Why Anesthesiologists Must Incorporate Focused Cardiac Ultrasound Into Daily Practice

The size, availability, cost, and quality of modern ultrasound devices have, for the first time in modern medicine, enabled point-of-care ultrasound by the noncardiologist physician. The appropriate application of focused cardiac ultrasound (FoCUS) by anesthesiologists has the potential to alter management and affect outcomes for a wide range of patients. In this article, the indications, benefits, and limitations of FoCUS are described. The training and equipment required to perform FoCUS are also discussed. (Anesth Analg 2017;124:761–5)   The modern era of ultrasound was ushered into the scientific community during the late 1930s with the advent of metal flaw detectors and World War II, when interest in advanced detection technology such as sound navigation and ranging and radio detection and ranging peaked. Later, application of ultrasound to medicine led to greater understanding of human anatomy, physiology, and pathology. In the past 20 years, evolution of the microprocessors enabled the miniaturization of large cumbersome ultrasound devices to hand-held, even pocketsized instruments. The size, cost, availability, and quality of these smaller ultrasound devices have placed point-of-care ultrasound in the noncardiologist physician’s armamentarium. The purpose of this article is to describe the concept of focused cardiac ultrasound (FoCUS), its diagnostic targets, indications, benefits, and limitations. Training and equipment required to perform FoCUS are also discussed. WHAT IS FOCUSED CARDIAC ULTRASOUND? Many terms are used to describe a narrowed ultrasound examination of the cardiovascular system including, but not limited to, hand-held, point-of-care, bedside, quick-look cardiac ultrasound, or ultrasound stethoscope. These multiple synonyms are compounded by the variety of acronyms applied to bedside ultrasound protocols, such as FAST, FATE, FEEL, and RUSH. To avoid any confusion, the term FoCUS will be used for the remainder of this article. FoCUS, as defined by the American Society of Echocardiography, is a “focused examination of the cardiovascular system performed by a physician using ultrasound as an adjunct to the physical examination to recognize specific ultrasonic signs that represent a narrow list of potential diagnoses in specific clinical settings.”

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