Point-of-care ultrasound (curriculum)

The point-of-care ultrasound (PoCUS) curriculum is one of our curriculum articles and aims to be a collection of articles that represent the core applications of ultrasonography in a point-of-care setting.

Point-of-care ultrasound refers to ultrasonography which may be simultaneously performed, interpreted and utilized by a health care provider at the time of consultation, in proximity to the patient. The goals and scope are fundamentally different from the traditional sonographer-performed ultrasound, limited to specific clinical questions that narrow a clinician's differentials, guide clinical therapy, and direct consultations and disposition. 

While more detailed and complex ultrasonography applications may provide information that is more detailed than PoCUS, have greater anatomic specificity, or identify alternative diagnoses, PoCUS is non-invasive, rapidly deployed and does not entail removal of the patient from their clinical area, e.g. resuscitation suite.

PoCUS consensus statements emphasize engaging consultants early on in work-up, ultimately improving initial diagnostic accuracy, initiation of proper management, and allowing PoCUS to play a complementary role to traditional imaging modalities.

While grouping applications of PoCUS is largely arbitrary, the indications for PoCUS tend to revolve around either the function of an anatomical structure or a syndrome eliciting interrogation of systems pertaining to the differential diagnosis.

Anatomy

Thorax

• trachea

• ribs

• lungs

• pleura

• key findings

  • lung

    • a lines

    • lung sliding

    • b lines

  • pleura

    • mirror sign

    • curtain sign

Cardiac

• anatomy

  • cardiac chambers

    • right atrium

    • right ventricle

      • moderator band

    • left atrium

    • left ventricle

  • cardiac valves

    • mitral valve

    • tricuspid valve

    • aortic valve

    • pulmonic valve

  • key findings

    • transthoracic echocardiography views

    • myocardial segments

    • right ventricular function (point of care ultrasound)

    • left ventricular ejection fraction (echocardiography)

    • chordae tendineae

    • coronary sinus

    • pericardial space

    • epicardial fat pad

Abdomen

• tubular gastrointestinal organs

  • esophagus

  • stomach

    • gastric antrum

  • small bowel

    • duodenum

    • jejunum

    • ileum

  • large bowel

• solid gastrointestinal organs

  • liver

    • mickey mouse sign

    • couinaud segments

  • biliary tree

    • common bile duct

    • gallbladder

      • fundus

      • body

      • neck

  • pancreas

    • head

    • uncinate process

    • neck

    • body 

    • tail

  • spleen

    • splenic vein

  • genitourinary

    • kidney

    • ureter

    • bladder

• key findings

  • jejunum vs ileum

  • gut signature

  • peristalsis

  • bladder volume

Aorta

• thoracic aorta

  • ascending aorta

  • aortic arch

  • descending aorta

• abdominal aorta

  • abdominal aorta branches

• key findings

  • aortic annulus

  • sinuses of valsalva

  • sinotubular junction

Upper and lower Limb

• upper limb

  • musculoskeletal

    • shoulder

    • elbow

    • hip

  • vessels

    • axillary artery

    • brachial artery

    • radial artery

    • ulnar artery

    • nerves

      • median nerve

      • radial nerve

      • ulnar nerve

• key findings

  • anisotropy

  • graded compression

Ear, Nose and Throat

• anatomy

  • maxillary sinus

  • pharynx

  • larynx

• key findings

  • true vocal cords

Ocular

• anatomy

  • anterior chamber

  • posterior chamber

  • crystalline lens

  • vitreous body

  • retina

  • optic nerve

• key findings

  • optic nerve sheath diameter

Gynecological

• pelvic viscera

  • uterus

  • ovaries

  • cervix

• key findings

  • rectouterine pouch

Nervous system

• central nervous system

  • transcranial doppler

• peripheral nervous system

  • brachial plexus

• key findings

Radiological examinations

• cardiac

  • FATE (Focus‐Assessed Transthoracic Echocardiography)

  • DEFG for basic echocardiography (summary)

  • focused echocardiography examination in life

• lung

  • bedside lung ultrasound in emergency (BLUE)

  • sonographic approach to dyspnea

• abdomen and thorax

  • focused assessment with sonography in HIV/TB (FASH)

  • rapid ultrasound in shock and hypotension

  • focused assessment with sonography for trauma (FAST) scan

  • pericardiocentesis (ultrasound)

  • thoracentesis (ultrasound)

  • paracentesis (ultrasound)

• neurovascular

  • nerves

    • interscalene brachial plexus block

    • supraclavicular brachial plexus block

    • axillary nerve block

    • radial nerve block

    • ulnar nerve block

    • median nerve block

  • vasculature

    • central venous access (ultrasound)

    • peripheral venous access (ultrasound)

Pathology

Thorax

• lungs and airways

  • trachea

    • evaluation of endotracheal intubation

      • double trachea sign

      • esophageal intubation

      • mainstem bronchus intubation

    • lungs

      • alveolar-interstitial pathology

        • shred sign

        • air bronchograms

          • dynamic

          • static

        • fluid bronchogram

      • interstitium

        • b-lines

    • pleural pathology

      • pneumothorax

        • lung point

      • pleural effusion

        • pleural effusion volume

        • quad sign

        • sinusoid sign

        • spine sign

        • pleuritis

          • pleural thickening

• vessels

  • thoracic aorta

    • aortic dissection

    • aortic aneurysm

• cardiac

  • structure

    • cardiac chamber enlargement

      • atria

        • left atrium

        • right atrium

      • ventricles

        • left ventricular hypertrophy

        • dilated cardiomyopathy

        • hypertrophic cardiomyopathy

        • arrhythmogenic right ventricular cardiomyopathy

  • function

    • systolic dysfunction

      • wall motion abnormalities

        • regional

          • myocardial infarction

          • takotsubo cardiomyopathy

        • global

          • congestive cardiac failure

      • diastolic dysfunction

        • left atrial pressure

          • elevated vs normal

        • grade I

          • formerly "impaired filling"

        • grade II

          • formerly "pseudonormal"

        • grade III

          • formerly "restrictive filling"

  • valvular dysfunction

    • atrioventricular valves

      • tricuspid valve

        • tricuspid regurgitation

        • tricuspid stenosis

      • mitral valve

        • mitral valve prolapse

        • mitral valve regurgitation

          • carpentier classification

        • mitral valve stenosis

    • semilunar valves

      • pulmonic valve

        • pulmonic valve stenosis

        • pulmonic valve regurgitation

      • aortic valve

        • aortic valve stenosis

        • aortic valve regurgitation

Abdomen

• gastrointestinal tract

  • mural

    • bowel wall thickening

    • intussusception

      • target sign

      • pseudo-kidney

    • hypertrophic pyloric stenosis

      • antral nipple sign

      • cervix sign

      • beak sign

      • shoulder sign

  • luminal

    • bowel dilatation (summary)

    • small bowel obstruction

  • diffuse/inflammatory

    • inflammatory bowel disease

    • appendicitis

      • appendicolith

    • ileus

• peritoneal recesses

  • free intraperitoneal fluid

  • free intraperitoneal air

    • pneumoperitoneum

      • peritoneal stripe sign

  • ascites

• right upper quadrant

  • liver

    • simple hepatic cyst

  • biliary tree

    • biliary tree dilatation

  • gallbladder

    • cholecystitis

      • wall echo shadow sign

    • cholelithiasis

      • rolling stone sign

    • gallbladder sludge

  • pancreas

    • acute pancreatitis

      • complications

    • chronic pancreatitis

  • spleen

    • splenomegaly

  • renal

    • hydronephrosis

      • hydronephrosis grading

Ocular

• retinal detachment

• vitreous hemorrhage

• lens dislocation

Male reproductive system

• scrotum

  • acute scrotum

• testes

  • testicular torsion

  • acute epididymo-orchitis

• testicular adnexa

  • epididymal abscess

Female reproductive system

• acute pelvic pain

• uterus

  • gravid

    • ​​gestational sac

    • t sign

    • yolk sac

    • fetal pole

      • fetal heart rate

    • abnormally eccentric gestational sac

  • puerperium

    • retained products of conception

  • non-gravid

    • abnormal endometrial thickness

  • adnexa

    • ectopic pregnancy

      • pregnancy of unknown location

      • tubal ectopic pregnancy

        • tubal ring sign

      • interstitial ectopic pregnancy

        • interstitial line sign

      • pelvic inflammatory disease

        • tubo-ovarian abscess

  • ovaries

    • ovarian torsion

      • whirlpool sign

    • ovarian cyst

      • ovarian cyst rupture

  • fallopian tubes

    • cogwheel sign

Upper and Lower extremities

• venous

  • deep venous thrombosis

    • axillary

• musculoskeletal

  • upper extremity

    • shoulder

      • anterior dislocation

    • proximal upper extremity

      • long head of biceps tendinopathy

Soft tissue

• infectious

  • abscess

  • cellulitis

Physics

• ultrasound (introduction)

  • basic physics

  • transducers

  • see ultrasound artifacts