![]() ![]() One scan, on one patient, changed my entire approach to medicine. Since then, I have become a staunch advocate of POCUS as an extension of the physical exam, and am now a POCUS instructor, to help others gain this skill. Immediately thereafter, I made the decision to join the Ultrasound Leadership Academy to receive formal training in POCUS. In that moment, I recognized the value of consistently enhancing my physical exam with POCUS, and wanted to ensure the quality of my interpretation to positively impact my patient management. As a direct result of this ultrasound scan and phone call, diuresis was stopped, IV fluids were administered and Cardiology was called to do an urgent pericardiocentesis. I immediately paged my partner and told him about our findings. This is the typical appearance of a pericardial effusion. We placed the probe over the apex of the heart, and both immediately recognized that there was a large pocket of fluid around it, impairing the heart’s ability to fill with blood returning from the IVC. We then placed the ultrasound probe on her chest. She was receiving diuretics, the appropriate therapy for CHF. We auscultated her heart and lung, hearing rales and noting jugular vein distention (JVD). We were examining one of my partners’ patients, an elderly woman with chronic heart failure (CHF). I was rounding with a medical student, teaching physical exam findings. Since then, I’ve come to know that cardiac POCUS alone has been shown to change management in up to 37% of patients, which is reason enough to tell this story. This defining moment changed my clinical practice irrevocably. My progress was cautious, as I continued to experiment with new methodologies and ways to incorporate POCUS.īut I will never forget the moment that my first diagnosis using POCUS radically changed my management of a patient. Another inevitable aspect of life is that no matter how well you know someone, at some point, everyone will surprise you. ![]() Gradually, I started using POCUS as a diagnostic tool to supplement my bedside physical exam. Our first kiss, the arrival of a child, the climbing of a mountain–these impact us personally, and professionally.Īs a Hospitalist, I began using Point of Care Ultrasound (POCUS) to help guide procedures, such as central lines and paracentesis. There are moments in life that are impossible to forget: critical achievements, coming of age milestones, or negotiated forks in the road.
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