Should point-of-care ultrasonography replace stethoscopes in acute respiratory failure?
BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5225 (Published 30 August 2019) Cite this as: BMJ 2019;366:l5225
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The use of a stethoscope is indispensable for the clinical assessment of patients. On the other hand, point of care ultrasound (POCUS) is a tool for diagnosing, peforming invasive procedures and evaluating the illness over time. Neither can replace each other. They work together and it will be so for years.
POCUS can demonstrate structural lessions in tissues, organs or systems, but by using the stethoscope we can hear the cardiac sounds, the bowel sounds, rales, roncus, and sibilants that cannot be documented by POCUS.
So, I consider both ultrasound and the stethoscope will be present together for a long, long time.
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Surely, cost cannot be a discouraging issue.
Nowadays, B-mode, and some 3D, portable ultrasound scanners cost under £1,000, consume only a few Watts of electric power, can operate efficiently for tens of hours, can help scan hundreds of patients daily, in expert hands.
These cheap lightweight scanners can be easily transported and operated in remote villages or during house calls.
Comfortably dispatching captured images/videos to far away operators in hospitals allows confirmed distant diagnoses.
Ultrasonic scanning adds a plethora of useful clinical information, of vital importance.
Competing interests: No competing interests
Fantastic head to head article. There is always some scepticism when a new technique is implemented in medicine: this is quite natural. I think bedside ultrasound examination should be used as an adjunct tool along with stethoscope, clinical findings and laboratory findings, e.g., increased C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), White blood Cell Count (WCC) and a relatively new marker Procalcitonin (PCT).
However, as mentioned in the article, there are some shortcomings of using bedside ultrasound like Q@A issues and who endorses / justifies its usage in day to day practice.
Moreover, there seem to be more prospective studies and meta analysis needed for its firm implementation.
Competing interests: No competing interests
Clinician-based ultrasound at the point-of-first-contact with the woman is essential to an efficient clinical service in both obstetrics and gynaecology. Whether you are in the labour ward, operating theatre, antenatal or gynaecology or early pregnancy clinic, ultrasound should be immediately available from a trained clinician. "Hand-held" might be added, though "trained" may be the important word in the sentence?
How refreshing to hear chest physicians getting involved.
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Re: Should point-of-care ultrasonography replace stethoscopes in acute respiratory failure?
The article is asking the wrong question, the title is slightly tabloid, and the message can be extremely clinical misleading. Point of care ultrasound is different than office based/radiology ultrasound precisely for the reason that it is the examining clinician doing the scanning. Therefore no chest ultrasound should be done without examining the patient, or taking a history, or taking into account existing radiographs, scans, etc., something the ultrasonographers or radiologists never do. Also the argument of the “No” authors is not frank or open, considering that their publishing history is precisely in favour of using chest ultrasonography. But I appreciate that for the sake of balance the No camp is proving hard to find negatives associated with the use of ultrasound, such as “limited data exists that the ultrasound can influence clinical thinking and management”. I am looking forward to larger randomised trial (funded by whom?) that will respond to these queries.
Competing interests: No competing interests