Table 6

The education and training goals for point-of-care gastric ultrasound (POCUS) following an Indication, Acquisition, Interpretation, and Medical decision-making framework

Education/training goals in gastric POCUSPreferred learning tool
Indications and background knowledge
(may be pre-existing)
Basic physics of ultrasound
Anatomy/sonoanatomy of the upper abdomen
Indications of gastric POCUS
Unclear history and/or unknown fasting status
Urgent surgery
Risk factors for delayed gastric emptying
Limitations and pitfalls
Previous gastric surgery
Large hiatal hernia
Didactics
Image acquisitionErgonomics
Transducer selection
Scan in a sagittal plane in the epigastrium
Recognize the importance of the right lateral decubitus position
Identify relevant anatomy (liver, pancreas, aorta, spine)
Consistently identify the gastric antrum, body and pylorus
Hands on training
Image interpretationQualitative classification of gastric content:
Empty (no content)
Clear fluid (3-point grading system)
Solid (early/late)/thick fluid
Quantitative evaluation of clear fluid
Estimate volume based on a CSA of the antrum in the RLD
Hands on training
Medical decision-makingAbility to integrate exam findings to patient management
If no content or low fluid volume (<1.5 mL/kg)
Consistent with an “empty stomach”
Proceed with the case
No special aspiration precautions indicated
If solid content or high fluid volume (>1.5 mL/kg)
Consistent with a “full stomach”
Consider postponing if elective with recent intake
If need to proceed, then use aspiration prophylaxis (eg, awake patient or tracheal intubation, rapid sequence induction)
Unclear/equivocal imaging
Manage based on available clinical information and local policies regarding fasting guidelines
Clinical case discussions
  • Adapted from Perlas et al, Br J Anaesth 2016.26

  • CSA, cross-sectional area of the gastric antrum in the right lateral decubitus; POCUS, point-of-care ultrasound; RLD, right lateral decubitus position.