I've been talking to my ER friends and they are all saying that an ultrasound machine in the back pocket is going to be standard of care eventually. The critical care forum has a thread about an ultasound course for intensivists. What does everyone think about hospitalists getting proficient at basic ultrasound? I'm doing night float right now and I've had lots of times when I would have loved to be able to quickly r/o something like tamponade in a post-MI patient with hypotension. Or localizing a loculated effusion so I don't have to wait till morning to tap it. Even during the day, it gets old waiting for radiology to do this stuff for me. The radiologists will always be better of course, but it would be pretty cool to do some basic stuff on our own.

I use Site-Rite a lot for locating fluid pockets, etc. To do this formally you would have to get credentialled with the according rise in risk and malpractice.

Or localizing a loculated effusion so I don't have to wait till morning to tap it.

I'm a bit confused - is there any direct therapeutic benefit to tapping a loculated pleural effusion at the bedside? Usually you just end up with a trapped lung that fills up again. I can appreciate the diagnostic reasons though.

Loculated effusions get a chest tube.

But even for tapping a plain uncomplicated effusion or ascites, U/S localization can be helpful because the exam is not always accurate.