The POCUS Consult: How Point of Care Ultrasound Helps Guide Medical Decision Making

The I-AIM (Indication, Acquisition, Interpretation, Medical decision-making) model is a conceptive framework uniquely applicable to every point of care ultrasound application. We present a systematic comprehensive approach to lung ultrasound based on the I-AIM framework. Supplemental Digital Content is available in the text.

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798 Introduction of Bedside Echocardiography by Mid-level Providers into Burn Intensive Care

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.375 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S235-S236

Author(s):

Michael G Chambers ◽

Garrett W Britton ◽

Leopoldo C Cancio

Keyword(s):

Decision Making ◽

Intensive Care ◽

Medical Decision Making ◽

Point Of Care ◽

Physical Exam ◽

Medical Decision ◽

Point Of Care Ultrasound ◽

Laboratory Findings ◽

Radiographic Findings ◽

Us Findings

Abstract Introduction Point-of-care ultrasound (US) has been shown to be a useful adjunct in assessment of various shock states and has been utilized to guide both resuscitation and post-resuscitation de-escalation. We aimed to characterize the use of bedside ultrasound examinations performed by advance practice providers (APPs) and attending physicians in a burn intensive care unit (BICU). Methods We introduced routine US by an APP into our BICU and evaluated our experience under an approved PI project. Daily beside US exams were performed utilizing a portable US machine with a cardiac probe and tissue filter. US exams included focused transthoracic echocardiography, assessment of inferior vena cava diameter with distensibility/collapsibility indices, and pulmonary evaluation. The images were archived to a centralized repository and reviewed daily during multi-disciplinary rounds. US data were utilized in conjunction with physical exam, radiographic, and laboratory findings for medical management decision making. Results Thirty-four exams of 34 patients have been conducted to date. 91% of US findings corresponded to physical, laboratory, and radiographic findings, and contributed positively to medical decision making. 9% of US findings either did not contribute to medical decision making or conflicted with physical exam, radiographic, or laboratory findings. Conclusions Our results demonstrate the feasibility of routine US by an APP in the BICU, and indicate that bedside US helps guide both resuscitative and post-resuscitative care. Applicability of Research to Practice It is well known that positive fluid balance is associated with worse clinical outcomes. We believe point-of-care US is a viable tool in preventing over-resuscitation as well as to guide post-resuscitative diuresis.

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Feasibility and Acceptability of a Structured Curriculum in Teaching Procedural and Basic Diagnostic Ultrasound Skills to Internal Medicine Residents

Journal of Graduate Medical Education ◽

10.4300/jgme-d-12-00214.1 ◽

2013 ◽

Vol 5 (3) ◽

pp. 493-497 ◽

Cited By ~ 24

Author(s):

Daniel J. Schnobrich ◽

Andrew P. J. Olson ◽

Alain Broccard ◽

Alisa Duran-Nelson

Keyword(s):

Internal Medicine ◽

Medical Decision Making ◽

Point Of Care ◽

Image Acquisition ◽

Abdominal Ultrasound ◽

Medical Decision ◽

Point Of Care Ultrasound ◽

Internal Medicine Residents ◽

Teaching Interventions ◽

Future Work

Abstract Background Point-of-care ultrasound has emerged as a powerful diagnostic tool and is also being increasingly used by clinicians to guide procedures. Many current and future internists desire training, yet no formal, multiple-application, program-wide teaching interventions have been described. Intervention We describe a structured 30-hour ultrasound training course in diagnostic and procedural ultrasound implemented during intern orientation. Internal medicine interns learned basic ultrasound physics and machine skills; focused cardiac, great vessel, pulmonary, and abdominal ultrasound diagnostic examinations; and procedural applications. Results In postcourse testing, learners demonstrated the ability to acquire images, had significantly increased knowledge scores (P < .001), and demonstrated good performance on practical scenarios designed to test abilities in image acquisition, interpretation, and incorporation into medical decision making. In the postcourse survey, learners strongly agreed (4.6 of 5.0) that ultrasound skills would be valuable during residency and in their careers. Conclusions A structured ultrasound course can increase knowledge and can result in learners who have skills in image acquisition, interpretation, and integration in management. Future work will focus on refining and improving these skills to allow these learners to be entrusted with the use of ultrasound independently for patient care decisions.

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A survey of doctors reveals that few laboratory tests are of primary importance at the Emergency Department

Diagnosis ◽

10.1515/dx-2014-0025 ◽

2014 ◽

Vol 1 (3) ◽

pp. 239-244 ◽

Cited By ~ 7

Author(s):

Dennis J. van de Wijngaart ◽

Jolanda Scherrenburg ◽

Lisette van den Broek ◽

Nadine van Dijk ◽

Pim M.W. Janssens

Keyword(s):

Decision Making ◽

Emergency Department ◽

Laboratory Tests ◽

Medical Decision Making ◽

Point Of Care ◽

Diagnostic Testing ◽

Medical Decision ◽

Optimal Decision ◽

Diagnostic Tools ◽

Optimal Decision Making

AbstractLaboratory tests in hospitals are among the most important diagnostic tools for medical decision making at the Emergency Department. They are often ordered as part of extended test panels, which, although helpful and convenient for doctors, may lead to overuse of tests and overdiagnosis. To improve the ordering process, we investigated which laboratory tests are essential for optimal decision making at the Emergency Department of our hospital.Forty-nine doctors regularly involved with the Emergency Department filled in a questionnaire asking for their opinions on laboratory test ordering and use.A limited number of laboratory tests are considered indispensable for the Emergency Department: CRP and leukocytes, urea and creatinin, sodium and potassium, and haemoglobin. Glucose and troponin should probably also be included in this list, but were not mentioned as glucose is measured using portable point-of-care devices in our hospital, while cardiac patients are referred directly to the cardiac care unit.Only a limited number of laboratory tests are essential for early medical decision making at the Emergency Department. Ordering facilities should be arranged such that these tests are permanently available, easy to order, and performed with short turnaround times. Test panels for the ED should incorporate these essential tests, with additional other tests so as to prevent essential tests from being forgotten, maintain convenience for doctors and promote sensible and effective use of diagnostic testing. The outcome of these conflicting aims is a compromise, as is discussed.

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