An Intro To POCUS

(Point of Care Ultrasound for Family Medicine)

Road Map
• Lectures with breakout components
• POCUS and US Basics (15 min)
• Hands-On Ultrasound Time (15 min)
• FAST (15 min)
• Hands-On Ultrasound Time (40 min)

• Evaluation (5 min)
Objectives
• Gain confidence using US as a point-of-care tool

• Demonstrate the basics of using an US machine to one of your

colleagues

• Preform an eFAST exam on one of your friends

Shout out to Contra Costa

Thanks Guys!
Why POCUS?
• Utilization by US is becoming more ubiquitous

• Family Doctors are already using ultrasound

• Underserved component to POCUS has been overlooked

The POCUS Philosophy
• Quick bedside answers to focused questions

• No diagnosis or procedure solely dependent on US

• aid to diagnosis like an EKG or CXR or as an adjunct to doing a

procedure

• Bedside US is an extension of the PE

STFM POCUS 2017

My Vision
• Yearly POCUS training during resident school
• Twice Monthly Trainings on the IPS
• Fall 2017 Faculty Training

• Expanded Yearly Resident Training?

• More robust US applications in clinic?
The Basics
• Transmission
• Probes
• Orientation
• Knobs and Buttons
Orientation
• US Machine should be on the
patient’s right

• Indicator should point to

• Head (longitudinal)
• Patient’s right side (transverse)

• Indicator on the screen should match

the probe
• Modes
• 2D
• Color
• M Mode

• Settings
• Software changes the image based on
the setting

• Depth
• Indicators on the side of the image

• Gain
• Brightness of the image
• Near and far gain
Your Mission (15 min):
• US Probes – What are they for?
• Settings
• Orientation of Machine and Indicators
• Gain
• Depth

• If there’s time… try M Mode

• Normal Lung VS Pneumothorax
 The eFAST Exam
Focused Assessment with Sonography in Trauma
Santa Rosa, NM
• 35yo male headed to the Pecos River in VW Van
• Head on collision with an elk

• Exam –
• HR 120, BP 120/70, RR 25, O2 90%
• Contusions to the left flank
• Decreased left sided BS
FAST Overview
• Clinical Questions
• Relevant windows of the fast exam
• Normal and Abnormal
2 questions
• Is there fluid in the abdomen?

• Is there fluid in the pericardium?

Windows…

Use a Phase Array or Curvelinear

Probe

1. Hepatorenal (Morison’s Pouch)

2. Subcostal
3. Perisplenic
4. Suprapubic
Hepatorenal (Morison’s Pouch)
• Longitudinal plane
• Axillary Line
• 7-9th intercostal space
Morison’s Pouch
Perisplenic Recess
• Posterior axillary line
• 5-7th intercostal space
• “knuckles to the bed”
Perisplenic
Suprapubic
• Transverse View
• Low in the pelvis
• Look for fluid behind the bladder.
Longitudinal View
• More sensitive for free fluid
Subxiphoid
• Probe marker to right
• Under the xiphiod process
• Look to the left.
• Real time subxiphoid view
• Pericardial Effusion
eFAST
eFAST
• Is there free fluid in the
thorax?
• Is there a pneumothorax?
Pleural Line
• Look for sliding sign
• Still above the pleura and
movement below
• Comet tails
• M mode – Sands on the beach
A video…
• Normal Lung VS Pneumothorax
Santa Rosa, NM
• 35yo male headed to the Pecos River in VW Van
• Head on collision with an elk

• Exam –
• HR 120, BP 120/70, RR 25, O2 90%
• Contusions to the left flank
• Decreased left sided BS
Your Mission (40 min):
• Identify the 4 windows of the fast exam
• Add the pulmonary exam to look for fluid in the thorax and
pneumothorax
Evaluations please!