Chapter One POCUS: Introduction

      Gregory R. Lisciandro

Veterinary POCUS (V‐POCUS) Defined

      We will use the acronyms POCUS and FAST throughout the textbook. It is important to read the Preface prior to Chapter One.

Terminology Updates

      Briefly, we will mention some of the more important changes and developments since our first edition. A more complete list of terminology and abbreviations is found in the Appendices. For a grasp of some of the basic concepts within this textbook, let’s define a few things.

       The “T 3” of Trauma, Triage, and Tracking

      We have mostly dropped the “T^3” designation that previously emphasized the “3‐T approach” of applying FAST for Trauma, Triage, and Tracking (T³), primarily because since the first edition, the T³ approach has become routine throughout North America, South America, Europe, and the Middle East in the author’s experience.

       COAST 3 is Out, POCUS is In

      COAST³ or “cageside organ assessment with sonography for trauma (triage and tracking)” is out (similar to BOAST in human medicine) and POCUS is now the preferred mainstream term similar to what has occurred in human medicine (Rozycki et al. 2005; Lisciandro et al. 2014).

      We have replaced COAST with POCUS in this second edition and advocate for POCUS (or Focused) X, or POCUS (Focused) Y, or POCUS (Focused) Z as giving better clarity to the examination and have proposed approaches to the various systems throughout this edition. The use of FoCUSED for “Focused Cardiac Ultrasound” and other confusing acronyms we hope to avoid in veterinary medicine. FoCUSED in human medicine would have been better named POCUS (or Focused Heart) Heart or POCUS (or Focused Echo) Echo. The term “Focused” as in our first edition similarly provides clarity to the examination and may be used interchangeably with specific POCUS examinations.

       FAST Survives and Continues

FAST stands for Focused Assessment with Sonography for Trauma and has been applied to the abdomen (FAST) and extended thorax (EFAST) in people (Rozycki 1998; Rozycki et al. 2001; Kirkpatrick et al. 2004). Its applications have expanded to nontrauma and tracking (Lisciandro 2011, 2016; McMurray et al. 2016). Problems arise in the human literature with terminology and they are not always right. For example, what exactly is EFAST? Is it a FAST and the thorax or only the thorax? What if we just do the thorax, then what FAST do we call it? Abdominal FAST (AFAST) and thoracic FAST (TFAST) give exact clarity and have been standardized and validated in published studies (Lisciandro et al. 2008, 2009; Lisciandro 2016; McMurray et al. 2016). Their acoustic windows have exact clarity, as does the “FAST” lung examination called Vet BLUE (Lisciandro et al. 2014, 2017).

       The Flash Exam is Not a FAST Exam

The “Flash Exam” term is applied for a general whole‐cavity acoustic window approach to rapidly answer a simple binary question: is free fluid present or not in the abdominal and thoracic cavity? And now, with lung ultrasound becoming accepted among colleagues, are B‐lines present or not? There is so much more to gain by using standardized acoustic windows of AFAST and TFAST (and Vet BLUE) that take about the same amount of time as the “Flash” approach. The “Flash” usually is followed by “looking around,” often leading to a “satisfaction of search error” approach. Again, in the same amount of time, you could have done AFAST, TFAST, and Vet BLUE (Global FAST) with standardized acoustic windows following a protocol and gained so much more unbiased baseline patient information, while avoiding “satisfaction of search error.” AFAST, TFAST, and Vet BLUE are not “Flash” exams and the terms should not be used interchangeably. We should stop teaching the “Flash” approach, just as we would not teach limited physical examinations – such as only quickly palpating the abdomen of a vomiting cat to draw clinical conclusions without looking further (Figure 1.1).

       Radiologist and Cardiologist Studies

      We will refer to these studies as complete detailed abdominal ultrasound” and “complete detailed echocardiography.” “Diagnostic” is a term that can be more universally applied as both a POCUS (or Focused) and FAST examination are potentially diagnostic, for example for ascites, pleural and pericardial effusion, calcaneus tendon rupture, skull fracture, a splenic mass, gallbladder mucocele, to name a few.