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Physical Examinations IV

Using Point of Care Ultrasound to Augment Acquisition of Physical Exam Skills: Organs

Published: April 30th, 2023

1Yale School of Medicine

Point of care ultrasound (POCUS) is used by clinicians for diagnosis, ongoing monitoring, and/or procedural guidance at the time of patient care. Many medical schools are now teaching POCUS as a part of their basic clinical skills training, in addition to history, physical exams, and clinical reasoning. Besides being an independent skill, POCUS is also an incredibly useful tool for augmenting the teaching and learning of the physical exam.

Learning the physical exam involves combining the knowledge of anatomy and physiology with the technical skills of performing maneuvers. This can be especially difficult when learning the physical exam on a healthy subject, where certain exam findings can be difficult to appreciate by palpation or percussion. Ultrasound is an imaging modality that can highlight anatomy and physiology in real-time and, when performed in conjunction with the physical exam, can lead to the improved acquisition of exam skills.

Examination of the cardiovascular system, lungs, abdomen, and thyroid can be a challenging skill for trainees to acquire, but an ultrasound can help to simplify the learning. With ultrasound, we can visualize the closing of heart valves and the timing of systole and diastole, thus adding visual clues to auscultation. Palpation of certain body parts, such as the popliteal and abdominal aorta, thyroid, liver edge, gall bladder, and spleen, are commonly met with uncertainty by learners. These body parts are easily visible using ultrasound, allowing learners to confirm hand placement and verify findings. Measurements of diaphragmatic excursion and liver span by percussion can also be confirmed under ultrasound, thus providing a standard for improving percussion technique. Finally, visualization of the internal jugular vein using ultrasound can improve inspection for jugular venous distension.

Studies have demonstrated that ultrasound training improves elements of the cardiac, pulmonary, abdominal, musculoskeletal, and vascular exams. Additionally, integrating ultrasound teaching with other clinical skills results in high student satisfaction and improved confidence in performing the physical exam. In this video, we will demonstrate how to use POCUS to facilitate learning the examination of the thyroid, lung, heart, liver, and spleen in a healthy subject.

1. Brief Orientation to the Ultrasound Machine and Image Acquisition

  1. Choose the appropriate probe and the preset based on the study you intend to perform.
  2. For superficial structure, choose the linear probe. For deeper structures, choose the curvilinear or phased array probe.
  3. Choose the exam preset that matches the area to be examined (for example, cardiac).
  4. Orientate yourself to the probe indicator, which matches the indicator on the left side of the ultrasound machine screen.

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