Bedside Ultrasound -Philippe Rola

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Philippe has built a great name for himself within he world of ultrasound…and comes with some ‘Sono-biceps’! So, when the opportunity came to review this book….I jumped for joy!

This is aimed at those who may have some POCUS skills and perhaps need some expert guidance as to how to seamlessly integrate POCUS into their clinical examination armoury. It provides guides and frameworks as to how one might go about doing this with ease and repeatability…then teach it too! Having said all of that…there is no reason why a novice wanting to learn this valuable skill shouldn’t pick up the book…you will see why when you read on…

Please check out Philippe’s fabulous blog here:

 

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Chapters

Heart

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We are led through all of the basic cardiac views in this section, and many of the images, refreshing for me, seem to be gathered from pocket devices👍👍 The good old Vscan appears here….we told you it was a great little workhorse didn’t we!? This is fabulous, as these devices are certainly growing in popularity…rapidly putting stethoscopes into the dusty past! You know how I feel about pocket devices….😉

The section regarding assessment of fluid responsiveness is poetic…..we all know how controversial the IVC is in this respect! Philippe handles this well and talks about all of the caveats that irritate us all! Incorporated throughout the text are coloured boxes, which direct us to pause and think for a moment….nutshell vignettes if you like. If anyone leaves having read this chapter thinking the IVC is a panacea for volume responsiveness and global fluid assessment….they haven’t read it properly.

As you see, we are then led through various clinical applications that befit the reality of clinical ICU care…chest pain, to shock and CHF all featuring. Santa Cabrini’s Advanced CHF Clinic protocol document is included as a useful guide in the assessment of the CHF patient.

Approaching shock with POCUS is certainly a popular application…it’s all included here too. The section closes on the use of POCUS in cardiac arrest…an area Philippe is well known for. This is full of legendary advice and talks us through many of the protocols we are all perhaps familiar with (RUSH, eFAST etc).

 

Lung

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The lung is a hugely popular area within POCUS. The fuse for this was lit way back in the 80’s by the father of lung US, Daniel Lichtenstein. I love to practice lung US and teach it. It’s addition to cardiac imaging opens huge diagnostic doors! Philippe talks us through how to integrate it into regular POCUS practice. If you can integrate this into your daily ward rounds, you will soon find you may be doing far fewer chest x-rays.

Specialist areas focussed on here are the patient with COPD, the patient with pulmonary hypertension and the generally dyspneic patient. Finally, we are guided through the observation of diaphragmatic ultrasound dynamics in the assessment of wean’ability from IPPV! These areas are often neglected within many of our POCUS assessments…mostly inadvertently. There is a wealth of publication and research going on into the main muscle of respiration…and pointing POCUS in this direction can be invaluable, when done properly.

 

Abdomen

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I have always said that POCUS assessment of the abdomen is a hidden wonder, often neglected. Think about it….it sits within eFAST / FAST / RUSH in a big way! Also within the assessment of the cardiac arrest patient as a source of leakage etc… What I am saying is, learn it!

See my POCUS-grams on this here

I love this section, it tails off with the assessment of the renal failure patient. Shine the diagnostic torch over the abdomen to reveal why your catheter has no flow, or why your kidneys are hydronephrotic and your patient is knocking at the dialysis door. The rest of the abdomen, when assessed with ultrasound, can demonstrate what goes on in fluid overload and why the patient won’t wean or is shocked! It also highlights when you might call the surgeons to point out the stomach won’t empty and the patient has ileus / obstruction after their operation…no CT needed!

Neuro and the rest!

Neuro-POCUS is taking off. Philippe talks us through ONSD assessment, TC doppler, Carotid assessment and more. Neuro POCUS can be utilised within most hospitals, not just neuro-trauma centres, so I recommend a good read of this section.

Specific patient populations are discussed towards the end…the post-op patient and what to look out for, as well as the general ICU patient.

The Special skills section is brilliant! We are walked through renovascular doppler, portal venous flow and general venous congestive states too. There is a wealth of data now appearing in support of these modalities and what they can offer. Philippe is well ahead of the game here!

The book finishes with a look at all of the common US view again, which is a beautiful recap aidé-memoire for us all.

 

JW summary

A very concise book on POCUS that I recommend you all go and buy asap! Within its simplicity lie many complexities, but you are finally left understanding them! This book has taught me how to integrate expansive possibilities into my POCUS skill-set….which should excite others to pick up a probe and #LEARNPOCUS! Well done Philippe Rola!

Well done and thanks so much to Philippe for the opportunity to review this brilliant text!

My mark – 10/10

 

 

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