Clinical Evidence

POCUS is used to guide various ED procedures such as central venous catheter insertion , difficult peripheral arterial and venous catheter insertion , arthrocentesis , airway management , thoracentesis, paracentesis, lumbar puncture, and regional nerve blocks . Using POCUS for procedure guidance helps improve the success rate and decrease the complication rate and is considered the standard of care for central venous catheter insertion.

There is evidence that peripheral nerve blocks performed by ultrasound guidance alone, or in combination with PNS, are superior in terms of improved sensory and motor block, reduced need for supplementation and fewer minor complications reported. Using ultrasound alone shortens performance time when compared with nerve stimulation, but when used in combination with PNS it increases performance time.

For many years the lung has been considered off-limits for ultrasound. However, it has been recently shown that lung ultrasound (LUS) may represent a useful tool for the evaluation of many pulmonary conditions in cardiovascular disease. The main application of LUS for the cardiologist is the assessment of B-lines. B-lines are reverberation artifacts, originating from water-thickened pulmonary interlobular septa. Multiple B-lines are present in pulmonary congestion, and may help in the detection, semiquantification and monitoring of extravascular lung water, in the differential diagnosis of dyspnea, and in the prognostic stratification of chronic heart failure and acute coronary syndromes.

Based upon our experience, we consider that lung ultrasonography has major utility for management of COVID-19 with respiratory involvement due to its safety, repeatability, absence of radiation, low cost and point of care use; chest CT may be reserved for cases where lung ultrasonography is not sufficient to answer the clinical question. We find there is utility of lung ultrasonography for rapid assessment of the severity of SARS-CoV-2 pneumonia/ARDS at presentation, to track the evolution of disease, to monitor lung recruitment maneuvers, to guide response to prone position, the management of extracorporeal membrane therapy, and for making decisions related to weaning the patient form ventilatory support.

Point-of-care ultrasound (POCUS) is a useful diagnostic tool and has become an integral part of the care provided in the Emergency Department. It has evolved over the past two decades to include diagnostic and therapeutic skills. POCUS helps emergency physicians improve their diagnostic accuracy and provide better overall patient care. This chapter will summarize 13 core POCUS applications that are considered within the diagnostic armamentarium of all emergency physicians.

sonographic-guided corticosteroid injections should be indicated, at least, in patients with poor response to previous blind injection to ensure accurate medication placement in order to improve therapeutic 

For all of these applications, POCUS is safe, accurate, and beneficial and can be performed with a relatively small amount of training by non-radiology specialists, including family physicians.

Although placement of a central venous catheter (CVC) is a routine procedure in intensive care medicine and anesthesiology, acute severe complications (such as arterial puncture or cannulation, hematoma, hemothorax, or pneumothorax) occur in a relevant proportion of patients. The use of ultrasound (US) has been proposed to reduce the number of CVC complications and to increase the safety and quality of CVC placement.