Shocked, breathless, and bloodied: Point-of-care ultrasound on the front line

Abstract

Point-of-care ultrasound (PoCUS) has come a long way since the days when ultrasound was a hidden dark art, only practised deep inside the recesses of radiology departments. The transition of the use of this technology from the assessment of relatively stable patients, into a tool used by front line clinicians has been proceeded steadily, to the point where many now consider PoCUS to be standard of care, much like the stethoscope, when assessing patients clinically. 1 In this issue of CJEM, three groups of authors tackle questions related to the use of PoCUS on the front line of emergency medicinein the resuscitation room. The use of PoCUS in undifferentiated hypotensive, or shocked, patients has evolved from the targeting of specific individual pathologies and etiologies, to the development of systematized PoCUS protocols designed to answer physiological questions, identify pathology, and guide resuscitation. 2-4 Stickles et al. looked at how reliable one of the most popular and commonly used of these protocols, the Rapid Ultrasound for Shock and Hypotension (RUSH) protocol, is in terms of accurately identifying the underlying category of shock in hypotensive patients. 4,5 Jones et al. previously reported that early use of a similar PoCUS protocol helped narrow the differential diagnosis when compared with delayed use, in one of the first comparative studies of PoCUS. 2 In their analysis, Stickles et al. performed a systematic review and meta-analysis of the literature, focusing on diagnostic studies for RUSH. 5 This well-done analysis included four relevant studies totalling 357 patients. With sensitivities ranging from 64% for distributive, to 93% for obstructive shock, and specificities ranging from 80% for mixed, to 98% for obstructive, they concluded that when used in isolation, the RUSH