Use of POCUS for earlier diagnosis of aortic dissection

As a rural generalist physician working in a rural emergency department I was interested to read the case report in the January issue of Canadian Family Physician of a life saved by the excellent and timely work of the whole rural health care team and community.¹

It struck me while reading, however, that the use of point-of-care ultrasound (POCUS) would have substantially shortened the time to diagnosis and reduced the risk of a poor outcome. My hospital does not have a computed tomography scanner and the nearest is a 1.5-hour drive. Our nearest tertiary care centre is 2 hours in the opposite direction.

With physician training and access to POCUS this dissection could have been diagnosed at the bedside as soon as suspected without the need for laboratory results, etc, or the delay to get the computed tomography scan arranged.

My comments are not to diminish the amazing work of this team but simply to advocate for the use of POCUS more widely and most importantly in rural, low-resource settings.

Point-of-care ultrasound was not something that was part of my training 20 years ago but it is now becoming a more important part of emergency department and hospital care, as well as physician office care. Seeing the promise of huge gains and improved outcomes in my rural community I have recently embarked on a 1-year virtual fellowship in POCUS, which I am able to complete without taking time away from work in my community or from family. I hope that the integration of POCUS into all rural health care settings will be something that is supported by all groups and funding organizations in the future.

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