Point of Care Ultrasound
Point of Care Ultrasound
This domain tests focused, goal-directed bedside scanning: lung, FAST, vascular, and basic cardiac views. It rewards a clear clinical question, standard windows, and artifact recognition.
Core rules
- Lung: identify the pleural line and sliding with A-lines. B-lines are vertical, laser-like, arise from the pleura, and move with respiration. Absent sliding plus B-lines suggests pneumothorax; absent sliding without B-lines suggests apnea or mainstem intubation.
- FAST: Morison's pouch, splenorenal recess, pelvis, and subxiphoid pericardium. Free fluid is anechoic and collects in dependent spaces.
- IVC: measure 2 cm below the right atrial junction; respirophasic collapse estimates volume status but is not a solitary endpoint.
- Cardiac: subcostal and parasternal windows; center the sector, adjust depth, and use a phased array probe.
- Use the highest-frequency probe that reaches the target; keep the orientation marker consistent and record clips, not stills.
Worked example
A hypotensive patient. The RUQ view shows an anechoic stripe between liver and kidney. Confirm it in a second plane, check pelvis and pericardium, and correlate with the clinical picture; one positive view is not a complete FAST.
Traps
Mistaking perinephric fat for fluid; scanning through ribs without fanning; losing the pleural line; overinterpreting IVC; failing to use color Doppler.