Episode Details

Episode 27: POCUS

The sun rises over the San Joaquin Valley, California, today is September 11, 2020. 

Today we honor those who lost their lives during the deadliest terrorist attacks in the history of the world, which happened in 2001. Today, nineteen years later, there are many tears to wipe off, hearts to comfort, and many unanswered questions. Our fight against evil is still unfolding, especially during this time of pandemic. Humans will continue their search for happiness and hopefully good will prevail.

How is the air quality where you live today? In Bakersfield, this week our air quality has been worsening, and asthma exacerbations will likely be on the rise. Recently, the American Family Physician journal published a practice guideline update issued by the Global Initiative for Asthma (GINA). GINA now recommends against using short-acting beta2 agonist (SABA) as sole therapy for patients with mild intermittent asthma (Step 1). A low-dose inhaled corticosteroid (ICS) and formoterol combination used as needed is the preferred treatment in adults and adolescents in the Step 1 group. If ICS/formoterol is not affordable, then a low dose ICS and SABA as needed is recommended, basically it is recommended to avoid prescribing SABA alone[1,2].

This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program, from Bakersfield, California. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care since 1971. 

“To cure sometimes, to relieve often, to comfort always,” Dr. Edward Trudeau

As doctors, we always want to heal our patients. I think that’s the reason all of us went to medical school. However, we have to recognize our limitations, and the limitations of modern medicine, even with all the advances of our era. Some patients may not be cured, and that can be devastating for some physicians, but even when we cannot cure, we can often offer relief, and always provide comfort.  What a great teaching for us!

Today we have Dr Verna Marquez. She is a faculty in our program who is always involved in new and exciting projects. Today, she will talk about POCUS. Dr Marquez, please introduce yourself.

What is POCUS? Why is it important?

POCUS stands for Point of Care Ultrasound. It is a goal-directed, bedside ultrasound examination performed by a healthcare provider to answer a specific question or to guide performance of an invasive procedure. 

History: In 1940s Diagnostic ultrasounds was first developed and used in medicine, but POCUS has been integrated into diverse areas of clinical practice since the early 1990s.

Impact in primary care: Many professional societies and national organizations nowadays have recognized the potent impact of POCUS and have endorsed its routine use in clinical practice. POCUS improves clinical outcomes, reduces failure rates during procedures, rapidly narrows differential diagnosis, shortens time to definitive treatment, lower costs, and reduces the use of ionizing radiation of CT imaging. It is especially empowering and critical for front line providers in rural, underserved, or resource-constrained environments where advance imaging and specialists are in scarce supply. Family physicians are often the providers in these key clinical contexts. Because Family medicine physicians have a strong background in obstetric ultrasound, family physicians are well positioned to learn other applications of POCUS.

When can we use POCUS?

POCUS can be used to assess most body systems. Generally, the rule is to “rule in” or “rule out” a specific condition or answer a “yes or no” question. 

Clinical applications:

As a FM physician, we perform it mostly for diagnostics –and the most commonly performed ones are evaluation of GB, liver, kidneys, bladder, grav