POCUS Beyond eFAST: Clinical Decisions in Shock and Trauma

POCUS is presented here not as another imaging protocol, but as a practical bridge between a broad differential diagnosis and a decision that must be made now.

The lecture follows three critically injured patients. A 27-year-old man with bilateral lower-limb trauma arrives in profound shock after vascular reconstruction, high-dose vasopressors, and significant diuresis during evacuation. Cardiac views, the inferior vena cava, B-mode assessment, and peripheral Doppler reveal why a cold, pulseless foot cannot be interpreted in isolation—and how repeated ultrasound examinations can reshape resuscitation and the plan for limb salvage.

The discussion then moves beyond circulation. One examination uncovers a markedly distended, fluid-filled stomach in a patient with severe traumatic brain injury and changes the approach to enteral feeding. Another case begins with agitation, hypertension, and rapidly progressive hypoxemia, leading to bilateral pulmonary edema and transient left ventricular dysfunction consistent with SCAPE physiology.

The final section addresses what genuine POCUS competence requires: acquiring interpretable images, distinguishing normal from pathology, integrating findings into clinical decisions, documenting examinations, and receiving mentored feedback. It is the case-based reasoning often missing from short ultrasound courses—and the step that turns a probe into a shared clinical language for surgeons, anesthesiologists, and critical care teams.