Point of Care Ultrasound

Your primary survey is as follows:

Airway – Patent

Breathing – Clearly tachypneic, speaking in 1 word sentences

Circulation – Sweaty and pale

Disability – Awake and restless

Your physician colleague Is extrapolating the history from the paramedics while your respiratory therapist is performing a focused respiratory physical examination. You have seen this situation before and you think to yourself: “I think this is a pulmonary embolism. I also remember seeing point-of-care ultrasound (POCUS) as a tool to help us with the diagnosis!”

What is POCUS?

Very briefly, POCUS is a handheld ultrasound where the images generated are performed by and       interpreted by the clinician, all at the patient’s location (Moore & Copel, 2011). This is different from      comprehensive ultrasound, which is a large machine that is usually operated in a dedicated radiology department and is meant to be comprehensive; POCUS is not meant to replace comprehensive ultrasound. In fact, POCUS is often viewed as an extension of the physical examination to increase diagnostic accuracy and support safer procedures (Moore & Copel, 2011). Some examples include: 

• Is there pulmonary edema?
• Are there gallstones?
• Is there decreased inotropy?
• Is there myocardial valvular pathology?
• Is there a pneumothorax?
• Is there free fluid in the abdomen? 
• Is there increased optic sheath diameter which suggests intracranial pressure?

POCUS and the Nurse

Understanding the utility and certain terminology of POCUS can help you, the Bedside Warrior, anticipate and plan patient care. 

Back to the Case Study

After receiving report from the paramedics, your physician colleague collects their POCUS and immediately begins performing a focused cardiac exam. As the nurse leader, you hear the following statements from your physician colleague:

“There’s a D Sign.”