Colligo Academy Pocus Basics

Ultrasound Beyond the basics

Point-of-Care ultrasound has revolutionized the practice of medicine, influencing how care is provided in nearly every medical and surgical speciality. For more than a century, clinicians had been limited to primitive bedside tools, such as the reflex hammer (c. 1888) and stethoscope (c.1816), but with bedside ultrasound, providers are equipped with a tool that allows them to actually see what they can only infer through palpation or auscultation.
Point-of-Care-Ultrasound’. 2nd Edition

Soni et al. 2020

Objectives

There are no mandatory video clips or quizes or learning objectives in this module. It’s just made for inspiration and as part of our ongoing investigation, evaluation, and evolution of what to include in a POCUS course.

1. Introduction

Ultrasound is used in almost every field of medicine and the boundaries between bedside ultrasound and non-bedside ultrasound is constantly changing. We had to make a choice of what we wanted to include in the course due to restraints concerning time and competence.

This section is a small selection of the possibilities that exists by using ultrasound beyond this course. It is our hope that we can push the skillset and competence of our selves and for the students of this course towards some of the fields mentioned below.

2. Ocular Ultrasound

Ocular bedside sonography can aid in the diagnosis of retinal and vitreous hemorrhage, retinal and vitreous detachments, ocular infections, foreign bodies, retrobulbar hematoma, or ocular vascular pathology. Optic nerve sheath diameter can be measured in patients with a suspected intracranial process as a surrogate for intracranial pressure, and may aid emergency diagnosis and management. An article from Kilker et al, published 2014, reviews bedside ocular ultrasound, and can be found here: *.

3. Temporal arteritis (giant cell arteritis)

Colour duplex sonography (CDS) of temporal arteries and large vessels is an emerging diagnostic tool for GCA. CDS can detect wall oedema, known as a halo, throughout the length of the vessel and shows higher sensitivity compared with biopsy. A review of the current evidence by Monti et al, published 2018, can be found here: *.

4. Appendicitis

While the golden standard alongside CT for diagnosing acute appendicitis, one systematic review from 2017 by Giljaca et al summarised that ultrasound did not exceed physical examination when it comes to sensitivity and specificity, the systematic review can be found here *. Instead of an ultrasound the authors of that review recommend more sensitive and specific diagnostic for patients that require additional diagnostic workup, such as CT.

5. Echocardiography

Echocardiography is a large and complex field that requires many months of daily practice before basic proficiency can be reached. There is nothing that can replace the need of a clinical rotation that provides the necessary number of daily patients and proctored exams needed for beginners. However one book that covers the basics that we can recommend is Textbook of Clinical Echocardiography by Catherine M. Otto *.

6. Gyn & Obstetrics

Ultrasound in the field of gyn/OB also requires practice/rotation in an appropriate clinic. Since most patients in Stockholm are referred to hospitals with gyn/OB emergencies the bedside ultrasound exam in these areas has not been something traditionally included in our POCUS courses.

7. Procedural Ultrasound

Ultrasound can help aid in everything from nerve blockades to tube or drain insertion. At the present moment this is something that is not done routinely by the ED physicians in our hospital and therefor not included in the course.

8. Abdomen

Ultrasound for the abdomen can provide useful information for diagnosis of the pancreas, liver, spleen, intestines, kidneys, gallbladder, and blood vessels. It can also be used with contrast for, among other uses, follow up after trauma injuries. There is also a promising technique called fusion imaging that helps overlay CT scan images onto the ultrasound.

9. MSK

As previously mentioned MSK ultrasound is widely included in this module, but might become more of a prominent feature over time.

10. Protocols

Besides the E-FAST and BLUE protocol mentioned in this course there are many other ultrasound protocols:

BLUE *
- Basic Lung Ultrasound Examination
FALLS *
- Fluid Administration Limited by Lung Sonography
FAST *
- Focused Assessment with Sonography in Trauma
FATE *
- Focus Assessed Transthoracic Echocardiography
RUSH *
- Rapid Ultrasound for Shock and Hypotension.

11. Summary

There is a lot to explore when it comes to ultrasound, and this page is created as inspiration for the starting POCUS practitioner and as a reminder for future POCUS curriculums.

Some ultrasound practices might find themselves incorporated into the POCUS curriculum over time while others may be discarded depending on difficulty, utility, and resources available.

12. Further Reading

Books

- Noble. ‘Manual of Emergency and Critical Care Ultrasound’. 2nd Edition. 2011.
  - Ch. 4 First trimester ultrasound
  - Ch. 10 Ocular ultrasound
  - Ch. 11 Soft tissue and musculoskeletal ultrasound
  - Ch. 13 Pediatric ultrasound
  - Ch. 16 Ultrasound for procedure guidance
- Dawson & Mallin. ‘Introduction to Bedside Ultrasound – Vol 1’. 2013.
  - Ch. 5 RUSH
  - Ch. 7 Pregnancy
  - Ch. 9 Central Lines
  - Ch. 10 Testicular
  - Ch. 11 Brachial Plexus Nerve Blocks
  - Ch. 13 Join Injections
  - Ch. 14 Hip
  - Ch. 15 Shoulder
- Dawson & Mallin. ‘Introduction to Bedside Ultrasound – Vol 2’. 2013.
  - Ch. 4 Transesophageal Echo
  - Ch. 5 Femoral Nerve Block
  - Ch. 6 Peripheral Nerve Blocks
  - Ch. 7 SUSS IT
  - Ch. 9 Procedures
  - Ch. 10 Soft Tissue
  - Ch. 11 Musculoskeletal Basics
  - Ch. 13 Appendicitis
  - Ch. 16 Ocular
  - Ch. 17 Pediatrics
  - Ch. 18 Prehospital Care
- Soni et al. ‘Point-of-Care-Ultrasound’. 2nd Edition. 2020
  - Ch. 39 Ocular Ultrasound
  - Ch. 40 Thyroid Gland
  - Ch. 41 Lymph Nodes
  - Ch. 42 Peripheral Nerve Blocks
  - Ch. 43 Lumbar Puncture
  - Ch. 44 Transcranial Ultrasound
  - Ch. 45 Soft Tissues and Joints
  - Ch. 46 Joints
  - Ch. 47 Pediatrics
  - Ch. 48 Neonatology

13. References

Keikha et al. ‘Diagnostic Accuracy of Rapid Ultrasound in Shock (RUSH) Exam; A Systematic Review and Meta-analysis’. 2018.
Kilker et al. ‘Bedside ocular ultrasound in the emergency department’. 2014.
Lichtenstein et al. ‘BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill’. 2015.
Monti et al. ‘The use of ultrasound to assess giant cell arteritis: review of the current evidence and practical guide for the rheumatologist’. 2018.
Ollerton et al. ‘Prospective study to evaluate the influence of FAST on trauma patient management’. 2006.
Otto. ‘Textbook of Clinical Echocardiography’. 6ed Edition. 2018

[Version 2.0 — Last updated 2022-07-01 — Status: Active]
[Version 2.0, update 2022-07-01: minor revisions/spell-checks.]