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Ultrasound in Primary care?

Discussion in 'Family Medicine' started by Slevin, Mar 14, 2019 at 10:00 PM.

  1. Slevin

    Physician 10+ Year Member

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

    galactus Devourer of WORLDS
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    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.
     
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  3. AMEHigh

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    I will be focusing on gyn/reproductive health (not OB) and yes my clinic uses US regularly.
     
  4. teacherman84

    Physician 10+ Year Member

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    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.
     
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  5. teacherman84

    Physician 10+ Year Member

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    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.
     
  6. Freezeout

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    You’re my hero
     
  7. Blue Dog

    Blue Dog Fides et ratio.
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    HTF did they "rule out" a DVT in the ER...?
     
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  8. teacherman84

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    Negative LE doppler
     
  9. Blue Dog

    Blue Dog Fides et ratio.
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    Pretty sure popliteal is usually included with those. So, hospital fail...? I hope you let them know.
     
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  10. teacherman84

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

    Blue Dog Fides et ratio.
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    Still, swing and a miss.
     
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  12. teacherman84

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    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.
     
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  13. septoplasty

    septoplasty Exceptional
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    Really atypical presentation, but cool.

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

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    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?
     

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