardial Effusion - diagnostic imaging / Pneumonia / Pneumothorax / Point-of-Care Systems / Pregnancy / Prenatal Care / Primary care / Respiratory Distress Syndrome / Retinal Detachment - diagnostic imaging / Rotator Cuff Injuries - diagnostic imaging / Soft Tissue Infections - diagnostic imaging / Spermatic Cord Torsion - diagnostic imaging / Stroke Volume / Success / Systematic review / Thoracentesis / Thrombosis / Ultrasonic imaging / Ultrasonography / Ultrasonography, Interventional / Venous Thrombosis - diagnostic imaging