While focussed ECHO and POCUS clearly have utility, I’m increasingly seeing them prioritised in emergency situations while the basics get forgotten about. And I don’t see it change management all that often 🤷
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In general I agree. But, referencing your later comments, it depends a little bit on whether you see a focused echo as an investigation or an extension of your examination. I see it as either/or/both depending on the intent, and detail/level of scan /
Though history, exam, investigations have the hierachical org of 1,2,3. We all know that with experience this becomes very horizontal, like how A-B-C-D-E can be dealt with mostly with talking to the patient and running your hands up their arm.
With experience, focused US becomes the extension of exam in the management of the sick person. Does it always change management? No. Issues come from people thinking that focused US is a panacea. But it needs experience of the sick patient before use. Time and time again, I’m referred 0400
Wake up SOB, bilateral crackles and low BP as pneumonia. Clinical reasoning tells me that that’s not the diagnosis. I don’t need echo for that. But I’ll echo them as a part of my assessment. But, the referrer also hasn’t integrated the history&exam properly already.
Yep, good points and I agree. I guess some of my frustration here stems from people training in Echo and then thinking that’s somehow a shortcut for experience or clinical judgement/competence. It’s a tool like any other in my book. Useful for sure, but not a panacea as you say.
When I’m being asked to do an echo in the ED for a syncope, after someone thought they saw pericardial effusion, but they can provide 0 history about the syncope itself.
POCUS is like any other tests. Neither good nor bad by itself, but absolutely useless (sometimes even deleterious) without medical history and careful physical examination.
I’d add, each time I think it aided/determined the diagnostics and management.
I fully get my biases here - at the time and retrospectively.
Have I seen others using POCUS without decent clinical grounding? Locally, not so much I think. But we are in Norfolk therefore are digitally compromised.
I’m just not so sure it’s *that* useful. Have outcomes started getting a lot better since we introduced these methods? The history and exam direct my investigations and management. Echo is one of those investigations no? I think that’s why I find it odd that we are doing it before history and exam.
Actually mainly in A&E with undifferentiated patients coming in. I’m all for it (echo) but after a proper A->E. I also want to get the history (collateral or otherwise) as the diagnosis is usually there.
Been thinking a lot about diagnostic yield of POCUS recently. Obviously hugely depends on your population. From evidence/ my experience in a mixed medical/surgical icu pop 50-60% of all scans will change management in some way and 5% will be a game changer.
Quick get the emergency AI language model. We need to take handover from the paramedics and the LLM can help us predict the cause of the patient's SEPSIS.
Curious about the scenarios where this occurs…What’s expected vs what’s practiced vs what’s trained? I assume these are ad hoc teams so practice variability exists to some degree
Yeah, even after doing all the basic FUSIC components, I honestly don't use them much (and very rarely in emergencies). I do wonder whether the basic stuff has pretty limited utility because I have seen more advanced echo change management but rarely if ever in an emergency.
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I think we’re probably on exactly the same page
#LaCliniqueBordayl (in french 😁)
On the wards or in Crit Care?
In lieu of an ABC approach?
Working 30-1st and had a few sig deteriorations to deal with.
I did hear myself saying can someone grab the US machine.
1/2
Is it cos POCUS has become my “crutch”? Or is it cos others were doing basics, so I was afforded the time?
I fully get my biases here - at the time and retrospectively.
Have I seen others using POCUS without decent clinical grounding? Locally, not so much I think. But we are in Norfolk therefore are digitally compromised.
Is the cause of shock obstructive, cardiogenic or distributive? Is the wheeze and T2RF from wet or obstructive lungs? Is the AKI post renal.
None are big ticket. Would argue they help. Needs the ongoing invx/therapy according to scan.
I do think POCUS gets us to a diagnosis faster - but only when used alongside pre-test probabilities.
POCUS without an associated intervention is pointless IMHO
And I say this as someone who does ward rounds with the ultrasound machine.
https://youtu.be/HMGIbOGu8q0?si=LGH-psfY-molWtNT