Have you ever struggled with discussing your POCUS findings with colleagues or consultants? Are you working to develop POCUS within your department but facing external resistance? Then this short excerpt from SASKSONO17 is for you! Spanning just 8 short minutes, you’ll hear from our expert panel about their experiences, how to face challenges, and the ingredients to success.
Does this resonate with you? We’d love to hear from you as well!
The Sasksonic Team
2 thoughts on “Breaking the sound barrier…”
Some great key points:
Treat the POCUS findings as data points and include all the other relevant data points in your discussion with consultants.
I never just tell a surgeon I see appendicitis on my POCUS. They need to hear about the other components of the patient’s presentation to decide if and when to intervene.
Acknowledge the limitations of POCUS in the specific case. These limits can involve the quality of the images, the limitations of ultrasound to rule in or rule out a pathology, the weight of the data point itself when combined with all the other clinical data.
The IVC looks full, but that’s not good enough on it’s own to decide on fluid resuscitation. The aorta is enlarged but that doesn’t confirm dissection or rupture.
Be respectful of the consultant’s expertise but also be aware of their potential ignorance of POCUS and seek to utilize the former and educate the latter.
In the early days of lung POCUS I carefully explained my findings to my internist when he was deciding on treatment of a patient with CHF. There is nothing so powerful as to tell him what POCUS shows then have him listen to the lungs, look at the CXR, see the response to therapy and realize how accurate and helpful the scan was.
Trust and experience are crucial. There is growing acceptance of POCUS when you make the right call and the results of your scans are routinely included in consultations.
That first ectopic diagnosed by POCUS in the ED resulted in the OB-GYNE demanding the tech come in to do another scan. We all watched it be done while I prepped the patient for the OR. Pointing out the positive findings to the OB during the tech scan, showing how it agreed with my own scan, this is a learning exercise in what we are capable of doing in the ED.
Share images and videos. Like a good writer, showing vs telling can be a powerful tool.
The first molar pregnancy I diagnosed was disbelieved by the radiologist. I sat down with the OB-GYNE and carefully reviewed my images and the clinical presentation and he not only was impressed at the quality of our images, but convinced it was the real deal. The final pathology was a seal on the deal. POCUS is now a common discussion point on referrals.
Understand there is variability in ED colleagues skill and confidence with POCUS. If the consultant doesn’t have a relationship with you, expect to be judged by the bar set by your less confident co-workers. Either demonstrate how you deserve to be rated differently or work on raising the bar for your department.
Consultants exposed to POCUS in their own residencies are far more likely to understand and make use of your ultrasound findings. The evolution continues.
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Sage advice from Dr. Greg Hall – highlighting the key role that bedside teaching can play in advancing adoption and communication.