Limited Focused Point of Care Ultrasound

As the ultrasound fellow, I have the privilege of scanning with the ultrasound faculty, all of our residents and all of our non-ultrasound faculty.  It is so refreshing to have such a variety to work with.  At times, the non-ultrasound faculty will bring issues to light that neither residents nor ultrasound faculty would.
On my most recent scanning shift, one of our faculty ended every encounter with a reassurance for the patient that “absolutely everything is normal.  Your heart is entirely normal.  All of your organs are normal.  You will live forever.”  The patients laughed and appreciated his humor, but each time, a little part of me died.  As soon as he stepped out of the room, I followed up with “Yes, Dr. X is a riot.  However, you should know that the ultrasound study we are doing today is limited and really looking to answer very focused questions.  This is not a comprehensive exam.”

Being scanned can be reassuring to patients.  You are taking the time to do  something that they don’t normally have done by their PMD, but your patients’ report of the results of the studies can be misconstrued by the patients themselves, their family, their providers, your colleagues in the ED, OB, Radiology.  So, when you are scanning your patients and you have answered your very focused questions for yourself, please, please save the humor for the next thought and let your patients know that this is not a comprehensive ultrasound, but a study designed only to answer very focused questions”.

AIUM 2010- preconference

Michael Blaivas organized an exciting preconference course on evaluation of the acutely decompensating patient.  Bret Nelson (speaking about vascular catastrophes) and Jim Tsung (describing the nuances of this evaluation in the pediatric patient) were among those presenting.

Faculty from emergency and critical care backgrounds gave cutting-edge presentations and the feedback from registrants was excellent. Faculty and their lectures after the break!

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Lecture Notes: Trauma


The trauma handout is available as a PDF here.



  • Heron MP, Hoyert DL, Murphy SL, Xu JQ, Kochanek KD, Tejada-Vera B. Deaths: Final data for 2006. National vital statistics reports; vol 57 no 14. Hyattsville, MD: National Center for Health Statistics. 2009.
  • Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF Jr, Kato K, McKenney MG, Nerlich ML, Ochsner MG, Yoshii H. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma,1999;46:466-72. Price D, Simon BC, Park RS. Evolution of emergency ultrasound. California J Emerg Med.2003;4:82-88.
  • Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, Hameed SM, Brown R, Simons R, Dulchavsky SA, Hamiilton DR, Nicolaou S. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment with Sonography for Trauma (EFAST). J Trauma,2004;57:288-95.
  • Lichtenstein D, Meziere G, Lascols N, Biderman P, Courret JP, Gepner A, Goldstein I, Tenoudji-Cohen M. Ultrasound diagnosis of occult pneumothorax. Crit Care Med,2005;33:1231-8.
  • Ma OJ, Mateer JR, Ogata M, Kefer MP, Wittmann D, Aprahamian C. Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma,1995;38:879-85.
  • Rozycki GS, Ochsner MG, Schmidt JA, Frankel HL, Davis TP, Wang D, Champion HR. A prospective study of surgeon-performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma,1995;39:492-500.
  • Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med, 1997;29:312-6.
  • Abrams BJ, Sukumvanich P, Seibel R, Moscati R, Jehle D. Ultrasound for the detection of intraperitoneal fluid: the role of Trendelenburg positioning. Am J Emerg Med,1999;17:117-20.
  • Reardon R, Ultrasound in Trauma – The FAST Exam. In sonoguide. Retrieved 3/1/2010, from
  • V. Noble, B. Nelson and A.N. Sutingco, Focused Assessment with Sonography in Trauma (FAST): Manual of emergency and critical care ultrasound (1st edn), Cambridge University Press, New York (2007).

Ocular Ultrasound

  • T Soldatos, K Chatzimichail, M Papathanasiou, et al. Optic nerve sonography: a new window for the non-invasive evaluation of intracranial pressure in brain injury. Emerg Med J 2009 26: 630-634.
  • Kevin R. Roth, Gregory Gafni-Pappas, Unique Method of Ocular Ultrasound Using Transparent Dressings, The Journal of Emergency Medicine, In Press, Corrected Proof, Available online 25 January 2010, ISSN 0736-4679, DOI: 10.1016/j.jemermed.2009.10.020.
  • Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M, Emergency Department Sonographic Measurement of Optic Nerve Sheath Diameter to Detect Findings of Increased Intracranial Pressure in Adult Head Injury Patients, Annals of Emergency Medicine, Volume 49, Issue 4, April 2007, Pages 508-514.
  • Blaivas M, Theodoro D, Sierzenski P. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emer Med.2003;10:376-381.
  • Blaivas M. Bedside emergency department ultrasonography in the evaluation of ocular pathology. Acad Emerg Med.2000;7:947-950.
  • V. Noble, B. Nelson and A.N. Sutingco, Ocular ultrasound: Manual of emergency and critical care ultrasound (1st edn), Cambridge University Press, New York (2007).


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Phillip Andrus, MD, FACEP
Department of Emergency Medicine
Division of Emergency Critical Care
Division of Emergency Ultrasound
1 Gustave L. Levy Place
New York, NY 10024