Is POCUS the New Stethoscope for the Critical Care PA?

The objective of this paper is to emphasize the vitality of POCUS (Point-of-care ultrasound) and the practical bedside application for diagnosing critical diseases in critical care, specifically critical respiratory illnesses. A literature review search was conducted using PubMed, and identified 5 journals to substantiate the purpose of the paper. The results showed that proper training in POCUS is crucial for practicing critical care PAs (Physician Associates/Assistants), but the type of training is still dependent on the credentialing that the hospital or practice requires. POCUS is not the ultimate authority, but proper utilization can decrease the need for advanced imaging, such as a CT scan (Computed Tomography). POCUS is an initial and noninvasive tool that allows PAs to gather real time, reliable, and reproducible information on acute respiratory illnesses such as pulmonary edema, pneumothorax, and lung effusion. These three respiratory diseases can be diagnosed through the BLUE Protocol, a fast algorithm (<3>minutes) that provides an analysis of the pulmonary system and the veins within the lungs. The protocol identifies the presence or absence of acute respiratory failure through identifying lung sliding, artifact (A lines/B lines), alveolar consolidation, and/or pleural effusion. With proper training and education in ultrasonography, and specifically the BLUE protocol, the cause of a critical care patient’s acute respiratory failure can be rapidly identified. The implications of these findings highlight the importance of increasing POCUS education among critical care PAs and the need for guidelines both in POCUS education and in diagnosing critical respiratory illnesses. Further research is warranted in ensuring proper training and diagnostic tools within critical care specialties and hospital systems.KEYWORDS: POCUS, critical care, respiratory, education, BLUE protocolAppendixBreitkopf R, Treml B, Rajsic S. Lung Sonography in Critical Care Medicine. Diagnostics (Basel). 2022;12(6):1405. Published 2022 Jun 6. doi:10.3390/diagnostics12061405Lau YH, See KC. Point-of-care ultrasound for critically-ill patients: A mini-review of key diagnostic features and protocols. World J Crit Care Med. 2022;11(2):70-84. Published 2022 Mar 9. doi:10.5492/wjccm.v11.i2.70Ocel S, Kekec Z, Taskin O, Belli F, Tugcan MO. Diagnostic role of thoracic ultrasound in patients with acute respiratory failure at emergency service. Ir J Med Sci. 2024;193(3):1573-1579. doi:10.1007/s11845-024-03618-4Sartini S, Ferrari L, Cutuli O, et al. The Role of Pocus in Acute Respiratory Failure: A Narrative Review on Airway and Breathing Assessment. J Clin Med. 2024;13(3):750. Published 2024 Jan 28. doi:10.3390/jcm13030750Williams JP, Nathanson R, LoPresti CM, et al. Current use, training, and barriers in point-of-care ultrasound in hospital medicine: A national survey of