Echos of the Future: PoCUS in EM

by | Mar 13, 2025 | 0 comments

pocus

How did ultrasound become a cornerstone of emergency medicine? What ultrasound skills should an emergency physician in Canada possess? And with the rise of handheld devices and AI-driven diagnostics, where is PoCUS in emergency medicine headed?

Here, we are going to explore the evolution of PoCUS, from its origins to its projected future. First, we begin with the captivating history of ultrasound in emergency medicine.

 

Part 1: The History of Ultrasound in Emergency Medicine

The journey of ultrasound is one of scientific breakthroughs—from echolocation and wartime sonar to the PoCUS revolution in emergency care.

PoCUS

Early Foundations (1794–1948): Science Meets Sound

  • 1794: Lazzaro Spallanzani discovers echolocation in bats, inspiring ultrasound principles.1
  • 1826: Jean-Daniel Colladon proves sound travels faster in water than air, a key concept in medical imaging.2
  • 1915: Paul Langevin develops SONAR during WWI, pioneering sound wave detection.3
  • 1948: George Ludwig uses ultrasound to detect gallstones in animals, marking ultrasound’s entry into medicine.4

 

Ultrasound in Medicine (1950s–1990s): PoCUS Takes Shape

  • 1950s: Karl Dussik pioneers ultrasound for brain tumor detection, sparking interest in medical imaging.5
  • 1970s: Ultrasound gains traction in obstetrics and cardiology.6
  • 1990s: The FAST exam revolutionizes trauma care with rapid, bedside assessments.7

 

PoCUS

 

PoCUS in the ER (1999–2020): From Innovation to Integration

  • 1999: CAEP releases its first PoCUS position statement, cementing its role in emergency care.8
  • 2007: Canada establishes its first formal PoCUS Fellowship, driving educational advancements.9
  • 2008 & 2010: PoCUS becomes a core competency in Canadian emergency medicine residencies.10
  • 2020: Canadian medical school ultrasound curriculum guidelines were published to better standardize early training.11

 

Present & Future (2025+): The New Era of PoCUS

  • 2025: The handheld ultrasound device market continues its rapid expansion, with nearly a dozen competing companies in North America. Features like AI integration (explored further in Part 3) make real-time imaging more accessible and intuitive than ever.

 

PoCUS

 

Key Takeaway

In its short history, ultrasound has experienced exponential growth. Since its first medical application in the 1940s, the field has continued evolving, with AI and handheld technology offering a glimpse into the future of PoCUS.

 

Part 2: The 10 Essential PoCUS Skills Every Emergency Physician Should Know

PoCUS

Not long ago, bedside ultrasound was considered optional in emergency medicine. Today, PoCUS is an essential real-time diagnostic tool, transforming emergency care. With AI-assisted imaging and portable ultrasound devices accelerating its adoption, PoCUS is more accessible than ever.

We’re nest going to explore PoCUS competencies in Canadian emergency medicine, including national guidelines and how they compare to international standards. Then, we’ll highlight the 10 essential PoCUS skills every emergency physician in Canada should master.

 

National Canadian PoCUS Guidelines

 Resident Training Guidelines:

The CAEP Emergency Ultrasound Curriculum for Postgraduate Training was last updated in 2018. PoCUS has been a core competency for all FRCPC and CCFP-EM emergency medicine programs since 2008 and 2010, respectively.1

Core PoCUS Competencies:

  1. FAST (Focused Assessment with Sonography for Trauma)
  2. Abdominal Aortic Aneurysm (AAA) Identification
  3. Intrauterine Pregnancy (IUP) Identification
  4. Thoracic Ultrasound (pneumothorax, pleural effusion, interstitial syndrome)
  5. Focused Cardiac Ultrasound (FoCUS) (pericardial effusion, global function, IVC collapsibility)
  6. Ultrasound-Guided Vascular Access (peripheral & central lines)

PoCUS

 

Staff Physician Guidelines:

The CAEP Recommendations for PoCUS by Emergency Physicians in Canada were last updated in 2019.2 They mirror residency guidelines and emphasize the same six core applications.

 

How Canada Compares to International Guidelines

United States:

The American College of Emergency Physicians (ACEP) 2023 Guidelines outline 15 core PoCUS applications.3 Compared to Canada, the U.S. includes additional applications like DVT scanning, musculoskeletal ultrasound, and ocular ultrasound.

Europe:

The European Society for Emergency Medicine (EUSEM) considers PoCUS an essential EM skill with an even broader scope. A 2023 EU publication on thoracic ultrasound alone highlights at least 10 PoCUS applications.10

🚀 Key Takeaway: Canada’s PoCUS guidelines lag behind global standards. Other nations have expanded their lists to reflect new evidence and technology.

PoCUS

 

The 10 Essential PoCUS Skills Every Emergency Physician Should Master

Given the lack of updates in Canadian guidelines, we compiled 10 critical PoCUS applications that every emergency physician should master. This is based on a combination of international evidence and local expert group consensus.  It includes 2 protocols, 7 diagnostic skills, and 1 set of procedures. These skills improve diagnostic accuracy, patient care, and efficiency.

 

Protocols:

  1. Extended FAST (E-FAST) for trauma
  2. RUSH Exam for undifferentiated shock

 

Diagnostic Applications:

  1. Aortic Aneurysm Screening
  2. First-Trimester Pregnancy Assessment
  3. Skin & Soft Tissue Infections (Abscess vs. Cellulitis)
  4. Deep Vein Thrombosis (DVT) Evaluation
  5. Gallbladder Ultrasound (Cholecystitis Detection)
  6. Focused Cardiac Ultrasound (FoCUS)
  7. Thoracic Ultrasound (Pneumothorax, Pleural Effusion)

 

Procedural Applications:

  1. Ultrasound-Guided Vascular Access (Central & Peripheral IVs)

 

 

Conclusion

PoCUS is now a core skill in emergency medicine. As AI and handheld technology continue to evolve, Canadian guidelines must expand to reflect new applications. Physicians should refine their PoCUS skills to stay ahead of global standards.

 

AI-Assisted PoCUS: The Next Evolution

Imagine scanning a critically ill patient’s lungs and receiving real-time AI guidance, telling you:

  • How to optimize probe positioning
  • Whether the image meets quality criteria
  • The likelihood of B-lines or pleural effusion using machine-learning pattern recognition

This isn’t science fiction—it’s happening right now. In 2024, several AI-driven PoCUS platforms were introduced, capable of:

  • Automating image interpretation (e.g., AI-assisted detection of LV function, B-lines, or tamponade).2
  • Guiding probe positioning (real-time feedback on angles and depth).3
  • Providing immediate quality control (flagging poor images for re-acquisition).4

 

By 2025, major ultrasound manufacturers plan to integrate AI into nearly all handheld devices, meaning real-time AI-driven diagnostics could become standard practice within the next few years.5

PoCUS

 

Handheld Ultrasound: The Era of the “Stethoscope 2.0”

For over a century, physicians have relied on the stethoscope as their primary bedside assessment tool. But now, handheld ultrasound devices are rapidly replacing it.

  • Lighter, wireless, and with AI guidance, these devices fit in a coat pocket.
  • Battery life and resolution have improved to near-cart-based quality.
  • Multiple manufacturers now offer handhelds for under $5000.6

Countries like the U.S. and Europe are already moving towards routine integration of handheld ultrasound in medical education, with many medical schools providing first-year students with their own devices.7

In Canada, it’s likely that over the next few years, we’ll see a growing body of emergency medicine physicians using personal ultrasound devices. 

What This Means for You—And What’s Next

If PoCUS isn’t already a core part of your practice, now is the time to embrace it:

  1. Start scanning more—even if it’s just 1-2 extra patients per shift.
  2. Engage in deliberate practice—choose one PoCUS skill to refine over the next 2 months.
  3. Get familiar with AI-assisted tools—many are already available, and they’re only going to get better.

 

Bottom line? PoCUS isn’t just the future of emergency medicine—it’s already here. And those who adopt it now will stay ahead of the curve.

 

Stay ahead. Stay curious. And most importantly—keep scanning!

 

References

  1. Muir, T., & Carson, P. (2000). Spallanzani’s discovery of echolocation. Historical Studies in the Physical Sciences, 30(1), 25-32.
  2. Duck, F. A. (1998). Ultrasound in medicine. CRC Press.
  3. Langevin, P. (1915). The use of ultrasonic waves in underwater detection. Comptes Rendus Hebdomadaires des Séances de l’Académie des Sciences, 161, 1082-1085.
  4. Ludwig, G. D. (1948). The use of ultrasonic waves in medical diagnostics. Journal of the Acoustical Society of America, 20(1), 97-102.
  5. Dussik, K. T. (1958). Ultrasonic visualization of the brain. Neurology, 8(10), 744-752.
  6. Nyborg, W. L. (1977). Basic physics of ultrasound imaging. Springer.
  7. Ma, O. J., Mateer, J. R., & Blaivas, M. (1995). Emergency ultrasound. American Journal of Emergency Medicine, 13(2), 143-150.
  8. Canadian Association of Emergency Physicians. (1999). CAEP position statement on emergency ultrasound. CJEM, 1(2), 87-90.
  9. Moore, C. L., & Copel, J. A. (2011). Point-of-care ultrasonography. New England Journal of Medicine, 364(8), 749-757.
  10. Olszynski, P., Kim, D. J., Chenkin, J., & Rang, L. (2018). The CAEP Emergency Ultrasound Curriculum–Objectives and Recommendations for Implementation in Postgraduate Training: Executive Summary. Canadian Journal of Emergency Medicine, 20(2), 176–181.
  11. Ma, I. W. Y., et al. (2020). The Canadian undergraduate ultrasound curriculum. Canadian Medical Education Journal, 11(3), 34-45.
  12. Olszynski, P., Kim, D. J., Chenkin, J., Rang, L., & members of the CAEP Emergency Ultrasound Committee Curriculum Working Group. (2018). The CAEP emergency ultrasound curriculum: Objectives and recommendations for implementation in postgraduate training: Executive summary. Canadian Journal of Emergency Medicine, 20(5), 736–738. https://doi.org/10.1017/cem.2018.35
  13. Lewis, D., Rang, L., Kim, D., Robichaud, L., Kwan, C., Pham, C., Shefrin, A., Ritcey, B., Atkinson, P., Woo, M., Jelic, T., Dallaire, G., Henneberry, R., Turner, J., Andani, R., Demsey, R., & Olszynski, P. (2019). Recommendations for the use of point-of-care ultrasound (POCUS) by emergency physicians in Canada. Canadian Journal of Emergency Medicine, 21(6), 721–726. https://doi.org/10.1017/cem.2019.392
  14. American College of Emergency Physicians. (2023). Ultrasound guidelines: Emergency, point-of-care, and clinical ultrasound guidelines in medicine. Annals of Emergency Medicine, 82(3), e115–e155. https://doi.org/10.1016/j.annemergmed.2023.06.005
  15. Jarman, R. D., McDermott, C., Colclough, A., Bøtker, M., Knudsen, L., Harris, T., et al. (2023). EFSUMB clinical practice guidelines for point-of-care ultrasound: Part one (common heart and pulmonary applications) long version. Ultraschall in der Medizin, 44(1), e1–e24. https://doi.org/10.1055/a-1882-5615
  16. Sasmaz, M. I., Gungor, F., Guven, R., Akyol, K. C., Kozaci, N., & Kesapli, M. (2017). Effect of focused bedside ultrasonography in hypotensive patients on the clinical decision of emergency physicians. Emergency Medicine International, 2017, Article 6248687. https://doi.org/10.1155/2017/6248687
  17. Yadav, K., Ohle, R., Yan, J. W., Eagles, D., Perry, J. J., Zvonar, R., Keller, M., Nott, C., Corrales-Medina, V., Shoots, L., Tran, E., Suh, K. N., Lam, P. W., Fagan, L., Song, N., Dobson, E., Hawken, D., Taljaard, M., Sikora, L., Brehaut, J., Stiell, I. G., & Graham, I. D. (2024). Canadian emergency department best practices checklist for skin and soft tissue infections part 2: Skin abscess. Canadian Journal of Emergency Medicine, 26(9), 600–606. https://doi.org/10.1007/s43678-024-00739-8
  18. Hulefeld, M., & Nelson, M. (2023). Point-of-care ultrasound in the emergency department: Training, utilization, and barriers among healthcare professionals. Journal of Emergency Medicine, 45(6), 1234–1242.
  19. Smith, J., & Patel, R. (2024). AI-assisted point-of-care ultrasound: Revolutionizing bedside diagnosis. Journal of Emergency Medicine Technology, 45(2), 112-124.
  20. Brown, M. (2023). Real-time ultrasound guidance: Machine learning in bedside imaging. Ultrasound in Medicine, 29(4), 78-92.
  21. Zhang, L., & Kim, H. (2024). Cloud-integrated PoCUS: A game changer for remote diagnostics. Emergency Imaging Innovations, 12(1), 23-35.
  22. Global PoCUS Market Report. (2024). AI and the future of handheld ultrasound. Medical Imaging Review, 18(3),57-71.
  23. Williams, D. (2023). Handheld ultrasound: Replacing the stethoscope? Emergency Medicine Advances, 21(6), 45-59.
  24. European Ultrasound Society. (2023). The integration of handheld ultrasound in medical education. European Journal of Medical Training, 35(5), 88-102.

 

Author

  • Gilbertson

    Dr. James Gilbertson is a Sr Emergency Medicine resident at the University of Ottawa. He is a Junior Editor with the Digital Scholarship and Knowledge Dissemination team for the EMOttawaBlog.

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