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Point-of-care ultrasound (curriculum)

Changed by David Carroll, 31 Aug 2018
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Updates to Article Attributes

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PointThe 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.

Definition

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. It is used by many specialties

Anatomy

Thorax
Gastrointestinal tract
Cardiac
Aorta
Lower and Upper Limb
  • approach
  • anatomy
  • key findings
  • conditions
Ear, Nose and Throat
Ocular
Hepatobiliary
Gynaecological
  • approach
  • key findings
  • conditions
Transcranial Doppler
  • approach
  • key findings

Radiological Examinations

Vascular Access
Pericardiocentesis

pericardiac tamponade

Paracentesis

ascites

Thoracentesis

pleural effusion

Suprapubic aspiration and catheterisation
Peripheral nerve blocks

Pathology

Respiratory Tract

  • Malposition of endotracheal tube
    • double trachea sign
    • oesophageal intubation
    • mainstem bronchus intubation
Gastrointestinal tract
Hepatobiliary
Scrotum
Uterus and adnexa in pregnancy
Lower extremities
  • Deep venous system
  • Superficial venous system

Thorax

Soft Tissue

Role of imaging

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 noninvasive, rapidly deployed and does not entail removal of the patient from the resuscitation area.

PoCUS consensus statements emphasize engaging consultants early on in workup, 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.

Physics

Structure-based studies

Airway Ultrasound
Thorax
Gastrointestinal tract
Cardiac
Aorta
Lower and Upper Limb
  • approach
  • anatomy
  • key findings
  • conditions
Ear, Nose and Throat
Ocular

Syndromic approaches 

Acute scrotum
Pregnancy
Paediatric

  • paediatric abdominal ultrasound

  • paediatric and neonatal intensive care
  • paediatric Musculoskeletal
    •
Deep Venous Thrombosis
Fractures
  • approach
  • anatomy
  • key findings
  • conditions
Chest pain
  • approach
  • anatomy
  • key findings
  • conditions
Dyspnoea/Respiratory Distress
  • approach: BLUE
  • anatomy
  • key findings
  • conditions
Resuscitation and Cardiac Arrest
  • approach: 
  • anatomy
  • key findings
  • conditions
Abdominal Pain
  • approach
  • anatomy
  • key findings
  • conditions
Hypotension
  • approach
  • anatomy
  • key findings
  • conditions
Trauma
(HIV) and Tuberculosis (TB) Co-Infection
  • approach
  • anatomy
  • key findings
  • conditions
Fever

  • approach

  • anatomy
  • key findings
  • conditions

System-based approach

Echocardiography/Haemodynamics
  • approach
  • key findings
  • conditions
Soft Tissue
Hepatobiliary
Gynaecological
  • approach
  • key findings
  • conditions
Transcranial Doppler
  • approach
  • key findings

Procedural adjunct

Vascular Access
Pericardiocentesis
Paracentesis
Thoracentesis
Suprapubic aspiration and catheterisation
Peripheral nerve blocks
  • -<p>Point-of-care ultrasound (PoCUS) 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. It is used by many specialties in and may be loosely divided into procedural and diagnostic applications.</p><p>Abnormal findings on FOCUS should be referred for comprehensive echocardiography, other testing, or consultation when the situation allows for this to be done safely</p><h4>Role of imaging</h4><p>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 noninvasive, rapidly deployed and does not entail removal of the patient from the resuscitation area.</p><p>PoCUS consensus statements emphasize engaging consultants early on in workup, ultimately improving initial diagnostic accuracy, initiation of proper management, and allowing PoCUS to play a complementary role to traditional imaging modalities.</p><p>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.</p><h4>Physics</h4><ul><li>
  • -<a href="/articles/ultrasound-introduction">ultrasound (introduction)</a><ul>
  • -<li>see <a href="/articles/ultrasound-artifacts-3">ultrasound artifacts</a>
  • -</li>
  • -<li><a href="/articles/physical-principles-of-ultrasound-1">basic physics</a></li>
  • -<li><a href="/articles/ultrasound-transducer">transducers</a></li>
  • -</ul>
  • -</li></ul><h4>Structure-based studies</h4><h5>Airway Ultrasound</h5><ul>
  • -<li>approach<ul><li><a href="/articles/tracheal-rapid-ultrasound-exam-true">tracheal rapid ultrasound exam (TRUE)</a></li></ul>
  • -</li>
  • -<li>anatomy<ul><li><a href="/articles/trachea">trachea</a></li></ul>
  • -</li>
  • -<li>key findings<ul><li>double trachea sign</li></ul>
  • -</li>
  • -<li>conditions<ul>
  • -<li>oesophageal intubation</li>
  • -<li>mainstem bronchus intubation</li>
  • -</ul>
  • -</li>
  • -</ul><h5>Thorax</h5><ul>
  • -<li>approach<ul><li>
  • -<a href="/articles/bedside-lung-ultrasound-in-emergency-approach">bedside lung ultrasound in </a><a href="/articles/bedside-lung-ultrasound-in-emergency-approach">emergency</a><a href="/articles/bedside-lung-ultrasound-in-emergency-approach"> (BLUE)</a>
  • -</li></ul>
  • -</li>
  • -<li>anatomy<ul>
  • -<li><a href="/articles/thoracic-anatomy">thorax</a></li>
  • +<p>The <strong>p</strong><strong>oint-of-care ultrasound (PoCUS) curriculum</strong> is one of our <a href="/articles/curriculum">curriculum</a> articles and aims to be a collection of articles that represent the core applications of ultrasonography in a point-of-care setting.</p><h4>Definition</h4><p>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. </p><h4>Anatomy</h4><h5>Thorax</h5><ul>
  • +<li><a href="/articles/trachea">trachea</a></li>
  • +<li><a href="/articles/ribs">ribs</a></li>
  • -</ul>
  • -</li>
  • -<li>conditions<ul>
  • -<li><a href="/articles/pneumothorax-ultrasound-1">pneumothorax</a></li>
  • -<li><a href="/articles/pneumonia">pneumonia</a></li>
  • -</ul>
  • -</li>
  • -<li>approach<ul><li>no standard protocol, but the vast majority of approaches to bowel pathology utilize a <a href="/articles/graded-compression">graded compression</a> technique</li></ul>
  • -</li>
  • -<li>anatomy<ul>
  • -</ul>
  • -</li>
  • -<li>approach<ul>
  • -<li><a href="/articles/fate-focusassessed-transthoracic-echocardiography">FATE (Focus‐Assessed Transthoracic Echocardiography)</a></li>
  • -<li><a href="/articles/defg-for-basic-echocardiography-summary">DEFG for Basic Echocardiography (summary)</a></li>
  • -</ul>
  • +<li>approach<ul><li>
  • +<br> </li></ul>
  • -<li>key findings<ul>
  • -<li><a href="/articles/chamber-enlargement">chamber enlargement</a></li>
  • -<li><a href="/articles/wall-thickening">wall thickening</a></li>
  • -<li>regional wall motion abnormalities</li>
  • -<li>valvular dysfunction<ul><li><a href="/articles/tricuspid-valve-regurgitation-1">tricuspid regurgitation</a></li></ul>
  • -</li>
  • -</ul>
  • -</li>
  • -<li>conditions<ul><li><a href="/articles/mitral-valve-prolapse">mitral valve prolapse</a></li></ul>
  • +<li>key findings<ul><li>
  • +<br> </li></ul>
  • -<li>conditions<ul>
  • -<li><a href="/articles/aortic-dissection">aortic dissection</a></li>
  • -<li>
  • -<a href="/articles/aortic-aneurysm-1">aortic</a><a href="/articles/aortic-aneurysm-1"> aneurysm</a>
  • -</li>
  • -</ul>
  • +<li>conditions<ul><li>
  • +<br> </li></ul>
  • -</ul><h4>Syndromic approaches </h4><h5>Acute scrotum</h5><ul>
  • +</ul><h5>Hepatobiliary</h5><ul>
  • +<li><a href="/articles/gallbladder">gallbladder</a></li>
  • +<li><a href="/articles/liver">liver </a></li>
  • +</ul><h5>Gynaecological</h5><ul>
  • +<li>approach<ul><li><a href="/articles/uterus">uterus</a></li></ul>
  • +</li>
  • +<li>key findings</li>
  • +<li>conditions</li>
  • +</ul><h5>Transcranial Doppler</h5><ul>
  • -<li>anatomy<ul><li><a href="/articles/testicular-and-scrotal-ultrasound">testicular Ultrasound</a></li></ul>
  • +<li>key findings</li>
  • +</ul><h4>Radiological Examinations</h4><ul>
  • +<li>
  • +<a href="/articles/bedside-lung-ultrasound-in-emergency-approach">bedside lung ultrasound in </a><a href="/articles/bedside-lung-ultrasound-in-emergency-approach">emergency</a><a href="/articles/bedside-lung-ultrasound-in-emergency-approach"> (BLUE)</a>
  • -<li>key findings<ul><li> </li></ul>
  • +<li><a href="/articles/focussed-echocardiography-examination-in-life">focussed echocardiography examination in life</a></li>
  • +<li><a href="/articles/rapid-ultrasound-in-shock-and-hypotension">rapid ultrasound in shock and hypotension</a></li>
  • +<li><a href="/articles/focussed-assessment-with-sonography-for-trauma-fast-scan">focussed assessment with sonography for trauma (FAST) scan</a></li>
  • +<li><a href="/articles/graded-compression">graded compression</a></li>
  • +<li>
  • +<a href="/articles/focussed-assessment-with-sonography-in-hiv-tb-fash">focussed</a> assessment with sonography<a href="/articles/focussed-assessment-with-sonography-in-hiv-tb-fash"> in HIV/TB (FASH)</a>
  • +</li>
  • +<li><a href="/articles/fate-focusassessed-transthoracic-echocardiography">FATE (Focus‐Assessed Transthoracic Echocardiography)</a></li>
  • +<li><a href="/articles/defg-for-basic-echocardiography-summary">DEFG for Basic Echocardiography (summary)</a></li>
  • +</ul><h5>Vascular Access</h5><h5>Pericardiocentesis</h5><p><a href="/articles/cardiac-tamponade">pericardiac tamponade</a></p><h5>Paracentesis</h5><p><a href="/articles/ascites">ascites</a></p><h5>Thoracentesis</h5><p><a href="/articles/pleural-effusion">pleural effusion</a></p><h5>Suprapubic aspiration and catheterisation</h5><h5>Peripheral nerve blocks</h5><h5> </h5><h4>Pathology</h4><p><strong>Respiratory Tract</strong></p><ul><li>Malposition of endotracheal tube<ul>
  • +<li>double trachea sign</li>
  • +<li>oesophageal intubation</li>
  • +<li>mainstem bronchus intubation</li>
  • +</ul>
  • +</li></ul><h5>Gastrointestinal tract</h5><ul>
  • +<li><ul>
  • +<li><a href="/articles/bowel-wall-thickening">bowel wall thickening</a></li>
  • +<li><a href="/articles/bowel-dilatation-summary">bowel dilatation (summary)</a></li>
  • +<li><a href="/articles/ascites">free intraperitoneal fluid</a></li>
  • +<li><a href="/articles/free-intraperitoneal-air">free intraperitoneal air</a></li>
  • +<li>presence or absence of peristalsis</li>
  • +<li>mural stratification</li>
  • +</ul></li>
  • +<li>conditions<ul>
  • +<li><a href="/articles/small-bowel-obstruction">small bowel obstruction</a></li>
  • +<li><a href="/articles/inflammatory-bowel-disease">inflammatory bowel disease</a></li>
  • +<li><a href="/articles/adynamic-ileus">ileus</a></li>
  • +</ul>
  • -<li>conditions<ul><li>t<a href="/articles/testicular-torsion">esticular torsion</a>
  • -</li></ul>
  • +</ul><h5>Hepatobiliary</h5><ul>
  • +<li><a href="/articles/wall-echo-shadow-sign-ultrasound">wall echo shadow sign</a></li>
  • +<li><a href="/articles/gallstones-1">cholelithiasis</a></li>
  • +<li><a href="/articles/cholecystitis">cholecystitis</a></li>
  • +</ul><h5>Scrotum</h5><ul><li>
  • +<a href="/articles/testicular-torsion">acute scrotum</a><ul>
  • +<li><a href="/articles/testicular-torsion">testicular torsion</a></li>
  • +<li><a href="/articles/epididymitis">acute epididymo-orchitis</a></li>
  • +</ul>
  • +</li></ul><h5>Uterus and adnexa in pregnancy</h5><ul>
  • +<li>intrauterine pregnancy<ul>
  • +<li>​​<a href="/articles/gestational-sac">gestational sac</a>
  • -</ul><h5>Pregnancy</h5><ul>
  • -<li>approach</li>
  • -<li>anatomy</li>
  • -<li>key findings<ul>
  • -<li><a href="/articles/gestational-sac">gestational sac</a></li>
  • -<li>conditions<ul><li><a href="/articles/pregnancy-of-unknown-location">pregnancy of unknown location</a></li></ul>
  • +<li>ectopic pregnancy<ul><li><a href="/articles/pregnancy-of-unknown-location">pregnancy of unknown location</a></li></ul>
  • -</ul><h5>Paediatric</h5><ul>
  • -<li><p>paediatric abdominal ultrasound</p></li>
  • -<li>paediatric and neonatal intensive care</li>
  • -<li>paediatric Musculoskeletal</li>
  • -</ul><p> </p><h5>Deep Venous Thrombosis</h5><ul>
  • -<li>approach<ul>
  • -<li>two‐point compression test</li>
  • -<li>graded compression</li>
  • -<li>with <a href="/articles/wells-criteria-for-pulmonary-embolism-1">wells score</a> and <a href="/articles/pulmonary-embolism-rule-out-criteria-perc">PERC</a> rule</li>
  • +</ul><h5>Lower extremities</h5><ul>
  • +<li>Deep venous system</li>
  • +<li>Superficial venous system</li>
  • +</ul><h4>Thorax</h4><ul>
  • +<li><p>lungs and airways</p></li>
  • +<li>pleura</li>
  • +<li>vessels<ul>
  • +<li><a href="/articles/aortic-dissection">aortic dissection</a></li>
  • +<li>
  • +<a href="/articles/aortic-aneurysm-1">aortic</a><a href="/articles/aortic-aneurysm-1"> aneurys</a>m</li>
  • -<li>anatomy</li>
  • -<li>key findings<ul>
  • -<li>lack of compression</li>
  • -<li>echogenic filling defect in lumen</li>
  • +<li>cardiac<ul>
  • +<li><a href="/articles/chamber-enlargement">chamber enlargement</a></li>
  • +<li><a href="/articles/wall-thickening">wall thickening</a></li>
  • +<li>regional wall motion abnormalities</li>
  • +<li>valvular dysfunction<ul>
  • +<li><a href="/articles/tricuspid-valve-regurgitation-1">tricuspid regurgitation</a></li>
  • +<li><a href="/articles/mitral-valve-prolapse">mitral valve prolapse</a></li>
  • -<li>conditions<ul>
  • -<li><a href="/articles/deep-venous-thrombi">deep venous thrombi </a></li>
  • -<li><a href="/articles/pulmonary-embolism">pulmonary embolism</a></li>
  • -</ul><h5>Fractures</h5><ul>
  • -<li>approach</li>
  • -<li>anatomy</li>
  • -<li>key findings<ul><li> </li></ul>
  • -</li>
  • -<li>conditions</li>
  • -</ul><h5>Chest pain</h5><ul>
  • -<li>approach</li>
  • -<li>anatomy</li>
  • -<li>key findings<ul><li> </li></ul>
  • -</li>
  • -<li>conditions</li>
  • -</ul><h5>Dyspnoea/Respiratory Distress</h5><ul>
  • -<li>approach: <a href="/articles/bedside-lung-ultrasound-in-emergency-approach">BLUE</a>
  • -</li>
  • -<li>anatomy</li>
  • -<li>key findings<ul><li> </li></ul>
  • -</li>
  • -<li>conditions</li>
  • -</ul><h5>Resuscitation and Cardiac Arrest</h5><ul>
  • -<li>approach: <ul><li><a href="/articles/feel">FEEL</a></li></ul>
  • -</li>
  • -<li>anatomy</li>
  • -<li>key findings<ul><li> </li></ul>
  • -</li>
  • -<li>conditions</li>
  • -</ul><h5>Abdominal Pain</h5><ul>
  • -<li>approach</li>
  • -<li>anatomy</li>
  • -<li>key findings<ul><li> </li></ul>
  • -</li>
  • -<li>conditions</li>
  • -</ul><h5>Hypotension</h5><ul>
  • -<li>approach<ul><li><a href="/articles/rapid-ultrasound-in-shock-1">RUSH</a></li></ul>
  • -</li>
  • -<li>anatomy</li>
  • -<li>key findings<ul><li> </li></ul>
  • -</li>
  • -<li>conditions</li>
  • -</ul><h5>Trauma</h5><ul>
  • -<li>approach<ul><li><a href="/articles/focussed-assessment-with-sonography-for-trauma-fast-scan">Focussed Assessment with Sonography for Trauma (FAST) scan</a></li></ul>
  • -</li>
  • -<li>anatomy</li>
  • -<li>key findings<ul><li> </li></ul>
  • -</li>
  • -<li>conditions</li>
  • -</ul><h5>(HIV) and Tuberculosis (TB) Co-Infection</h5><ul>
  • -<li>approach<ul><li><a href="/articles/fash">FASH</a></li></ul>
  • -</li>
  • -<li>anatomy</li>
  • -<li>key findings<ul><li> </li></ul>
  • -</li>
  • -<li>conditions</li>
  • -</ul><h5>Fever</h5><ul>
  • -<li><p>approach</p></li>
  • -<li>anatomy</li>
  • -<li>key findings<ul><li> </li></ul>
  • -</li>
  • -<li>conditions</li>
  • -</ul><h4>System-based approach</h4><h5>Echocardiography/Haemodynamics</h5><ul>
  • -<li>approach<ul><li> </li></ul>
  • -</li>
  • -<li>key findings<ul><li> </li></ul>
  • -</li>
  • -<li>conditions</li>
  • -<li>approach</li>
  • -<li>key findings<ul><li> </li></ul>
  • -</li>
  • -<li>conditions</li>
  • -<li><ul>
  • -</ul></li>
  • -</ul><h5>Hepatobiliary</h5><ul>
  • -<li>approach<ul>
  • -<li><a href="/articles/gallbladder">gallbladder</a></li>
  • -<li><a href="/articles/liver">liver</a></li>
  • -</ul>
  • -</li>
  • -<li>key findings<ul><li><a href="/articles/wall-echo-shadow-sign-ultrasound">wall echo shadow sign</a></li></ul>
  • +</ul><h5> </h5><h4>Role of imaging</h4><p>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 noninvasive, rapidly deployed and does not entail removal of the patient from the resuscitation area.</p><p>PoCUS consensus statements emphasize engaging consultants early on in workup, ultimately improving initial diagnostic accuracy, initiation of proper management, and allowing PoCUS to play a complementary role to traditional imaging modalities.</p><p>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.</p><h4>Physics</h4><ul><li>
  • +<a href="/articles/ultrasound-introduction">ultrasound (introduction)</a><ul>
  • +<li>see <a href="/articles/ultrasound-artifacts-3">ultrasound artifacts</a>
  • -<li>conditions<ul>
  • -<li><a href="/articles/gallstones-1">cholelithiasis</a></li>
  • -<li><a href="/articles/cholecystitis">cholecystitis</a></li>
  • +<li><a href="/articles/physical-principles-of-ultrasound-1">basic physics</a></li>
  • +<li><a href="/articles/ultrasound-transducer">transducers</a></li>
  • -</li>
  • -</ul><h5>Gynaecological</h5><ul>
  • -<li>approach<ul><li><a href="/articles/uterus">uterus</a></li></ul>
  • -</li>
  • -<li>key findings</li>
  • -<li>conditions</li>
  • -</ul><h5>Transcranial Doppler</h5><ul>
  • -<li>approach</li>
  • -<li>key findings</li>
  • -</ul><h4>Procedural adjunct</h4><h5>Vascular Access</h5><h5>Pericardiocentesis</h5><ul><li><a href="/articles/cardiac-tamponade">pericardiac tamponade</a></li></ul><h5>Paracentesis</h5><ul><li><a href="/articles/ascites">ascites</a></li></ul><h5>Thoracentesis</h5><ul><li><a href="/articles/pleural-effusion">pleural effusion</a></li></ul><h5>Suprapubic aspiration and catheterisation</h5><h5>Peripheral nerve blocks</h5>
  • +</li></ul><p>Procedural adjunct</p><h5>Vascular Access</h5><h5>Pericardiocentesis</h5><ul><li><a href="/articles/cardiac-tamponade">pericardiac tamponade</a></li></ul><h5>Paracentesis</h5><ul><li><a href="/articles/ascites">ascites</a></li></ul><h5>Thoracentesis</h5><ul><li><a href="/articles/pleural-effusion">pleural effusion</a></li></ul><h5>Suprapubic aspiration and catheterisation</h5><h5>Peripheral nerve blocks</h5>

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