Point-of-care Ultrasound in Veterinary Medicine: Insights from Experts

Interview with Dr. Soren Boysen and Dr. Serge Chalhoub

2024-10-16

POCUS can be performed by ANYONE, it is used across all veterinary practices, from beginners to advanced practitioners, EVERYONE can learn and use POCUS.

Curious about how Point-of-Care Ultrasound (POCUS) is transforming veterinary medicine? How do top veterinarians incorporate this technology into their daily practice? To answer these questions, Mindray Animal Medical hosted a Q&A session with Dr. Soren Boysen and Dr. Serge Chalhoub from the Faculty of Veterinary Medicine at the University of Calgary, Canada. Their insights covered a range of topics including education, training, workflow, in POCUS.

Prof. Soren Boysen

DVM, DACVECC
Faculty of Veterinary Medicine, University of Calgary

It's a focused approach, much like triage exams, aimed at addressing the most critical, life-threatening issues. For patients transferred from the emergency department, we conduct comprehensive POCUS.

Dr. Serge Chalhoub

BSC.DVM, DACVIM (SAIM)
Faculty of Veterinary Medicine, University of Calgary

POCUS can be performed by ANYONE, all specialties, and even technicians. Many general practitioners cannot refer patients to specialists due to costs or distance, but POCUS empowers them to make confident, patient-centered decisions.

What is POCUS in Veterinary Medicine?

What does POCUS mean exactly? In human medicine, the term "bedside" is often used. Is there an equivalent term in veterinary medicine like "cage-side"? And is scanning a sea lion in an aquarium or a black bear in a wild animal reserve park considered POCUS?
Scanning a sea lion or a black bear is definitely POCUS. Point of Care Ultrasound (POCUS) is defined as the integration of ultrasound findings at the cage-side or patient-side at that moment to answer specific clinical questions without the need to examine all organs or planes.

Prof. Boysen

POCUS is highly focused. "Cage-side" might be a common term; for example, with a dog suffering from congestive heart failure, we might not want to move the patient. Instead, we bring the ultrasound machine to the patient, who is already receiving oxygen, to examine the heart and lungs. This rapid, focused approach allows us to treat the patient more efficiently, reducing anxiety and improving outcomes.

Dr. Chalhoub

Where Should POCUS be Applied?

Generally speaking, what kind of hospital or clinic should perform POCUS? Are there differences in its application across different levels of hospitals?
POCUS can be performed by ANYONE —small clinics, mobile practitioners, large hospitals, general practices, emergency departments, all specialties, and even technicians. It's an extremely versatile and useful tool. For instance, to answer a simple yes-or-no question, such as whether there is free fluid, you don't need to be a specialist; assessing the left atrium in a patient with respiratory distress can help determine if the patient is in congestive heart failure, guiding immediate life-saving treatments. That's the beauty of POCUS. Many general practitioners cannot refer patients to specialists due to costs or distance, but POCUS empowers them to make confident, patient-centered decisions.

Dr. Chalhoub

Feline ascites

Feline HCM & pericardial effusion

Canine lung mass

In practice, we scan patients "cage-side" while they are still in their cages in the ICU or "table-side" in the emergency room, though "patient-side" works for all situations. POCUS is used across all veterinary practices, from beginners to advanced practitioners, because the questions asked and answered depend on the clinician's skill level and the specific environment they are working in.

Prof. Boysen

Who Can Learn and Use POCUS?

Who are your typical students of POCUS? Are they DVM students, residents, or specialists?
We train EVERYONE—from tech students and vet students to interns, residents, and specialists. At Cornell University, we conduct boot camps for third-year emergency and critical care (ECC) residents. We also train general small animal interns, ER doctors, and seasoned practitioners who may have graduated before ultrasound was widely available. We teach ultrasound skills from the undergraduate level right through to specialists.

Prof. Boysen

Technicians are also included. We train a lot of technicians and vet nurses to use POCUS for vascular access and as part of the triage process.

Dr. Chalhoub

Feline external iliac artery thrombosis

When is POCUS Most Useful in Veterinary Medicine?

Are there similarities or differences between POCUS in human and veterinary medicine? For example, in human medicine, there is a “golden triangle” in POCUS that includes ER, critical care, and anesthesia.
The terms used in human medicine don't translate directly to veterinary practice, mainly because the applications differ. In humans, the “golden triangle” focuses on trauma and wound care. In veterinary medicine, POCUS is applied based on the clinical setting. In the ER, we use triage POCUS to quickly identify the underlying problem and stabilize the patient.

Prof. Boysen

POCUS Application Scenarios
It's a focused approach, much like triage exams, aimed at addressing the most critical, life-threatening issues. We also use interventional POC ultrasound for procedures like fluid removal and serial tracking of pathology. For patients transferred from the emergency department, we conduct comprehensive POCUS. The "golden triangle" doesn't fully capture the breadth of our applications in veterinary medicine. When patients first arrive, we assess them with POC ultrasound while performing other diagnostics and stabilization within the crucial first 5-10 minutes of triage.

Prof. Boysen

There are some unique challenges. For one, our patients are furry, unlike humans. We don't usually shave them but can get most of our POCUS done by parting the fur and applying alcohol. Additionally, our patients are less cooperative than humans. You can't tell an animal “don't move” or ask them where it hurts. Since animals can't communicate, POCUS in veterinary medicine is even more valuable, as it truly extends our physical exam and clinical reasoning.

Dr. Chalhoub

Canine greater ischiatic notch block

How to Improve Scanning and Interpretation Skills in POCUS

Any advice on how to improve scanning and interpretation skills?
Practice, practice, practice—especially on normal animals. Knowing normal anatomy is essential, and you need to get comfortable manipulating the probe and identifying normal structures. Only then can you confidently diagnose emergency cases. It's similar to reading radiographs; you don't start with abnormal cases. You need to read hundreds of normal radiographs first. That's crucial.

Dr. Chalhoub

Research shows that to gain confidence in answering specific questions, you need practice. For instance, identifying free fluid in the abdomen requires examining about twenty cases of dogs with free fluid to feel confident in your diagnosis. We're conducting ongoing research with the University of Liège on how much training it takes to become proficient, and it varies depending on individual skill levels and the specific POCUS questions being addressed.

Prof. Boysen

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