Vital Times 2017 - 56

Similar to the evolution of computers, ultrasound
machines have become much more portable (some are
even pocket size) with functionality similar to "high-end"
units used in imaging laboratories. New technologies
even allow one's smartphone to become an ultrasound
device. This innovation allows the physician to have
access to ultrasound imaging during their physical exam
at the point of care.
The utility of POCUS has been demonstrated for
nearly every type of physical exam including cardiac,
pulmonary, neurologic, pulmonary, and abdominal.
How often have you wondered: What is the ventricular
function? How severe is that aortic stenosis? How bad
is the COPD? Is there a pneumothorax? What is the
amount gastric volume, or what is the patient's volume
status? These are all questions that can be answered in
"real-time" by POCUS.
Sadly, the utility for POCUS to facilitate acute care
management has mostly been shown in emergency
medicine and critical care specialties.4 This has been
viewed with some criticism given the fact that patients
have the same comorbidities and acute care events in the
perioperative setting.5 From a patient care standpoint,
why should the skillset for bedside evaluation of the
patient change simply because they transition from
the emergency room or intensive care unit to the
perioperative setting?
Fortunately, evidence of the utility of POCUS to
improve patient care in the perioperative settings is
starting to rapidly emerge.6,7 Interest in perioperative
point of care ultrasound (P-POCUS) has been reported
by anesthesiology trainees, along with integration
of P-POCUS curriculums into residency training.8
Moreover, implementation of a perioperative POCUS
service has also demonstrated a positive clinical impact.8
While it is encouraging to see the growth of P-POCUS
there is much more that can be developed. Other
specialties have developed formalized educational
and certification pathways.5 Emergency medicine has

56 		|	 	 CSA	Vital	Times

adopted POCUS training as a "core competency" for
residency training. Currently, the certification and
educational processes for the perioperative setting are
limited, but the concept is growing.
A collaboration of academic programs, including Loma
Linda University Medical Center, UCI Medical Center,
and UCLA Medical Center are working together to help
address the need for education and training on this topic.
Every year, more academic programs are developing
training curriculums on P-POCUS.

One such curriculum, termed F.O.R.E.S.I.G.H.T.
(Focused periOperative Risk Evaluation Sonography
Involving Gastroabdominal Hemodynamic and
Transthoracic ultrasound) has been published as
an effective strategy for education. This curriculum
incorporates the assessment of the following topics and
highlights their relevance for the perioperative setting:
1. Cardiac,
2. Pulmonary,
3. Hemodynamic,
4. Gastro-Abdominal
5. Airway,
6. Vascular access, and
7. Intracranial pressure.
To further P-POCUS education this curriculum is now
online and is open access, under a Creative Commons



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