The advent of smaller, portable, and less expensive ultrasound machines is leading to a revolution in bedside patient care. Now clinicians can rapidly evaluate for specific life-threatening conditions such as abdominal aortic aneurysm, at the bedside, in real time.
In addition, the fact that clinicians often approach the use of ultrasound technology in non-traditional ways is leading to ever increasing possibilities. The barriers separating radiology, physiology, and bedside care are being broken down. By melding clinical knowledge and technology at the bedside, it is possible to better understand many clinical scenarios. Ultrasound can, for example, be used to differentiate various forms of shock at the bedside. As this technology spreads, more novel uses will undoubtedly be discovered that will dramatically impact bedside patient care.
Ultrasound use can be broken down into three main types: Emergency Ultrasound (EUS), Diagnostic Ultrasound and Clinical Ultrasound. Typical EUS focuses on the use of ultrasound to answer a clinical question in a yes or no fashion. For example, is a given patient's abdominal discomfort due to gallstones? EUS must be used in conjunction with the clinical assessment to have any value. The limited exam typical of EUS is distinctly different from diagnostic ultrasound. Diagnostic ultrasound is typically performed by ultrasound technologists and radiologists, involves a complete examination, and its use should not be discounted. Clinical ultrasound falls in between the yes / no questions of EUS but is still quite different from diagnostic ultrasound exam. Clinical ultrasound is still limited point of care ultrasound but evaluates a condition or a state of physiology. An example of clinical ultrasound would be the use of ultrasound to distinguish the type of shock present in a patient, as well as guiding the treatment.
This guide is a reference for the clinician who utilizes ultrasound in the bedside evaluation of patients. Foremost, the intent is to assist the clinician in identifying clinical scenarios in which bedside ultrasound would be useful. The guide also provides guidance on technical matters such as probe selection, probe placement and interpretation of normal anatomy. Perhaps most importantly, the guide assists the clinician in determining how best to integrate the ultrasound results into clinical practice. The clinician must, however, possess knowledge of the limitations of ultrasound in each scenario and must recognize when other diagnostic modalities are needed. Further, this guide is not to serve as a complete reference or as a substitute for adequate cognitive and practical hands-on training.
Before incorporating ultrasound into your clinical practice, one must possess a baseline level of didactic knowledge and the technical competency required to generate adequate images. These goals should be accomplished through dedicated ultrasound course work and hands on training.
Matthew Lyon, MD
Carl Menckhoff, MD
Stephen Shiver, MD