Ultrasound in Primary care?

[Slevin]

Outside of OB patients has anyone found a benefit to using POCUS in a FM clinic?

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[galactus]

I do POCUS all the time... and I don't do OB. I mostly do it for MSK reasons, but occasionally I'll do AAA or Abdominal scans.

 

[AMEHigh]

I will be focusing on gyn/reproductive health (not OB) and yes my clinic uses US regularly.

 

[teacherman84]

I'm FM/sports so I'm using it all the time for diagnostic MSK exams and guiding procedures, but doing more POCUS applications. The quick ones I use most is soft tissue (cellulitis vs abcess), LE DVT scans, Lung US, and OB. I do less RUQUS, AAA screen, limited ECHO... but want to get more comfortable. I think with things like butterfly coming out. This is going to be more and more prevalent. As a specialty, and medical education in general, we need to embrace it.

 

[teacherman84]

Outside of OB patients has anyone found a benefit to using POCUS in a FM clinic?

As a specific recent anecdote...a resident came to for me to do a scan of a calf. It was a weight lifter, immediate onset pain and swelling while lifting. Here for an ER follow up, was in the ED a few days prior where they ruled out DVT and said FU with primary care.
The resident was concerned about gastric tear given he was lifting hard when it started to hurt (he doesnt skip leg day). The MSK scan looked good but swelling seemed out of proportion. I scanned over the popliteal vasculature...no flow, let alone ability to compress where the popliteal vein should have been. Formal doppler later confirmed Large DVT.

 

[Freezeout]

As a specific recent anecdote...a resident came to for me to do a scan of a calf. It was a weight lifter, immediate onset pain and swelling while lifting. Here for an ER follow up, was in the ED a few days prior where they ruled out DVT and said FU with primary care.
The resident was concerned about gastric tear given he was lifting hard when it started to hurt (he doesnt skip leg day). The MSK scan looked good but swelling seemed out of proportion. I scanned over the popliteal vasculature...no flow, let alone ability to compress where the popliteal vein should have been. Formal doppler later confirmed Large DVT.

You’re my hero

 

[deleted87716]

As a specific recent anecdote...a resident came to for me to do a scan of a calf. It was a weight lifter, immediate onset pain and swelling while lifting. Here for an ER follow up, was in the ED a few days prior where they ruled out DVT and said FU with primary care.
The resident was concerned about gastric tear given he was lifting hard when it started to hurt (he doesnt skip leg day). The MSK scan looked good but swelling seemed out of proportion. I scanned over the popliteal vasculature...no flow, let alone ability to compress where the popliteal vein should have been. Formal doppler later confirmed Large DVT.

HTF did they "rule out" a DVT in the ER...?

 

[teacherman84]

HTF did they "rule out" a DVT in the ER...?

Negative LE doppler

 

[deleted87716]

Negative LE doppler

Pretty sure popliteal is usually included with those. So, hospital fail...? I hope you let them know.

 

[teacherman84]

Pretty sure popliteal is usually included with those. So, hospital fail...? I hope you let them know.

It does. Maybe it was below where they scanned and propagated above. Swelling had worsened from initial onset of pain.

 

[deleted87716]

It does. Maybe it was below where they scanned and propagated above. Swelling had worsened from initial onset of pain.

Still, swing and a miss.

 

[teacherman84]

Still, swing and a miss.

I agree...and because of that negative report in hand the resident had stopped thinking about DVT and had honed in on looking at an MSK issue. I don't know that I would've have jumped to a repeat formal LE doppler for this follow up so soon...but a quick scan and seeing the clot myself seals the deal.
Again, less about the example...more a testament to how having that technology can change patient care in the FM clinic.

 

[septoplasty]

As a specific recent anecdote...a resident came to for me to do a scan of a calf. It was a weight lifter, immediate onset pain and swelling while lifting. Here for an ER follow up, was in the ED a few days prior where they ruled out DVT and said FU with primary care.
The resident was concerned about gastric tear given he was lifting hard when it started to hurt (he doesnt skip leg day). The MSK scan looked good but swelling seemed out of proportion. I scanned over the popliteal vasculature...no flow, let alone ability to compress where the popliteal vein should have been. Formal doppler later confirmed Large DVT.

Really atypical presentation, but cool.

Yes, I do POC US (MSK Purposes), I'm SM trained though like some of the above posters.

 

[hallowmann]

What kind of training/certification did you all use to get confident using POCUS? My program has a regular didactics course on POCUS, which I can attend at least some of the time, and obviously I used it a lot in the ED (usually only to find abscesses or veins) and OB, but I honestly don't use it a lot in clinic. I don't think I'll be comfortable enough and trust my skills to use it independently in practice after training. Is there are preferred certification course that you recommend?

 

[Freezeout]

What kind of training/certification did you all use to get confident using POCUS? My program has a regular didactics course on POCUS, which I can attend at least some of the time, and obviously I used it a lot in the ED (usually only to find abscesses or veins) and OB, but I honestly don't use it a lot in clinic. I don't think I'll be comfortable enough and trust my skills to use it independently in practice after training. Is there are preferred certification course that you recommend?

You could check out the AIUM site. If you just wanted to look at MSK applications OrthoSono and MSKUS offer great courses. There’s also 123sonography.

 

[TableMD]

I use it almost every day, often for diagnostic purposes, often for MSk issues that come up in sports or primary care. Like others hve said its a great tool.

 

[septoplasty]

What kind of training/certification did you all use to get confident using POCUS? My program has a regular didactics course on POCUS, which I can attend at least some of the time, and obviously I used it a lot in the ED (usually only to find abscesses or veins) and OB, but I honestly don't use it a lot in clinic. I don't think I'll be comfortable enough and trust my skills to use it independently in practice after training. Is there are preferred certification course that you recommend?

If you want to do it for MSK, the sports conference usually has modules you can sign up for.
Too late for this year though, they are usually given to priority based applicants (fellows, sports attending, than everyone else). But certainly this is an avenue.

Again, just be sure you're comfortable. A conference/5 day CME =/= competency, especially when it isn't a part of GME in residency.

 

[teacherman84]

What kind of training/certification did you all use to get confident using POCUS? My program has a regular didactics course on POCUS, which I can attend at least some of the time, and obviously I used it a lot in the ED (usually only to find abscesses or veins) and OB, but I honestly don't use it a lot in clinic. I don't think I'll be comfortable enough and trust my skills to use it independently in practice after training. Is there are preferred certification course that you recommend?

There isn't really a certain course as there is no certification for pocus. There are a lot of great training options, some free, some very expensive.
Some free FOAMed options (like Ultrasound Ninja) or intense, expensive options with a certificate (Ultrasound Leadership Academy)
AAFP conferences like FMX usually have training as well.

 

[KeikoTanaka]

I'm glad more PCPs are using this and it is accessible. I think having tools like this really separates offices in terms of quality. Saving patients tons of time/money by not sending them out to get all these scans done (Assuming you also have an X-ray machine in the office). It makes me excited for the future of primary care (Current MS-1 thinking about primary )

 

[Hamhock]

Still, swing and a miss.

It is also not that uncommon for clots distal to the trifurcation to "propagate" towards the popliteal.

There is significant debate within the POCUS community regarding the timing and need of repeat DVT ultrasound.

Perhaps this was a swing and a miss...but it is likely also an expected event.

HH

 

[BigSib]

I got a GE V-scan for about $2000 a few months ago. Had some training in residency and watch some tutorial videos here and there. I use it about once a week to mostly eval abdominal organs, like for vague abdominal pain. Honestly is more of a placebo eval (free for patient) for those with probable IBS and such but I have seen a few inflamed gallbladders and such along the way. I usually get formal imaging if I have concerns. Would like to get more experience on echos; it does a pretty good job with that. Need a vascular probe for more superficial things.