Point-of-Care Ultrasound: A Practical Guide for Primary Care
Ultrasound has head-to-toe applications for primary care, and the newest machines are portable and affordable enough to fit into almost any practice.
Fam Pract Manag. 2020 Nov-Dec;27(6):33-40.
Author disclosures: Dr. Deutchman is on the medical advisory board of EchoNous, a point-of-care ultrasound device manufacturer. It is an unpaid position. He also owns stock in the company. No other relevant financial affiliations disclosed.
Family physicians can order a wide range of imaging services for patients. But barriers such as time, money, and physical distance sometimes prevent patients from accessing those services, causing gaps in care. Incorporating point-of-care ultrasound (POCUS) into clinical practice is one way to bridge those gaps.
Technological advancements have allowed more physicians to bring ultrasound services to the office visit or bedside, and to make POCUS an integral part of practice. I [Dr. Deutchman] was an early adopter, adding ultrasound to my rural practice in 1980 after delivering a surprise set of twins in the wee hours of the morning. I have never since been surprised by twins, nor missed an ectopic pregnancy. In addition, I [Dr. Shen-Wagner] first used POCUS during residency in 2011, after a patient complained that it felt like her intrauterine device (IUD) had moved. Everything looked normal on the pelvic exam, but a hand-me-down ultrasound machine from the clinic's obstetrics department revealed the unmistakable flutter of a tiny heartbeat. The patient was pregnant, despite having an IUD for three years.
These are just two examples of the many ways POCUS can benefit doctors and patients. There is robust evidence that POCUS improves care in critically ill patients and improves the efficiency and safety of many invasive ambulatory surgeries that are otherwise performed blindly or by anatomic landmarks.1 There is also preliminary but growing evidence that POCUS can improve diagnostic capabilities, expedite patient care, and inform bedside treatment and management.2,3 Most recently, POCUS has proven to be a valuable tool for confirming COVID-19 diagnoses, as well as monitoring some symptoms of the disease.4
The hands-on, “showing while telling” nature of POCUS advances physical diagnosis skills, fosters doctor-patient communication, and increases patient satisfaction.5 This article outlines some common uses for POCUS and explains how to add it to a practice.
Advances in technology have made ultrasound machines more portable and affordable, increasing their accessibility for primary care clinicians.
Point-of-care ultrasound beginners should start with impactful procedures that are easy to perform, simple to interpret, and relatively low liability for both patient and physician. Move on to more complex uses only after those are learned.
Pocket-sized ultrasound machines cost $2,000 to $10,000, plus the costs of gel, probe covers, and cleaning supplies. But several high-yield ultrasound codes can help recoup those expenses.
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