E3 - Emergency Ultrasound

Abstract

Over the past 20 years emergency ultrasound (EUS) has become an integral part of emergency medical care in the United States and has become standard in the evaluation of emergency medical conditions. EUS or point-of-care ultrasound is simultaneously performed and interpreted by the treating clinician at the patient’s bedside for use in diagnosis, resuscitation, physiologic monitoring, procedural guidance, and assessment of specific clinical conditions in emergency medicine. EUS provides clinically important information that cannot be gleaned from inspection, palpation, auscultation, or percussion and is a distinct clinical modality, not an extension of the physical exam. EUS can also be beneficial in shared decision making with the patient, with the main risk management issue related to the failure to perform EUS in a timely manner and exceeding the scope of practice defined by the American College of Emergency Physicians (ACEP) EUS guidelines. ACEP first published guidelines for the use of EUS in 2001, expanding the scope of practice with each iteration. The 2016 guidelines include 12 core applications: (1) trauma, (2) pregnancy, (3) cardiac/hemodynamic assessment, (4) abdominal aorta, (5) airway/thoracic, (6) biliary, (7) urinary tract, (8) deep vein thrombosis (DVT), (9) soft tissue/musculoskeletal, (10) ocular, (11) bowel, and (12) procedural guidance. EUS training may be obtained in residency or, for those emergency physicians who trained prior to the EUS residency requirements, initial training often occurs through continuing medical education courses, followed by a period of proctoring or supervision. Either pathway may be used to achieve competency and integration into clinical practice.