Many physicians view sonography as primarily within the radiologist's domain, often opting to rely on clinical parameters or traditional tools for assessment. This preference can lead to remote views or delayed diagnoses when more advanced tools are not immediately accessible.

Point-of-care sonography is increasingly being adopted across various specialties due to the limitations of traditional tools and the impracticality of using sophisticated ones. Modern ultrasound machines are now more affordable and portable, offering advantages such as speed, repeatability, safety, and a promising steep learning curve.

I would like to share some applications of point-of-care sonography by junior anesthesia trainees. After a modest learning period, they have made a significant difference in the outcomes of critical cases, eased management, and enabled early prediction of potential problems. Many of these uses, supported by studies conducted by my team and me, relate directly or indirectly to patients with endocrine problems.

In a case of gradual hypoxemia intraoperatively that was non-responsive to usual measures, sonographic examination revealed a pneumothorax. Typically, clear clinical parameters for this condition appear too late, and portable X-ray machines are often unavailable in the operating theater. 

In a case of postoperative hypoxemia, tachypnea, and tachycardia with elevated D-dimer levels, the initial approach was to treat it as a pulmonary embolism. Sonography excluded pulmonary consolidation and pleural effusion, but revealed a significantly elevated diaphragm, leading to a diagnosis of collapse. This finding shifted the management away from the initial diagnosis, pulmonary embolism.

In an acute case of chest pain and shock, a resident used ultrasound to exclude pericardial effusion and massive pulmonary embolism. However, significant myocardial hypokinesia, an early sign of cardiac ischemia that explains the presentation, was detected. Troponin levels and ECG changes were observed only later.

During CPR, we couldn't confirm the correct placement of the tracheal tube as capnography is ineffective in this situation. Our examination revealed a "double trachea" sign, indicating esophageal intubation (This work is also supported by a study conducted by our team).

These are in addition to routine use of ultrasound machines by some junior anesthetists for the following purposes:

1. To preoperatively rule out deep vein thrombosis in immobile or high-risk patients (feasibility was studied by our team).

2. To confirm an empty stomach preoperatively (feasibility was demonstrated by our study).

3. Approaching shock by assessing inferior vena cava collapsibility during respiration to guide fluid responsiveness, while monitoring B-lines to prevent pulmonary fluid overload. This method eliminates the need for central venous pressure measurements, along with their associated risks and limitations. ( also one of our studies)

With the aid of ultrasound, peripherally inserted catheters (or cannulas) have gradually replaced central venous catheter placements, reducing associated risks. This technique has even been adopted by some nurses, successfully saving many patients with coagulopathy, prolonged hospitalization, undergoing chemotherapy, limited experience with central catheterization, and those suffering from shock, obesity, or burn injuries. (This practice, along with the ability to rule out extravasation, was the subject of two studies conducted by our team.)

5. Systolic blood pressure can be measured using ultrasound detection of arterial pulsation in patients for whom regular methods are challenging.

6. All these measures, along with the application of the FAST (Focused Assessment with Sonography in Trauma) exam to identify pathologies.

Unfortunately, the use of this tool is not yet widespread among different clinical specialties. We don't need to be experts in ultrasound to make a significant impact on patients' lives. Let's encourage the adoption of these machines.