The year 1816 was a turning point in the world of medicine: Until then, doctors had to place their ears on the patients’ chests to listen to the sounds of breathing and the heart.
Since then, the stethoscope has undergone many incarnations and the new generations are already digital, making it possible to record the sounds inside the body and transmit them even remotely to the doctor. But the stethoscope also has quite a few drawbacks: the sounds heard through it are not always accurate and do not always allow an accurate diagnosis to be made.
In recent years there has been another revolution in the field: the ultrasound device invented as early as 1917 has become more sophisticated, with today the image produced by the device that uses sound waves, without any radiation, is more accurate, clearer, and the once huge devices became small, lightweight, portable And allow to simulate almost any organ in the body and reach many diagnoses quickly, and even at the patient’s bedside and at home.
Ultrasound devices have been used for many years as an integral part of the work of radiologists, gynecologists and cardiologists, but a new method has recently been developed that other non-radiologists use to reach a diagnosis. Meet: POCUS, an acronym for Point Of Care Ultra Sound, or in Hebrew: Al-Kul by the patient’s bed.
According to the new method, pediatricians and inpatients use the ultrasound device on a spot basis, to detect specific problems. The resulting image makes it possible to reach many diagnoses in a matter of minutes, in the clinic or emergency room, without teasing the patient for a long wait for a full ultrasound examination at the imaging institute, and without delaying the treatment.
Thus using the new method it is possible to scan the lungs and diagnose pneumonia, check the heart and watch for signs of inflammation or heart failure, detect life-threatening bleeding around internal organs, detect appendicitis, detect dehydration by looking at a central blood vessel that carries blood to the heart, and even detect fractures , Suspicious lymph nodes, or even find a vein for insertion.
Dr. Ron Burnett, director of the Department of Emergency Medicine at the Schneider Center for Pediatrics, is one of the top experts in the field, who trained his POCUS skills during an internship at the Children’s Hospital in Canada, and upon his return to Israel trained many physicians who already use ultrasound routines.
Ultrasound examination. Also at the patient’s bedside
“This is a standard ultrasound examination whose uniqueness is that it is done at the patient’s bedside,” explains Dr. Burnett, “it can be in the emergency room, in the clinic, and even by a doctor who comes to make a home visit. In fact, the test can be performed anywhere, and is done not by a radiologist but by doctors in various professions, from GPs to internists, urologists, pulmonologists and even orthopedists.
“We can use the device to see a skull fracture, a suspicious lymph node, skin abscesses. You can look at the eye and see if there is evidence of edema in the optic nerve or a foreign body. During resuscitation you can check if the tube is inside the trachea and how the heart is beating.
“We detect foreign bodies, pneumonia, free fluid in the abdomen, appendicitis, fluid in the femur, and even locate nerves and perform targeted anesthesia without simply stabbing the patient.”
The method has already entered all emergency rooms in Israel: “Every emergency department has at least one person who knows how to use and teach the device,” adds Dr. Burnett. “The use is becoming so routine that the field has already become part of the medical students’ program.” Who must know about it, just as they should know how to read ECG.
The device has already proven itself quite a few times. “There was a five-week-old baby who came to our emergency room after the parents saw she was not normal,” Dr. Burnett recalls. “We put the ultrasound transducer on the opening of her skull, the porch, and noticed a suspicion of bleeding in the brain. Turns out she had an abnormal blood vessel that ruptured. “Within 45 minutes she was already on the operating table, the bleeding was draining and thanks to the speed of the diagnosis using the ultrasound, we were able to know what she had in seconds and save her life.”
He recalled another incident: “Another girl arrived with a diagnosis of fever and pneumonia, and looked in poor condition. She was taken to the resuscitation room, with the medical staff’s automatic response usually giving her a fluid infusion. A moment before, we put the ultrasound transducer on her and saw her heart barely contract. It was not a pneumonia, but a viral disease that lowers heart function.
“If we had infused fluids on her, she would have died. She was taken to intensive care, on a heart-lung machine, and recovered. Without the ultrasound diagnosis, they could have given her fluids and endangered her life. This ability of rapid diagnosis makes a difference between heaven and earth and saves. Haim”.
Dr. Burnett concludes: “This is clearly a revolution in the world of medicine. Of course, you never rely solely on ultrasound, it is another tool that joins the decision-making process in medicine. “There is no doubt that when used correctly, it makes it possible to diagnose faster, more accurately, without radiation, often saves unnecessary X-rays and helps us provide the right and immediate treatment to the patient, just before the deterioration.”