Introduction
In the fast-paced, decision-making environment of the emergency department, handheld ultrasound is rapidly becoming an important tool for emergency physicians because it is small, portable, usable at the patient bedside, and provides immediate images. Although more clinicians recognize the value of pocket ultrasound in various clinical situations, many remain unsure about its applications and how to choose the right device. For which clinical applications is portable ultrasound suitable as the primary imaging method? What technical parameters should be prioritized when purchasing a pocket-sized handheld ultrasound?
This article explores the application of handheld point-of-care ultrasound in emergency medicine and the key points for device selection to help clinicians choose more suitable devices.
What is POCUS ultrasound?
Point-of-care ultrasound (POCUS) is a cost-effective diagnostic tool. With basic training, it’s easy to use and highly portable. POCUS lets clinicians assess and treat patients wherever they are, without requiring them to be at a specific location and at a specific time.
As a rapid diagnostic tool, bedside ultrasound has gained widespread adoption across multiple specialties, particularly in emergency medicine. Emergency ultrasound has been used to assist in the diagnosis of a variety of conditions, including pneumothorax, cardiac assessment, abdominal aortic aneurysm, and traumatic injury assessment.
Benefits of Handheld Ultrasound in Emergency Medicine
Improved Patient Safety
During invasive tests such as puncture and catheterization, visual ultrasound image guidance can reduce the incidence of mispuncture, vascular injury, and organ damage, thereby improving patient safety.
Reduced Time to Diagnosis
Wireless ultrasound devices are portable and start quickly. They can quickly obtain real-time images of a patient’s critical areas (such as the heart, lungs, and abdomen) at the emergency room scene, helping doctors quickly determine the cause of illness, reducing diagnosis time and saving critical time for subsequent treatment.
Support Prehospital Care
Healthcare staff can use prehospital ultrasound at the scene or during transport for early patient assessment, delivering critical diagnostic information before hospital arrival.
Decrease Complication Rates
For unstable patients, traditional CT or MRI often requires transport to radiology, which may increase risks. Handheld ultrasound can be used directly in the emergency room or ambulance, avoiding unnecessary transfers and reducing complications.
The Use of Handheld Ultrasound Devices in Emergency Medicine
Trauma Assessment
In trauma cases, handheld ultrasound can be used to perform a focused assessment with ultrasound for trauma (FAST) examination. The FAST exam is a diagnostic point-of-care ultrasound examination used to screen for the presence of free fluid in the pericardium and peritoneum. It helps identify internal bleeding, effusion, or organ damage. By providing immediate imaging, it helps clinicians quickly determine whether emergency surgical intervention is needed.
The FAST exam typically uses a 2–5 MHz convex probe to obtain B‑mode ultrasound images. The patient is usually supine. If possible, elevating or extending the patient’s arms facilitates assessment of the left and right upper abdomen. The entire examination should be completed within 5 minutes.
The routine FAST examination evaluates the following four areas in sequence:
(1) Pericardium
Purpose: Use a subxiphoid view to detect pericardial fluid and avoid cardiac tamponade.
Probe Position: Placed under the xiphoid process, with the probe mark facing the patient’s right shoulder, and scanned in a slightly upward tilted direction on the coronal section (long axis).
(2) Right upper quadrant (RUQ)
Purpose: Scan the hepatorenal recesses to screen for bleeding in the right upper quadrant and to alert for liver and kidney injury.
Probe Position: Placed in the right midaxillary line between the 8th and 11th intercostal spaces, with the probe marking facing cephalad (coronal view), locate the junction of the liver, kidney, and diaphragm.
(3) Left Upper Quadrant (LUQ)
Purpose: Evaluate the splenorenal recess to check for left upper quadrant fluid and to screen for splenic rupture.
Probe Position: Place the probe in the left posterior axillary line between the 6th and 9th intercostal spaces, with the probe marking facing cephalad (coronal view), to locate the junction of the spleen, left kidney, and diaphragm.
(4) Pelvic
Purpose: Check whether there is free fluid in the rectovaginal pouch (male) or rectouterine pouch (female) to identify pelvic bleeding.
Probe Position: Scan suprapubically in transverse and longitudinal planes, with the probe marker toward the patient’s right for transverse scans or toward the head for longitudinal scans.
Cardiac Emergencies
Cardiac disease remains one of the leading causes of death in the United States. Point-of-care ultrasound cardiac assessments for patients with chest pain, dyspnea, and hypotension are becoming increasingly common in emergency departments. This simple cardiac examination allows clinicians to early detect various conditions (such as congestive heart failure, pericardial effusion, and pulmonary embolism) and initiate optimal medical care. Furthermore, standardizing and integrating cardiac point-of-care ultrasound into patient resuscitation efforts can help improve the effectiveness of cardiopulmonary resuscitation (CPR).
In the management of cardiac arrest and acute chest pain/acute heart failure, POCUS can rapidly provide critical information, such as:
Pericardial effusion: Observe for anechoic areas surrounding the heart using parasternal long-axis and apical four-chamber views.
Cardiac tamponade: Note signs of right atrial and right ventricular collapse during diastole and inferior vena cava dilation with reduced respiratory variation.
Pocket-sized handheld ultrasound can quickly detect these critical findings, often significantly impacting immediate treatment decisions.
Pulmonary Assessment
In respiratory emergencies, handheld ultrasound can assist in the diagnosis and identification of conditions such as pneumothorax, pulmonary edema, or pleural effusion. Rapid identification of these conditions is crucial for prompt initiation of appropriate treatment.
Ultrasound Diagnosis of Pulmonary Edema
Pulmonary edema refers to leakage of fluid from the pulmonary capillaries into the interstitium and alveoli, exceeding lymphatic drainage capacity, resulting in increased interstitial and alveolar fluid. Pulmonary edema can be categorized as cardiogenic or noncardiogenic. Cardiogenic pulmonary edema is secondary to left ventricular failure (increased left ventricular filling pressure, pulmonary venous pressure, and pulmonary capillary hydrostatic pressure). Noncardiogenic pulmonary edema can be categorized by etiology as permeability-related (increased capillary permeability), infectious pulmonary edema, neurogenic pulmonary edema, and high-altitude pulmonary edema.
Ultrasound Signs
B-lines: Cardiogenic pulmonary edema often presents with diffuse, confluent B-lines and a smooth, continuous pleural line with normal lung sliding. Pulmonary edema associated with acute respiratory distress syndrome (ARDS) often shows an irregular B-line distribution, with multiple focal or patchy B-lines and an irregular or fragmented pleural line depending on disease severity.
Ultrasound training enables clinicians to detect abnormal B-lines and selectively assess or rule out pulmonary edema. The increased frequency and pattern of B-lines observed in patients with pulmonary edema vary and are distinguishable from the normal A-lines seen in healthy lungs. Therefore, portable ultrasound can help identify and differentiate between normal and pathological respiratory findings.
Abdominal Pain Evaluation
In patients with acute abdominal pain, handheld ultrasound devices can help diagnose conditions such as appendicitis, cholecystitis, renal colic/kidney stones, and abdominal aortic aneurysm (AAA). Rapid imaging reduces the need for more time-consuming and expensive diagnostic tests, enabling faster treatment decisions.
Ultrasound Diagnosis of AAA
An abdominal aortic aneurysm (AAA) is an enlargement or bulge in the portion of the aorta that extends into the abdomen (abdominal aorta). The larger the aneurysm, the greater the likelihood it will rupture (burst) and cause life-threatening internal bleeding. In the United States, approximately 1.4% of adults aged 50 to 84, or approximately 1.1 million people, have an AAA. Among men over 65, 1% to 2% will develop an AAA. The risk of developing an AAA doubles with every decade of age.
Many protocols for evaluating patients in shock include point-of-care ultrasound to detect an abdominal aortic aneurysm (AAA) because visualization of a normal-caliber aorta can effectively rule out a ruptured AAA. The sensitivity and specificity of emergency physicians identifying AAA have been reported as approximately 99% and 98%, respectively, enabling early diagnosis of AAA rupture.
Why Choose to Purchase Handheld Ultrasound From Medtribs?
“How to make an ultrasound image clearer?”
Use probes with more elements. We offer probes with 80 / 96 / 128 / 192 elements. Elements are the basic units in an ultrasound probe that transmit and receive ultrasound waves. More elements mean a denser beam scan, capturing subtle differences in tissue structure and reducing image blur and distortion.
“Are there subscription charges for the Medtribs App?”
No, the app is completely free with no hidden charges. You can access, save, and share your ultrasound scans at no cost.
“Is the Medtribs APP powerful?”
Yes. Our APP not only has standard features like image adjustment, needle guidance, image replay and saving, and measurements/calculations, but also includes vessel localization and upcoming features like needle-tip enhancement and magnetic navigation.
“What is the warranty on Medtribs ultrasounds?”
We offer an 18-month warranty. Additionally, those who want additional peace of mind can purchase an extended warranty.
“Are your products certified?”
Yes. Medtribs handheld ultrasound devices are CE and FDA certified.
Medtribs Select
We recommend 4 handheld ultrasounds for emergency medicine. Choose by your needs:
192 Element 3‑In‑1 Dual‑Head Portable Ultrasound Scanner: The clearest images, suitable for users with high imaging quality requirements.
128 Elements Dual‑Probes Whole Body Portable Ultrasound Scanner: Only 120g, ultra-light and easy to carry, suitable for training or mobile use.
128‑Element Linear/Convex/Phased Array 3‑In‑1 Portable Ultrasound Scanner: One probe with three array modes, versatile.
128‑Element Dual Probes Multipurpose Handheld Ultrasound Scanner: High cost-performance, suitable for routine emergency use.
Conclusion
Pocket-sized handheld ultrasound devices have become indispensable aids in emergency medicine. They can provide rapid diagnosis, improve diagnostic accuracy, and support bedside ultrasound examinations. Their portability and ease of use make them important tools for emergency medical professionals. If you would like a quote on handheld ultrasound devices or are looking for a reliable supplier, please contact us.
