Thanks for your kind words. As a preface for the below (so I don't have to repeat it), I'm privileged to be a salaried US federal employee protected by FTCA in

Thanks for your kind words. As a preface for the below (so I don't have to repeat it), I'm privileged to be a salaried US federal employee protected by FTCA in a rural and baseline non-litigious community. We get to provide care with "what we think is right" being the 1st, 2nd, and 3rd concerns, with billing, medical-legal risk, and productivity having minimal influence. It's fantastic. We have no overnight or on-the-weekend US availability, no echo whatsoever, and for the last several years we can rarely transfer a patient anywhere less than 100 miles away. My POCUS practice and scope reflects the above, is strictly limited to focused questions and clinical decision making in the ED. For example with OB I'm not terribly interested at becoming an expert on e.g. CRL, but would love to get better at evaluations at rule-in torsion. > One of the issues to keep in mind with POCUS is monitoring outcomes / comparing with gold standards Yes, establishing a QA process has been challenging. > There is a certain amount of variation by centre, but it is definitely not true that every trauma goes to CT first I'm sure it's very institution dependent. I trained at L1TS where the OR was much, much farther away than CT. CT was basically in the trauma bay, multiple scanners so almost always 1 open, so I don't recall a single case going straight to OR. CT usually only took a few minutes longer than an intern's FAST honestly. I'm sure there were a few that went without CT, but I don't remember any. In my current L4TS our surgeons won't take trauma, so it's usually a multi-hour process just to get the patient accepted for transfer somewhere, during which they also always get scanned (or die if they're never stable enough). > 3. Early OB - are you performing TVUS? Yes, frequently. My wife is the chair of our Ob/Gyn department, so I have a bit of a leg up. Yes mostly eval for IUP / rule-in ectopic. Tremendous number of patients presenting late for prenatal care so will occasionally estimate a CRL / BPD / femur length, but only as a ballpark when communicating with colleagues -- rarely much time pressure on these so can be formalized as outpatient. > Soft tissue - as in abscess or MSK? Not MSK. Abscess, cellulitis (high burden of NSTI but don't want to scan them all). MSK mostly limited to joint effusions / shoulder dislocations in the obese. Occasionally for fracture reductions -- we have no C-ARM). > 5. Biliary - Assuming you mean cholecystitis and gross bil dil Yes, this. Lots of these, very high burden of alcoholism and gallbladder disease here (as many as 5 acute choles in 1 morning between 8 AM and noon, all confirmed in the OR), so lots of abnormal LFTs, belly pain, and vomiting. POCUS critical here! Many of our surgeons hesitant, but the sensitivity seems to be pretty good and helpful for making overnight dispos in people with clearly normal studies (esp in the context of labs, vitals, exam -- which admittedly bias our interpretation of the study). > 6. Echo - Assuming you mean for ER indications? Yes -- mostly wall motion, severe acute CHF, gross RV dilation, large effusion, gross valvular incompetence. Can get formal studies later for the details, this is mostly for "does this seem to be a likely cause of this patient's critical illness?" > 7. Peritonsillar Tons of PTAs here. Yes, useful -- both for Dx as well as "where to aim the needle / scalpel." I forgot to add DVT -- we do lots of those.