The POCUS Textbook - Larry Istrail

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What’s it about?

I love it when Larry brings out yet another text you can’t put down!

“The POCUS Textbook: Learn Point-of-Care Ultrasound of the Blood Vessels, Heart, & Lungs” by Dr. Larry Istrail is a unique educational book designed to help clinicians master point-of-care ultrasound (POCUS) through practical, integrated learning.

The book provides step-by-step instructions on acquiring, interpreting, and applying ultrasound images for key cardiopulmonary structures and diseases. His fantastic methodology for learning by bedside application really impressed us in his latest book! As we move further into the age of POCUS, this resource acts as a hands-on manual for practitioners aiming to bridge the gap, rethinking the essence of a physical examination by setting aside old habits and evaluating every tool and method from a foundational perspective. Which assessments and approaches best align with the huge leaps in medical understanding and tech we’ve experienced since the stethoscope first appeared in 1816? Might a forward-thinking doctor still rely on a simple tube for picking up secondary noises and clues, when we can now directly observe internal structures and spot issues right away?

Stylistics come flowing through his writing methodology…engagemtn is often hard to maintain with medical texts. There will be glue on your hands with this one….as there was for us with the POCUS Manifesto…see our review here:

The POCUS Manifesto

The book emphasises and advises an active scanning process, so that sonographers can learn and retain information, blending in contemporary tools that let us examine organs inside the body and check blood circulation trends. This will aid the readers in their quest to cut down on extra tests and avoid unnecessary radiation risks. There are over 100 beautiful illustrations, crafted neatly without any puzzling shortcuts or charts. This is right up my alley…as a very visual learner!

The material is structured by cardiopulmonary areas and pathologies thereon. The way it is structured really appeals to the practising clinician, in that commonplace ‘wish list’ topics are covered, putting relevance to the subject areas in a clinical, relatable context. The heart, lungs and major vessels, are used to blend in ideas about ultrasound basics and equipment handling right within the practical sections. This volume offers a thorough, actionable roadmap to an ideal modern check-up, doable right next to the patient using just your expertise, sharp thinking, and a portable scanner that slips into your lab coat (well, your scrubs these days!).

It’s more than just an ultrasound atlas; it’s a systematic approach to help clinicians visualize and diagnose at the bedside. We love the way Larry continually uses explanations and comparisons to other diagnostics to guide users through each step. It skips the usual structure found in many similar guides, which often kick off with technical details like sound wave principles, device selection, or control adjustments that can feel tedious. Instead, this one launches into summaries of conditions and their backgrounds, weaving in ultrasound ideas as part of grasping how diseases work and what testing choices exist. It starts from the specific health issue or body part, posing key inquiries like: How did we end up with our present ways of spotting this problem, and where does it fit in the broader timeline of medicine? What are the pros and cons of the tools we use now, and in what ways does ultrasound shift that balance? How accurate is ultrasound at confirming or excluding a certain condition, and what’s the smartest way to apply it during patient care? After all, the tests we do have to have a sensitivity and specificity profile that benefits the patient on the end of the probe?!

How is it structured?

The book is divided into twenty chapters, each focusing on a different aspect of POCUS and its clinical integration. Here’s a breakdown of the chapters:

Internal Jugular Vein : Covers limitations of visual inspection and POCUS of the jugular vein. This will be gold for residents and attendings alike. I always remember this foundation being particularly useful to grasp, what with the need to assess venous pressures!
Common Carotid Artery : Focuses on carotid Doppler basics, color Doppler, and pulsed-wave Doppler. As a clinician, this part was always daunting, but Larry lays it out with panache.
Detecting Cardiac Disease at the Carotid : Details aortic stenosis, pulsus tardus et parvus, aortic regurgitation, and low flow states. With POCUS becoming ubiquitous in practice, this adds fantastic insight into understanding cardiac pathology and reinforcing essentials for disease processes.
Common Carotid Flow & Cardiac Output : Explores flow measurements and their relation to cardiac output. This section will be particularly useful to those with an interest in hemodynamics.
Lung Ultrasound Overview : Includes lung sliding, A-lines, B-lines, and scanning techniques.
Pneumothorax : Covers diagnosing pneumothorax with POCUS.
Pulmonary Edema : Details diagnosing pulmonary edema with POCUS.
Pneumonia : Focuses on lung ultrasound signs in pneumonia.
Pleural Effusions : Explores identification and assessment of pleural effusions.
Pulmonary Fibrosis : Covers POCUS applications in pulmonary fibrosis.
Pulmonary Embolus & Deep Vein Thrombosis : Includes criteria, diagnostic tests, diagnosing PE with POCUS, and DVT with lower extremity vein POCUS. This will be gold for those dealing with thromboembolic diseases.
CT Scans, Radiation, & Cancer Risk : Discusses risks of traditional imaging and introduction to cardiac POCUS.
Cardiac Views : Details parasternal long and short axis, apical 4 and 5 chamber, subcostal 4 chamber, and subcostal IVC views.
Estimating Left Ventricular Ejection Fraction : Focuses on assessing LV function at the bedside.
Volume Overload and Venous Congestion : Covers using POCUS for congestion, IVC collapsibility, jugular vein POCUS, calculating pressures, VExUS score, hepatic, portal, and renal vessels.
Pulmonary Embolism, Pulmonary Hypertension, & Cardiac POCUS : Includes right ventricular dilation, TAPSE, and RVOT Doppler for PE and hypertension.
Wall Motion Abnormalities & Myocardial Infarction : Explores the role of POCUS in detecting infarction and abnormalities.
Cardiac Output : Details measuring cardiac output at the bedside.
Pericardial Effusions & Tamponade : Covers diagnosing tamponade with POCUS and venous dilation in jugular and IVC.
Detecting Valvular Disease : Focuses on diagnosing valvular disease with POCUS, including mitral, tricuspid, and aortic regurgitation and stenosis, plus screening for aortic stenosis. This section will be particularly useful to those with an interest in cardiology, and for those who may go on to perform regular echoes.

Is it for me?

Dr Istrail also emphasises that you don’t need to be a sonographer to benefit from this book; all you need is a probe and some practice. This inclusivity opens the door for individuals from all backgrounds to engage with the material, whether they are seasoned experts or complete beginners.

The methodical approach of breaking down complex ultrasound into simple, repeatable steps is designed to aid in learning and retention. This systematic technique not only makes it easier to grasp intricate findings but also reinforces memory through repetition. Each concept builds on the previous one, allowing learners to gradually enhance their understanding and skills without feeling overwhelmed. It’s packed with fascinating looks back at medical history, the latest research findings, attractive and uncomplicated diagrams free of shorthand, plus quick, watchable instructional clips that pair with most images and can be pulled up easily on a phone.

Videos are always a beautiful addition to assist the learner, and Larry has plenty to accompany the visuals in the book. These videos provide additional support, offering demonstrations that clarify the steps described in the text and ensure that regardless of one’s learning style, there are diverse resources available to facilitate mastery. By visually engaging with the content, learners can better understand the nuances of POCUS, making the overall learning experience more dynamic and effective.

Here is Larry’s YouTube channel: