The most commonly used outpatient primary care point-of-care ultrasound (POCUS) applications are similar to those used in the inpatient setting (eg, cardiac, pulmonary, and abdominal ultrasound). However, there are several additional POCUS applications that are highly applicable to the outpatient setting and should be considered for use by primary care practitioners. This article reviews 3 outpatient POCUS applications and their potential role in the primary care setting.

Integrated multi-organ ultrasound is increasingly used across various medical specialties. It should be performed in conjunction with history, physical examination, and other investigations in the diagnostic process to enhance the detection of conditions in the lung, heart, and abdomen. Multi-organ ultrasound has been shown to improve diagnostic accuracy in a sizeable portion of patients, potentially altering treatment plans. Specifically, it aids in assessing shock, sepsis, dyspnea, delirium, and in the perioperative setting, contributing to a more comprehensive patient assessment process.

Ultrasound guidance for bedside procedures improves rates of success while reducing complications. It is the standard of care for most bedside procedures and has ever-increasing utility for peri-procedural assessment. Herein, we provide a concise description with associated images and videos detailing the proper technique for ultrasound image acquisition and interpretation, along with common pitfalls to be avoided.

Doppler ultrasonography has evolved into a cornerstone of ultrasound imaging. In this article, we delve into the fundamental principles of Doppler ultrasonography, introduce color and spectral Doppler analysis, and highlight common applications relevant to point-of-care (POCUS) practitioners. From enhancing the safety of bedside procedures to estimating cardiac output, to exploring findings of venous congestion, we review the key advantages, disadvantages, and challenges of using Doppler in POCUS.

Proficiency in basic lung ultrasound is highly recommended for clinicians in general and internal medicine. This article will review and provide guidance for novice users on how to use lung ultrasound in clinical practice, through a pathology-oriented approach. The authors recommend a 12-zone protocol and describe how to perform and apply it in clinical practice while examining patients with clinical suspicion for the following diseases: pleural effusion, heart failure, pneumonia (bacterial and viral), interstitial lung disease, and pneumothorax.

Abdominal point-of-care ultrasound is an essential diagnostic tool for internal medicine physicians. It can identify intraperitoneal free fluid, evaluate the liver for size, presence of steatosis, and assessment for possible cirrhosis. Diagnosing cholelithiasis or cholecystitis can expedite care. Physical examination for mild splenomegaly may be insensitive. In such cases, sonographic measurements may provide a more definitive diagnosis. With the proper training, these organs can be evaluated at the bedside and guide clinical decision making.

An increasing number of indications are emerging for point-of-care ultrasound to diagnose and treat musculoskeletal complaints. Low cost, dynamic imaging, immediate results, and added advantage of portability have made ultrasound an important imaging modality in urgent care, emergency department (ED), and other musculoskeletal care clinics. This article reviews the use of musculoskeletal ultrasound to help evaluate articular and periarticular structures to evaluate for mechanical injuries and inflammatory arthritis.

Ultrasound imaging is a safe diagnostic tool that has become ubiquitous, in part due to its portability, effectiveness, and safety record. The latter is aided be adherence to regulatory limits, safety guidelines, and the "as low as reasonably achievable" principle. Operators receive feedback on potential tissue heating and mechanical effects through output display standard that shows the thermal index and mechanical index. To prevent the spread of infections, ultrasound transducers require varying levels of disinfection based on procedure invasiveness, following detailed infection control protocols, even in resource-limited settings. Ergonomic sonography practices are emphasized to prevent work-related musculoskeletal disorders (WRMSD), with professional organizations encouraging the use of ergonomically designed equipment and proper body positioning during scans. Operators should understand and properly apply ergonomic practices. Administrators play a key role by providing ergonomic equipment, education on WRMSD prevention, and creating workplace policies.

Point-of-care ultrasound (POCUS) bridges diagnostic gaps across the continuum of care worldwide and is a particularly potent tool in resource-limited settings (RLS). To capture the scope of its current impact in RLS, this narrative review of POCUS use in public health, primary care, outpatient specialty, pre-hospital, and palliative care settings discusses its use in reducing diagnostic health care inequities. Disease-specific protocols, longitudinal training, quality assurance, and task shifting are key to robust expansion of POCUS in RLS.

Point-of-care ultrasound (POCUS) provides immediate and useful information that aids clinical decision making at the bedside. The purpose of this article is to describe how POCUS can be integrated in the evaluation of the urinary system. In the first section, the authors aim to describe image acquisition and typical sonoanatomy of the kidney and bladder. The rest of the article focuses on three common scenarios where POCUS can be integrated into clinical practice: hydronephrosis, nephrolithiasis, and bladder distension. The authors include evidence from the literature and describe commonly encountered pitfalls.

The information obtained from cardiac POCUS relies on the ability to acquire optimized images and identify errors in image acquisition. In the following, we describe basic approaches to image optimization and detail common measurements obtained by cardiac POCUS. We highlight the impact of image acquisition errors and patient anatomy on these measurements including LV/RV function, identification of RV strain, their pitfalls, and the impact of error in image acquisition and patient anatomy on their clinical interpretation or integration.

Basic cardiac point-of-care ultrasound (POCUS)/focused cardiac ultrasound (FoCUS) often reveals incidental findings. Consider a patient with dyspnea in whom FoCUS reveals left ventricular (LV) hypertrophy, calcified valves, and pericardial effusion but "normal" LV systolic function. Such findings may trigger comprehensive echocardiography. Although advanced cardiac POCUS cannot replace comprehensive echocardiography, its role at the bedside is evolving. This systematic review identified studies suggesting that a sufficiently trained practitioner can leverage advanced techniques to evaluate conditions such as hypertrophic cardiomyopathy (4), LV diastolic dysfunction (6), severe valvular heart disease (6), and tamponade (8). This article discusses the use of advanced cardiac POCUS in these conditions.

Patients with abdominal symptoms are among the most common to present both urgently and non-urgently for medical evaluation. While intestinal ultrasound (IUS) is useful to aid management of these patients, it is not routinely taught, performed, or included as part of the core set of point-of-care ultrasound competencies. The authors present an approach to performing a systematic, but focused, IUS at the bedside and diagnostic accuracies for small bowel obstruction inflammatory bowel disease, appendicitis, and diverticulitis. An approach on how to integrate IUS findings and common pitfalls will also be discussed.

Point-of-care ultrasound (POCUS) infrastructure is the underpinning of a well integrated POCUS program. In order to achieve its full potential and fully integrate into the health care system, a POCUS program requires a robust and resilient infrastructure. The essential components of POCUS infrastructure are hardware, software, and an informed, well-integrated governance structure. This infrastructure can be leveraged for clinical decision-making, education, research, credentialing, documentation, health record integration as well as quality assurance and improvement.

Bedside point-of-care ultrasound (POCUS) has a high utility in clinical settings for scanning soft tissue-related conditions such as skin and soft tissue infections, identifying abscesses or necrotizing soft tissue infections, localization and extraction of embedded foreign bodies, and assessing hospitalized patients for sarcopenia. Regular use of POCUS in patients with soft tissue conditions can improve clinical efficiency and care.

Point-of-care ultrasound (POCUS) enhances diagnostic accurate, reduces time to diagnosis, and improves patient satisfaction. Competenties encompass indications, image acquisition, interpretation, and medical decision-making. Education involves didactic methods and hands-on practice with emphasis on longitudinal training and feedback. Assessment tools target knowledge, psychomotor, attitudinal domains. POCUS portfolios and quality assurance ensure competence and continued overarching POCUS oversight and feedback. Scan numbers are often used as a surrogate for competency; however, it is important to note that learning curves vary by POCUS application. Proper POCUS use requires understanding its diagnostic power and potential limitations. POCUS indications vary by clinical scenarios and beneficial applications for training and credentialing vary by medical niche. This text underscores the importance of standardized training and evidence-based practices in POCUS utilization.

An accurate assessment of intracardiac pressure and etiology of its pathologic change is crucial in assessing volume status and cardiac hemodynamics. The assessment for abnormal central venous pressure in heart failure has driven the development of noninvasive assessment of the central veins: the inferior vena cava and, more recently, ultrasound assessment of the jugular venous pressure. This article discusses the evidence, techniques, and limitations of estimating central venous pressure by ultrasound assessment of the inferior vena cava and internal jugular vein.

Errors and pitfalls associated with the performance of point-of-care ultrasound (POCUS) are common and can stem from errors in image acquisition, interpretation, and clinical integration. In this article, the author discuss the technical and cognitive mechanisms involved and propose a framework in systematically approaching potential errors in POCUS, as well as strategies to mitigate them.

The use of point-of-care ultrasound (POCUS) of the vasculature has expanded beyond procedural guidance and is utilized by multiple specialties in varied clinical settings. Evidence supports the use of POCUS for diagnosing deep venous thrombosis in the lower extremities, while for thrombosis in the upper extremities or abdominal aortic aneurysm screening, the evidence is still nascent. Here, we review POCUS of the extremity veins and abdominal aorta with a summary of the pertinent literature, review of the relevant anatomy, description of the appropriate acquisition technique, introduction to associated pathology, and discussion of pitfalls one could encounter.