Editorial
Physical exam with ultrasound, lights and shadows of an unstoppable multidisciplinary advance
La exploración física con ultrasonidos, luces y sombras de un avance multidisciplinar imparable
a Coordinador del Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna (GTECo-SEMI), Servicio de Medicina Interna, Hospital Universitario La Paz; Departamento de Medicina, Universidad Alfonso X El Sabio, Madrid, Spain
b Presidenta saliente de la Sociedad Española de Radiología Médica (SERAM) y Sociedad Española de Radiología de Urgencias (SERAU), Jefa de Sección de Radiología de Urgencias, Hospital Universitario La Paz, Madrid, Spain
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Tung-Chen, M. Martí-de Gracia" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Y." "apellidos" => "Tung-Chen" "email" => array:1 [ 0 => "yale.tung@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Martí-de Gracia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Coordinador del Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna (GTECo-SEMI), Servicio de Medicina Interna, Hospital Universitario La Paz; Departamento de Medicina, Universidad Alfonso X El Sabio, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Presidenta saliente de la Sociedad Española de Radiología Médica (SERAM) y Sociedad Española de Radiología de Urgencias (SERAU), Jefa de Sección de Radiología de Urgencias, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La exploración física con ultrasonidos, luces y sombras de un avance multidisciplinar imparable" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ultrasound has expanded considerably in recent years and is currently used by multiple specialists classically unrelated to imaging techniques and applied at the patient bedside. This has led to the concept of PoCUS (Point-of-Care UltraSound). In this regard, PoCUS is regarded as a complementary tool to physical examination that allows for a more precise and agile approach, guiding the diagnosis and treatment, and monitoring or guiding minimally invasive procedures with greater patient safety.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It has thus become the fifth cornerstone of the exploration procedure: inspection, palpation, percussion, auscultation and insonation.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The time taken to perform the examination is usually shorter than for a standard protocolized study, since its purpose is very specific and with a very defined protocol, and the knowledge of the person performing it is also often more limited.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In specific clinical scenarios, the exploration of one or more foci of interest, simultaneously or consecutively, allows a large amount of relevant information to be obtained quickly and in a noninvasive manner. The objectives and exploration process are specific to each protocol, and aim to resolve practical management issues in a short time, limited to the area of interest of each medical specialty in a given moment: Is there free fluid in this patient? Is there a decrease in left ventricular ejection fraction? Is there urine retention?, etc. On the other hand, the technique may also facilitate procedures (catheterization, thoracocentesis, paracentesis, fine needle aspiration, etc.), perform a multiorgan examination in certain clinical scenarios (arterial hypotension, assessment of cardiovascular risk, etc.), or monitor the patient course or response to treatment, such as fluid supply, the evolution of pneumonia with antibiotic therapy, or the detection of early complications after thoracocentesis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Scientific societies have included training, research and the promotion of this area of competence among their strategic objectives.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In fact, it is already widely recognized that PoCUS is changing our professional practice, thanks also to advances in equipment miniaturization and the introduction of artificial intelligence programs that will facilitate access to the technique.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">PoCUS</span> is here to stay. Given its potential, it is crucial for scientific societies to establish a standardized training plan in order to generalize the correct use of the technique.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,5</span></a> It is important to be able to convey not only what the benefits are, but above all also the limitations of the technique carried out with the diversity of current equipment and with less thorough training. The fact that PoCUS is noninvasive does not mean that there are no risks associated with the indication of use, the training of the operator, the quality of the data obtained, their interpretation, and the resulting decisions made. It cannot be sufficiently stressed that, like any other imaging technique, PoCUS must be performed under the same rigorous quality standards as any other specialty such as Cardiology or Radiology.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Failure to do so may cause harm to our patients.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, <span class="elsevierStyleItalic">PoCUS</span> is an imaging technique not limited to a given specialty, protocol or organ.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Consequently, collaborative multidisciplinary efforts should focus on adequate training, through the accreditation of specific competences, research and promotion, guaranteeing correct application of the technique at the right time,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> for the benefit of patients as our true points of care.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The ideas and opinions expressed in this editorial are those of the authors and do not necessarily reflect the views or positions of any society they represent.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. 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