Point of care ultrasound in the ED
The new RCEM curriculum has suggested an expanded role for POCUS in the ED. The new curriculum requires ultrasound competencies to be gained from an earlier stage in training so that a higher level of competency is achieved by the end of training. Table 1 outlines the new requirements.1
| Diagnostic | Procedural |
| Abdominal Aorta | Vascular access – central and peripheral |
| Extended focussed assessment of sonography in trauma (E-FAST) / Focussed assessment of free fluid (FAFF) | Fascia iliaca compartment block |
| Echo in life support | |
| Shock assessment | |
| Pleural ultrasound |
Table1
The literature suggests that POCUS could have further roles in the ED. Figure 1 is a pictorial representation of the common areas where ultrasound might be used.
A recent blinded observational single centre trial examined the use of whole-body POCUS protocol (focussed cardiac USS, focussed lung ultrasound, FAST/FAFF, and focussed abdominal USS) in 403 patients. The ultrasound findings influence on diagnosis or treatment was as follows: no new information (249 (61.8%)), no further action (45 (11.2%)), further diagnostic workup needed (52 (12.9%)), presumptive diagnosis confirmed (38 (9.4%)), and immediate treatment needed (19 (4.7%)).
Predictors of ultrasound being of diagnostic utility were a high triage category, patient comorbidities (cardiac disease, hypertension or lung disease) and patients presenting with abdominal pain, dyspnoea, or syncope.2