Point‐of‐care ultrasound use in emergencies: what every anaesthetist should know

Abstract

Summary Point‐of‐care ultrasound has been embraced by anaesthetists as an invaluable tool for rapid diagnosis of haemodynamic instability, to ensure procedural safety and monitor response to treatments. Increasingly available, affordable and portable, with emerging evidence of improved patient outcomes, point‐of‐care ultrasound has become a valuable tool in the emergency setting. This state‐of‐the‐art review describes the feasibility of point‐of‐care ultrasound practice, training and maintenance of competence. It also describes the many uses of point‐of‐care ultrasound for the anaesthetist and describes the most salient point‐of‐care ultrasound views for anaesthetic emergencies including: undifferentiated shock; hypoxemia; and trauma. Procedural safety is also discussed in addition to relevant important governance aspects. Cardiac function should be assessed using the parasternal long axis, parasternal short basal/mid‐papillary/apical, apical four chamber and subcostal four chamber views, and should include a visual estimation of global left ventricular ejection fraction. Other cardiovascular conditions that can be identified using point‐of‐care ultrasound include: pericardial effusion; cardiac tamponade; and pulmonary embolism. Pulmonary emergency conditions that can be diagnosed using point‐of‐care ultrasound include pneumothorax; pleural effusion; and interstitial syndrome. The extended focused assessment with sonography for trauma examination may of value in patients who are hypotensive in order to identify intra‐abdominal haemorrhage, pneumothoraces and haemothoraces.

Ability of anaesthetists to identify the position of the right internal jugular vein using anatomical landmarks: A double-blind study

“…Given the low correct phantom needle insertion point and trajectory for RIJV cannulation in this study (56%) and the wide availability of ultrasound equipment in anaesthetic practice in the UK, 7 the findings of this study do not support the use of a landmark technique, particularly by inexperienced clinicians. Indeed, the increased incidence of potential carotid puncture from our study was notable and cautions against the use of the landmark technique, even in emergency situations.…”

HOCUS POCUS: ultrasound beyond regional anesthesia in the ambulatory setting

“…POCUS during pulse checks may delay compressions but not in the hands of trained, skillful clinicians as it has been shown to be quick, effective and provide more information during this critical time. At present there is not enough evidence to show that it alters outcomes or to use it for terminating resuscitation [32 ▪▪ ,36 ▪ ].…”

“…As a preoperative screening tool cardiac POCUS can assess global function and structural abnormalities [31]. POCUS enables identification of patients who need more extensive cardiac workup and optimization or are safe to undergo surgery in day care settings [32 ▪▪ ,33].…”

“…Fluid Management: Fluid responsiveness in hypotensive patients can be assessed with IVC diameter and respirophasic variation. Generally, patients with IVC diameter <2 cm and collapsibility > 50% have been shown to be responsive to fluids [32 ▪▪ ,36 ▪ ]. It can be particularly helpful in patients with advanced age, cardiac comorbidities or following neuraxial blocks.…”

“…One of the important discharge criteria in ambulatory centers is the patient's ability to void urine without significant residual volume in the urinary bladder. Trans-abdominal bladder ultrasound has been used to evaluate bladder volume especially when neuraxial anesthesia is used [1 ▪▪ ,32 ▪▪ ]. It is helpful in avoiding unnecessary bladder interventions and confirming placement of a urinary catheter.…”