Limitations of PoCUS

Khalid Azzam

What are the limitations of point-of-care ultrasound?

Khalid Azzam: As anything else, this has been an argument from people who are against the use of point-of-care ultrasound. As you know, ultrasound is a very subjective modality. I say, stethoscope is a very subjective modality. How many times we disagree on, “Do you hear the crepitation?” “No, I hear wheezes.” If I do not know whether it is crepitation or wheezes, we start calling them rhonchi, come up with these terminologies, and no one is sure what they are. How many times have you listened to a murmur and you bring in someone to listen to it and you cannot hear it anymore, and then you put your hand and you try to feel the liver. All physical exams, unless you see it with your eyes and you have a measure or a picture, are very subjective.

I think ultrasound is not worse than any of those, but I keep saying to practicing clinicians that you need to know your limitations, you need to know what you have learnt, you need to know what your limitations are, what you are good in, what you are becoming better in, what you are not good in. I am not good in doing proper assessment of the left ventricle function using focused cardiac ultrasound (FoCUS), and I know this, and I may try it and see where I can fit that piece of information into my clinical decision making but I do not give a lot of weight to it. It is exactly like when you know you are not very good at observing your jugular venous pressure (JVP), but you know what? JVP is a bad test anyway, so let’s use a good test, decide on our abilities, and use it then in our clinical decision making. So the limitation sits in the hands of the clinician, and we should know our limits.

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