Clinical Ultrasound (POCUS): The revolution in medical examination in the 21st century and its impact on medical practice

Point-of-Care Ultrasound (POCUS) is an examination technique based on ultrasound imaging. Also known in French-speaking countries as "échoscopie", this rapidly expanding technique is dramatically changing the way healthcare professionals diagnose and refer patients. 

Non-invasive, fast and precise, this technique enables the practitioner to visualize the patient's internal organs in real time, directly at the bedside. As a result, it is increasingly used in various medical specialties, improving the accuracy of the initial diagnosis and enabling faster, more efficient care planning. In this article, we'll explore what POCUS is, its clinical applications, existing evidence of its effectiveness in the medical literature, and the difference between clinical and conventional ultrasound. 

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What is clinical ultrasound?

The history of POCUS dates back to the 1990s, when emergency physicians and anesthetists began using portable ultrasound scanners to guide procedures and rapidly assess patients. One of the earliest examples of POCUS use in emergency medicine was the FAST (Focused Assessment with Sonography for Trauma) protocol, developed to rapidly detect blood effusions in trauma patients.

In the 1990s and 2000s, the use of POCUS spread to other medical specialties, such as general medicine, gastroenterology, nephrology, pneumology and geriatrics. Technological advances have also enabled ultrasound scanners to be miniaturized, making them portable and as easy to handle as a blood pressure monitor, making POCUS even more attractive to healthcare professionals who feel the need to enhance their clinical examination with an inexpensive and rapidly accessible imaging solution.

Unlike conventional ultrasound, which is usually performed by radiologists during a dedicated appointment, POCUS enables rapid answers to specific clinical questions, improves diagnostic accuracy and reduces waiting time for patients... and all this directly in the office or at the patient's bedside.

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Clinical applications of POCUS

POCUS is used in a variety of medical specialties, including emergency medicine, general medicine, nephrology, gastroenterology, hepatology, pulmonology and urology, among others.

Here are a few examples of clinical applications:

1. Emergency medicine: rapid assessment of patients with abdominal, thoracic or pelvic pain, trauma, internal bleeding or breathing difficulties. It can also be used to guide procedures such as central venous catheterization.

2. General medicine : assessment of abdominal, thoracic and musculoskeletal pain, detection of cardiac and vascular pathologies, and guidance for procedures such as punctures and biopsies. 

3. Nephrology : assessment and management of kidney disease, including evaluation of kidney size and structure, detection of urinary obstructions, assessment of renal function, and guidance for procedures such as renal biopsies and peritoneal dialysis catheterization. 

4. Gastroenterology: assessment of abdominal pain, detection of liver, biliary and pancreatic pathologies, and guidance for procedures such as biopsies and drainages. 

‍5.Hepatology: assessment and monitoring of liver disorders, including detection and monitoring of diseases such as hepatic steatosis, fibrosis, cirrhosis and liver tumors, as well as assessment of hepatic vascularization. 

‍6.Pneumology: assessment of respiratory symptoms, detection of pathologies such as pneumothorax, pleural effusions and lung consolidations, as well as guidance for procedures such as thoracentesis and lung biopsies. 

7. Urology: detection and follow-up of renal and ureteral calculi, evaluation of prostate hypertrophy, detection of urinary tract tumors and monitoring of urinary retention.

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Recommendations from medical publications

Many learned societies and medical publications strongly recommend the use of the POCUS in various specialties. The ultrasound scanner, once seen as a gadget, is increasingly becoming as essential a tool as the stethoscope or blood pressure monitor. 

The American College of Emergency Physicians (ACEP), for example, supports the integration of POCUS into emergency physician training and its use in daily clinical practice. Similarly, the Journal of the American Medical Association (JAMA) positions it as the fifth pillar of the physical examination, as essential as inspection, palpation, percussion and auscultation.

In France, the SFMU considers the use of ultrasound in emergency medicine to be essential, and recommends that all emergency physicians be trained to at least the first level of competence in ultrasound.
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echOpen an affordable way to get started with POCUS

Given the many advantages of POCUS, it is essential that doctors in different specialties are trained in this technique and equipped with the necessary tools. echOpen is an innovative solution that facilitates training and equipping doctors. echOpen offers a portable, affordable and easy-to-use ultrasound probe, as well as an online training platform that enables professionals to acquire the skills needed to integrate clinical ultrasound into their clinical practice, and a collaborative space that facilitates interpretation and discussion of images between specialists.
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Conclusion

POCUS, or clinical ultrasound, is a revolutionary technology that is transforming medical practice by offering healthcare professionals a fast, accurate and non-invasive tool for diagnosing and guiding their patients. With its many clinical applications and the support of learned societies, POCUS is set to become an essential part of the physical examination.

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