Introduction: Point of care ultrasound (POCUS) has become a common practice in prehospital care over the last 10 years. There is lack of literature on its use and governance structure in United Kingdom (UK) prehospital care services. We aimed to survey the use, governance of prehospital POCUS among UK prehospital services and perceptions of clinicians and services regarding its utility and barriers to its implementation.  Methods: Four electronic questionnaire surveys were delivered to UK helicopter emergency medical service (HEMS) & clinicians, ambulance and community emergency medicine (CEM) services between 1st of April and 31st of July 2021 investigating current use, governance structure for POCUS and perception about its benefits and barriers. Invitations were sent via email to medical directors or research leads of services and using social media. Survey links remained live for two months each.  Results: Overall, 90%, 62% and 60% of UK HEMS, ambulance and CEM services respectively, responded to surveys. Most of the services used prehospital POCUS, however only two HEMS organisations fulfilled the Royal College of Radiology  governance criteria for POCUS. The most commonly performed POCUS modality was echo in cardiac arrest. Majority of clinicians judged POCUS to be beneficial and the common perceived benefit was promotion of enhanced and effective clinical care. Major barriers to its implementation included a lack of formal governance, limited literature supporting its use and difficulties in performing POCUS in prehospital environment.  Conclusion:  This survey demonstrates that prehospital POCUS is being provided by a majority of the prehospital care services and clinicians have found it beneficial in providing enhanced clinical care to their patients. However, the barriers to its implementation are relative lack of governance structure and supportive literature.

The use of point of care ultrasound (POCUS) to aid diagnosis of tuberculosis has been investigated in countries where concomitant endemic prevalence of HIV increases the incidence of extrapulmonary tuberculosis (EPTB). In such cases, using a focused assessment with sonography for HIV-associated tuberculosis (FASH) scan has found to be immensely advantageous as a rapid diagnostic tool in low resource settings where other imaging modalities are scarce. The prevalence of EPTB in immunocompetent patients in industrialised countries is growing. Since EPTB can manifest itself in almost any part of the human body, symptomatic patients present with constitutional and non-specific symptoms. In our case, a 44-year-old male presented to the emergency department (ED) with a 3-month history of left-sided chest pain and swelling of the chest wall. Clinical examination revealed a swollen and tender lump above the left first rib. Palpation of the thoracic (T7) vertebral body demonstrated localised pain. POCUS showed a collection of heterogenous material with fluid content and specks of hyperechoic ‘ring-like’ structures. Further investigations led to the diagnosis of EPTB. The patient was admitted and treated for EPTB where he went on to make a full recovery. This case report highlights the role of integrating POCUS in clinical examination of patients with suspected EPTB, which can expedite its diagnosis and management.

We describe a case of cardiac arrest with pulmonary embolism and deep venous thrombosis diagnosed by point-of-care ultrasound, which resulted in a favorable outcome. In this article, we have also delineated bradycardia as an atypical sign of pulmonary embolism and explained the potential mechanism behind it.