Title: Incorporating Integrative Volume Status Assessment Via POCUS in a Community Hospital Setting: A Case Series

Authors: Kayla Trautman-Buckley, DO, Ester Deschenes, MD, Gregory Polcha, DO, Erdal Sarac, MD

Email: ktrautman-buckley@mercy.com

Introduction:  The evaluation of volume status is paramount to providing appropriate care to a clinician’s patients through fluid management. Combining physical examination with Point of Care Ultrasound (POCUS) is termed Integrative Volume Status Assessment. POCUS can be incorporated into floor based and emergency medicine evaluation due to safety concerns. Even though POCUS is readily available and prevalent in medicine, the availability of well-trained physicians in community-based hospitals still proves a challenge.  In this case series, we show various examples of how Integrative Volume Status Assessment can be utilized to improve patient outcomes and reduce morbidity and mortality for patients.

Cases: We present four different patient examples of POCUS being used to guide treatment. Images were saved and interpreted. The positive and negative results are discussed, and the images will be presented on a computer presentation alongside the discussion. The cases show AKI due to cardiogenic, hypovolemic, post obstructive, and contrast induced and relate imaging differences in patients.

Discussion: As seen in these cases, Integrative Volume Assessment by combining physical examination findings and POCUS can be used to appropriately differentiate AKI causes. By using US at the bedside rather than waiting for imaging to be gathered and read. Even though these cases show promise for clinical use, the change in practice cannot occur unless there are clinicians able to perform said maneuvers.  Education in POCUS and image interpretation has been established at a national level but mad is currently being integrated into residency programs at St. Elizabeth Youngstown Hospital. The curriculum allows clinicians to expand their knowledge base and improve treatment of not only AKI but also other disease processes. This case series serves as a basis for furthering medical education and showing how new innovations can be used at all levels of medicine.