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 POCUS | Preferred learning tool | |
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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 acquisition | Ergonomics 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 interpretation | Qualitative 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-making | Ability 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.