Coming of age: emergency point of care ultrasonography in Canada.

In the spring of 2012, the Canadian Association of Emergency Physicians (CAEP) issued an important revised position statement outlining its support for point-of-care ultrasonography (PoCUS) by emergency physicians in the emergency department. Emergency PoCUS was born in Canada in 2001: Emergency department echocardiography was a child of the international emergency ultrasound movement that traces its origins back to the late 1980s in the United States. The Canadian Emergency Ultrasound Society (CEUS) has been the only organization providing formal certification for the practice of emergency ultrasonography in Canada over the past decade. We support the continued growth of emergency ultrasonography in Canada and call for a renewed effort to ensure that it becomes a universal skill for all emergency physicians. Definitions of emergency ultrasonography may vary depending on the clinical indications; however, most emergency physicians would describe it as ‘‘diagnostic or procedural ultrasound that is performed and interpreted by the emergency physician during the initial patient encounter for the evaluation of emergent conditions.’’ The use of PoCUS as an adjunct to the practice of emergency medicine (EM) is now well established both internationally and in Canada. Initially, evidence to support using PoCUS came from experiences managing patients who had sustained blunt trauma. However, the scope of practice has expanded as emergency physicians have identified further clinical problems where PoCUS is able to aid evaluation and procedures. Core applications include identification of abdominal aortic aneurysm, focused echocardiography in cardiac arrest, and identification of an intrauterine pregnancy in the first trimester, in addition to trauma. More recently, the scope of the answers provided by PoCUS has expanded to include such problems as identification of pleural fluid and pneumothorax, identification of a deep vein thrombosis, assessment of the inferior vena cava for filling status, shock protocols, and more traditional ultrasound indications, such as cholelithiasis and hydronephrosis. Ultrasound guidance makes insertion of central venous catheters safer and improves success rates for regional nerve blocks. In everyday practice, the emergency physician regularly faces challenges trying to identify serious pathology or reduce procedural complications in a timely manner. Necessity is the mother of invention, and as a result, emergency physicians have continued to develop innovative uses for and expanded the indications for PoCUS. It should be noted that the American College of Emergency Physicians (ACEP) has recently classified emergency ultrasonography into five functional clinical categories to more clearly distinguish its various uses: