POCUS, any US reccs?

[NRAI2001]

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Hey guys,

I recently took a 5 hour POCUS course (I know it was short but actually really good and I learned a lot). I am signed up to take a 2 day course next month in POCUS. I really enjoyed and walked away really interested in it.

Any recommendations on portable US to purchase? Especially when it comes to imaging quality, apps and additional functions of the machine, tech support, education and training. I would like it to be able to fit in a laptop bag.

Thanks

 

[DrMetal]

Any recommendations

Order formal US studies (done by a tech, read by a radiologist). Your future lawyers will appreciate it . . .

 

[NotAProgDirector]

You should definitely check out the Butterfly: The clear answer in point-of-care ultrasound | Butterfly iQ3

 

[NRAI2001]

Order formal US studies (done by a tech, read by a radiologist). Your future lawyers will appreciate it . . .

I guess no physician should ever read an EKG if they re not a cardiologist, CXR if they re not a pulmonologist, cbc if they re not an oncologist, cmp if they re not a nephrologist , a1c if they re not an endocrinologist and so on either with this logic??

I think we can all determine when a formal study is needed.

 

[DrMetal]

I guess no physician should ever read an EKG if they re not a cardiologist, CXR if they re not a pulmonologist, cbc if they re not an oncologist, cmp if they re not a nephrologist , a1c if they re not an endocrinologist and so on either with this logic??

Nor use a stethoscope (get the formal echo), nor use a reflex hammer (get the MRI).

Sorry kiddo, is the way of the world.

US is tricky. Unless you're doing it everyday, I'd have a low threshold for getting the formal studies, to rule in or out pathology.

If you don't take my word for it, your future lawyers and hosp admin will explain in better detail.

 

[NRAI2001]

Nor use a stethoscope (get the formal echo), nor use a reflex hammer (get the MRI).

Sorry kiddo, is the way of the world.

US is tricky. Unless you're doing it everyday, I'd have a low threshold for getting the formal studies, to rule in or out pathology.

If you don't take my word for it, your future lawyers and hosp admin will explain in better detail.

Nothing is 100% accurate and if a formal study is needed I would think having done a POCUS or any sort of physical exam (I believe POCUS falls inline with physical exam more than a "Study") would look better if anything would have occurred while waiting for the formal study. You are responsible for the patient until the specialist sees them or the study is completed, read and reported.

Infact I have heard of cases where something did happen and an US was available in clinic and the lawyers questioned why it wasnt used. Not knowing how to use it isnt a good explanation.

 

[greatnt249]

Nothing is 100% accurate and if a formal study is needed I would think having done a POCUS or any sort of physical exam (I believe POCUS falls inline with physical exam more than a "Study") would look better if anything would have occurred while waiting for the formal study. You are responsible for the patient until the specialist sees them or the study is completed, read and reported.

Infact I have heard of cases where something did happen and an US was available in clinic and the lawyers questioned why it wasnt used. Not knowing how to use it isnt a good explanation.

It's not a good explanation, in fact. Why? Because it isn't a reasonable expectation under the purview of an internist to be able to perform POCUS. On the flip side of what you describe, I've seen people state that findings were present on POCUS that were decidedly not present on formal study (pleural effusion misidentified as pericardial effusion, for instance).

Ultrasound is a useful tool, sure. But I believe the spirit of what Dr Metal was getting at was that, when in doubt, just get a formal study; you want to have a leg to stand on to defend your actions.

 

[NRAI2001]

It's not a good explanation, in fact. Why? Because it isn't a reasonable expectation under the purview of an internist to be able to perform POCUS. On the flip side of what you describe, I've seen people state that findings were present on POCUS that were decidedly not present on formal study (pleural effusion misidentified as pericardial effusion, for instance).

Ultrasound is a useful tool, sure. But I believe the spirit of what Dr Metal was getting at was that, when in doubt, just get a formal study; you want to have a leg to stand on to defend your actions.

Yes of course. Being able to do POCUS doesn't replace a formal US. If have high suspicion or high concern I would always get formal studies.

Why argue against it being tool similar to your stethoscope? What really is the point of all of it? Which US would be good for POCUS (not replacing formal US) was the question. Its a new emerging bedside tool that will be used more and more. If you re trying to stay uptodate then POCUS is a reasonable area to further examine. IF you haven't taken a POCUS class you ll be surprised how good they ve gotten.

A lawyer may ask why you didn't use your stethoscope to listen to the heart and lungs (regardless if you ordered a formal echo or cardio consult). I spoke to physicians where the question was asked by lawyers why did you not use the US for bedside exam when you had it available at your clinic/facility in situations where a bad outcome occurred. If your clinic or facility has an US you may take the opportunity to familiarize yourself with it or it maybe better not to have that equipment present.

 

[DrMetal]

Why argue against it being tool similar to your stethoscope?

B/c you might pigeon-hole yourself with it and get yourself into trouble. That's what we're cautioning you against.

Look, the sad reality is: the bedside physical exam---and any tools that might go with it, stethoscope, POCUS, anoscope (my favorite)---has fallen by the wayside. They're not definsible tools. They have to almost always get formal studies. So sadly, there's no point in using them. If you have a good history and high enough clinical suspicion, just go straight to the formal study.

They don't teach this in medical school/GME. GME makes you think you're practicing 1950s medicine (each patient gets a 30-minute thorough physical exam, with all sorts of tools, you gather around and sing kumbayah, etc).

But ok . . . if you insist, go for it (with POCUS I mean . . . don't use an anoscope).

 

[NRAI2001]

B/c you might pigeon-hole yourself with it and get yourself into trouble. That's what we're cautioning you against.

Look, the sad reality is: the bedside physical exam---and any tools that might go with it, stethoscope, POCUS, anoscope (my favorite)---has fallen by the wayside. They're not definsible tools. They have to almost always get formal studies. So sadly, there's no point in using them. If you have a good history and high enough clinical suspicion, just go straight to the formal study.

They don't teach this in medical school/GME. GME makes you think you're practicing 1950s medicine (each patient gets a 30-minute thorough physical exam, with all sorts of tools, you gather around and sing kumbayah, etc).

But ok . . . if you insist, go for it (with POCUS I mean . . . don't use an anoscope).

I agree with all that you said. I just think there is a place for POCUS as a tool though not required and it doesn't surpass a formal study.

 

[ThoracicGuy]

Yes of course. Being able to do POCUS doesn't replace a formal US. If have high suspicion or high concern I would always get formal studies.

Why argue against it being tool similar to your stethoscope? What really is the point of all of it? Which US would be good for POCUS (not replacing formal US) was the question. Its a new emerging bedside tool that will be used more and more. If you re trying to stay uptodate then POCUS is a reasonable area to further examine. IF you haven't taken a POCUS class you ll be surprised how good they ve gotten.

A lawyer may ask why you didn't use your stethoscope to listen to the heart and lungs (regardless if you ordered a formal echo or cardio consult). I spoke to physicians where the question was asked by lawyers why did you not use the US for bedside exam when you had it available at your clinic/facility in situations where a bad outcome occurred. If your clinic or facility has an US you may take the opportunity to familiarize yourself with it or it maybe better not to have that equipment present.

And when you use it but then don't send them for a formal exam and something ends up showing up later that potentially harms the patient, they'll come after you for relying on your bedside exam that you took a weekend course for instead of the exam read by a boarded radiologist. It opens you up to trouble even if it's not an inciting event.

 

[Powdermonkey]

You should definitely check out the Butterfly: The clear answer in point-of-care ultrasound | Butterfly iQ3

The butterfly is pretty easy to use, but their subscription service that you have to use to get the functionality bothers me. Especially since they just killed any support for their v1 probes basically bricking them. Sucks for those who have one. I am going into sports med, and of all the handheld probes I've used, the GE VScan Air is my favorite. It is a little more expensive at the onset, but no subscription makes it well worth it, imho.

@NRAI2001 OP, for your case, it depends what you want to do with it. If you just like gathering more info before ordering tests and making decisions, it might help. But. If you aren't using it regularly, you will be slow at it, your images likely won't be great, and you need some way to store or reference them. In my ED practice I will use it to supplement when I am looking/localizing for foreign bodies in the skin WITH xray imaging. When the nurses cant find a fetal heart rste with the handheld doppler, I can with the US. And if I can't, formal US time. I've diagnosed a few MSK injuries (Rotator cuff, torn hamstring, joint aspirations), and then promptly referred to ortho. I use it for almost any line I place save for maybe less than a handful of trauma/code/crash fem lines, but I still like to look with the US to make sure its venous and not arterial.

In non ED clinical or office based practice? It really just depends on how much time you want to put into it. If you do PM&R or sports, or something more procedure based, you will use it often. Otherwise, you could see another 1-2 patients instead of futzing around with the US and then eventually ordering the formal study anyway. This isnt trying to detract you from trying, just trying to be realistic. And this is coming from a 10+ year ED attending who enjoys US and procedures enough to go back to fellowship in July so that I can get trained to utilize it efficiently and bill for it. Feel free to PM me if you have any specific questions.

 

[greatnt249]

Yes of course. Being able to do POCUS doesn't replace a formal US. If have high suspicion or high concern I would always get formal studies.

Why argue against it being tool similar to your stethoscope? What really is the point of all of it? Which US would be good for POCUS (not replacing formal US) was the question. Its a new emerging bedside tool that will be used more and more. If you re trying to stay uptodate then POCUS is a reasonable area to further examine. IF you haven't taken a POCUS class you ll be surprised how good they ve gotten.

A lawyer may ask why you didn't use your stethoscope to listen to the heart and lungs (regardless if you ordered a formal echo or cardio consult). I spoke to physicians where the question was asked by lawyers why did you not use the US for bedside exam when you had it available at your clinic/facility in situations where a bad outcome occurred. If your clinic or facility has an US you may take the opportunity to familiarize yourself with it or it maybe better not to have that equipment present.

I don't see why you could be held liable for not doing something you're not specifically credentialed to do. That would be like suing me for not performing an emergent tracheostomy on a coding patient in my clinic despite scalpels being available in the facility.