POCUS (point of care ultrasound)

What is point of care ultrasound?

In the ICU environment, it is an imaging modality used for both diagnostic therapeutic purposes at bedside in order to improve patient outcomes. It is quick, fast, cheap and evidence based way to make your patients better. 

Practice

We often post cases or examples of POCUS on our instagram feed. Check out the posts below.

 
💜💛🖤 𝚌𝚊𝚛𝚍𝚒𝚊𝚌 𝚝𝚊𝚖𝚙𝚘𝚗𝚊𝚍𝚎 🖤💛💜 ⠀ The accumulation of pericardial fluid under pressure. This impedes cardiac filling, causing the pericardium to markedly stiffen.⠀ ..⠀ ⬆️ this causes the left and right heart chambers to be influenced by each other to a MUCH greater degree than normal. ⬆️ ⠀ ..⠀ 🤺 The heart COMPETES with the fluid for the fixed intrapericardial volume.. and unfortunately, often loses⠀ 🏋️ PHYSICAL FINDINGS: Sinus tach, elevated JVP, hypotension +/- new pericardial rub⠀ 💿 Whip out your phased array probe: This can be seen via a formal echo or on your #POCUS exam.⠀ ⚖️ a common finding is Pulses Pardoxus - or a large decrease in SBP (>10mmHg) on inspiration. This is due to the ventricular independence 🇺🇸⠀ ❓ Etiologies: can be infectious, hemorrhagic, neoplastic, from trauma and much more⠀ 🔅 Size doesn't matter - although commonly a moderate to large effusion is present in tamponade, it can occur in small effusions as well⠀ ..⠀ ✊ TREATMENT requires early drainage; interventional cardiology evaluation for catheter pericardiocentesis versus surgical drainage.⠀ ..⠀ ..⠀ Source: Uptodate⠀ #MedEd #FOAMed #FOAMcc #pastudent #medicalstudent #medstudent #futureMD #futurePA #futurenurse #nursingstudent #paschool #medlife #medicine #intensivecareunit #icu #medicalschool #tamponade #pericardialeffusion #cardiology #cardiactamponade #intensivecare #medical #medicine #pulmcastpocus
🚨 CASE ALERT 🚨⠀ A 42 year old female with a history of rheumatoid arthritis (on immunosupressive medications) comes to the ED with severe malaise. ⠀ ..⠀ She is hypotensive despite fluid resuscitation and started on levophed. Fever 102.3. Labs reveal severe leukopenia, transaminitis with mildly elevated INR, AKI, bicarb 14. ⠀ ..⠀ Your colleague, who inserted a central line prior to your arrival, mentions to you: "Her veins were pretty dilated and non-compressible." This prompts you to pick up a probe and freshen up your #POCUS skills. ⠀ ..⠀ What do you see? What's your next step?⠀ ..⠀ ..⠀ ..⠀ ..⠀ ..⠀ #MedEd #FOAMed #FOAMcc #pastudent #medicalstudent #medstudent #futureMD #futurePA #futurenurse #nursingstudent #paschool #medlife #medicine #intensivecareunit #icu #medicalschool #nursingschool #echocardiogram #echocardiography #echo #ultrasound #physicianassistant #criticalcarenurse #pulmcast #pulmcastpocus
A patient with a history of GOLD stage 3/group D COPD and chronic respiratory failure presents with dyspnea, cough and wheeze x 3 days. You perform a cardiac #POCUS. . . What do you see? . . What are the most likely diagnoses? . . What diagnostic test(s) should you consider ordering? . . . . . #FOAMcc #FOAMed #physicianassistant #icu #intensivecareunit #criticalcare #futurepa #pastudent #paschool #pulmcast #medic #medlife #medicine #EMS #medschool #medstudent #healthcare #podcast #nursesofinstagram #criticalcarenurse #meded #POCUS #pulmcastpocus
.🚨 CODE BLUE 🚨. .. .. Here’s a post-ROSC parasternal long view of the heart. .. .. What do you see? .. .. What’s the etiology of the arrest? .. .. What’s your next move? . . . . . #FOAMcc #FOAMed #physicianassistant #icu #intensivecareunit #criticalcare #futurepa #pastudent #paschool #pulmcast #medic #medlife #medicine #EMS #medschool #medstudent #healthcare #podcast #nursesofinstagram #criticalcarenurse #meded #POCUS #echo #pulmcastpocus
Lung #POCUS - what’s the name of this sign and what’s the likely underlying pathology?. . . . . . . #FOAMcc #FOAMed #physicianassistant #icu #intensivecareunit #criticalcare #futurepa #pastudent #paschool #pulmcast #medic #medlife #medicine #EMS #medschool #medstudent #healthcare #podcast #nursesofinstagram #criticalcarenurse #meded #POCUS #pulmcastpocus
This is a patient presenting with “undifferentiated shock.” Luckily, we have the great differentiator: point of care ultrasound! Top left: pulmonary B lines (vertical comet tails) suggestive of pulmonary edema. Bottom left: Longitudinal view of dilated IVC with <50% respiratory variation indicating the patient is NOT clinically volume responsive. Right: dilated LA/LV, poor LV function. Why is this patient in shock(distributive, obstructive, cardiogenic or hypovolemic)? How would you treat them? If you don’t know the answer go check out our most recent shock podcast! (link in bio) . . . . . #FOAMcc #FOAMed #physicianassistant #icu #intensivecareunit #criticalcare #futurepa #pastudent #paschool #pulmcast #medic #medlife #medicine #EMS #medschool #medstudent #healthcare #podcast #nursesofinstagram #criticalcarenurse #shock #corecontent #POCUS #pulmcastpocus
Right ventricular dysfunction (RV is on left of screen) in a patient with submassive #PulmonaryEmbolism. You can see RV dilation and a +McConnell’s sign (RV apex looks like a trampoline). Remember ‘submassive’ isn’t about size, it’s about the presence of RV dysfunction (⬆️RV/LV ratio on echo or CT, ⬆️troponin/BNP, Echo/EKG changes). . . . . #POCUS #FOAMcc #FOAMed #physicianassistant #icu #criticalcare #futurepa #pastudent #paschool #medic #medlife #medicine #medschool #medstudent #healthcare #podcast #nursesofinstagram #criticalcarenurse #pulmcastpocus
A patient with a history of GOLD stage 3/group D COPD and chronic respiratory failure presents with dyspnea, cough and wheeze x 3 days. You perform a cardiac #POCUS. . . What do you see? . . What are the most likely diagnoses? . . What diagnostic test(s) should you consider ordering? . . . . . #FOAMcc #FOAMed #physicianassistant #icu #intensivecareunit #criticalcare #futurepa #pastudent #paschool #pulmcast #medic #medlife #medicine #EMS #medschool #medstudent #healthcare #podcast #nursesofinstagram #criticalcarenurse #meded #POCUS #pulmcastpocus
.🚨 CODE BLUE 🚨. .. .. Here’s a post-ROSC parasternal long view of the heart. .. .. What do you see? .. .. What’s the etiology of the arrest? .. .. What’s your next move? . . . . . #FOAMcc #FOAMed #physicianassistant #icu #intensivecareunit #criticalcare #futurepa #pastudent #paschool #pulmcast #medic #medlife #medicine #EMS #medschool #medstudent #healthcare #podcast #nursesofinstagram #criticalcarenurse #meded #POCUS #echo #pulmcastpocus
Lung #POCUS - what’s the name of this sign and what’s the likely underlying pathology?. . . . . . . #FOAMcc #FOAMed #physicianassistant #icu #intensivecareunit #criticalcare #futurepa #pastudent #paschool #pulmcast #medic #medlife #medicine #EMS #medschool #medstudent #healthcare #podcast #nursesofinstagram #criticalcarenurse #meded #POCUS #pulmcastpocus
This is a patient presenting with “undifferentiated shock.” Luckily, we have the great differentiator: point of care ultrasound! Top left: pulmonary B lines (vertical comet tails) suggestive of pulmonary edema. Bottom left: Longitudinal view of dilated IVC with
Right ventricular dysfunction (RV is on left of screen) in a patient with submassive #PulmonaryEmbolism. You can see RV dilation and a +McConnell’s sign (RV apex looks like a trampoline). Remember ‘submassive’ isn’t about size, it’s about the presence of RV dysfunction (⬆️RV/LV ratio on echo or CT, ⬆️troponin/BNP, Echo/EKG changes). . . . . #POCUS #FOAMcc #FOAMed #physicianassistant #icu #criticalcare #futurepa #pastudent #paschool #medic #medlife #medicine #medschool #medstudent #healthcare #podcast #nursesofinstagram #criticalcarenurse #pulmcastpocus