Insonation: the Fifth Pillar of Physical Examination

In the POCUSX podcast, José Mariz, MD, PhD welcomes Philippe Rola , a reference for Point-of-Care Ultrasound enthusiasts. The theme is based on a classic, the article by Jagat Narula MD PhD, Y. Chandrashekhar, MD, and Eugene Braunwald, MD, "Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation."

POCUS Mundi Canada with Philippe Rola

His career has made him one of the leading advocates for the use of Point-of-Care Ultrasound and serves as inspiration for doctors around the world. He is currently ICU (Intensive Care Unit) Chief of Service at Santa Cabrini Hospital and President at the Critical Care & Ultrasound Institute.

Ultrasound Training: A Personal Journey

In the 90s, Philippe Rola was a resident in medicine and, at that time, there was no POCUS training for physicians. One night in the Coronary Care Unit, he was called to attend a case of cardiac tamponade. The cardiologist present handed him an ultrasound probe and, while his colleague drained the fluid around the heart, he realized that the technique was not as complicated as it seemed.

That moment was revealing. With the help of a radiologist and an old ultrasound machine forgotten in Cardiology, he learned to do ultrasound. To make this possible, he highlighted the great advantage of working in a community hospital: the absence of "territoriality". A radiologist generously shared his knowledge with him, allowing him to incorporate ultrasound as an essential part of the physical examination.

Fast forward to the present day, and the landscape of medical education has changed dramatically. If in the past POCUS training was practically non-existent, nowadays the incorporation of insonation as the fifth pillar of the physical examination is widely advocated.

In his experience, two main factors contribute to the "turf war" in medicine: egos and financial interests. Many professionals feel threatened by the diffusion of the technique, fearing a reduction in the demand for their services. However, he notes that its use by physicians does not decrease requests for radiological examinations, which leads him to believe that resistance to integrating point-of-care ultrasound into clinical practice is often linked to financial concerns.

VExUS: Passion for Resuscitation

Philippe Rola's true passion is resuscitation, and POCUS has become a crucial tool in this context. It considers ultrasonography as a window into physiology at the patient's bedside, assisting in precise clinical decisions such as fluid administration. He points out that he has not used the stethoscope to auscultate hearts for a long time, preferring the ultrasound for its precision and effectiveness.

He is a firm believer in the importance of sharing knowledge. He actively participates in annual conferences, such as CCUS (Critical Care Ultrasound), which he organized from 2008 to 2014. After that, he began to focus more on resuscitation, organizing annual meetings where POCUS is the main star. These conferences are an opportunity to learn from other professionals and improve patient care.

These are some of the points addressed in the conversation between José Mariz and Philippe Rola, where they offer valuable insights into the evolution of Point-of-Care ultrasound and the importance of collaboration in medicine. Discover in this podcast episode the transformative power of POCUS in medical practice, as the fifth pillar of the physical examination.

Inspection, Palpation, Percussion, Auscultation, and Insonation

We recommend reading the article that gave the motto to this podcast, by Jagat Narula, MD, PhD, Y. Chandrashekhar, MD, and Eugene Braunwald, MD, for a better understanding of the topic addressed: Time to Add a Fifth Pillar to Bedside Physical Examination

The transformative potential of POCUS

It is worth revisiting José Mariz's conversation with Luke Baldwin , VP of Global Marketing at EchoNous , on the same subject, where they explore the revolutionary impact of POCUS on medical practice.