use point‐of‐care ultrasound, and veterinary medicine is ideally suited for integration of point‐of‐care ultrasound given the diverse complaints and wide range of animals that are cared for by veterinarians on a daily basis.
The first edition of this book, called Focused Ultrasound Techniques for the Small Animal Practitioner, was published in 2014 and described the most common focused ultrasound examinations in veterinary medicine. The first edition established a standardized approach to perform a multisystem veterinary ultrasound examination, particularly of the heart, lungs, and abdomen, and has served as a guide for veterinarians to incorporate ultrasound into their clinical practices around the world. The book has been translated into Spanish, Chinese, Greek, Japanese, and Polish, and over 2000 copies have been sold worldwide.
In this second edition, the reader experience has been enhanced in several ways. The core chapters describing the fundamental veterinary ultrasound examinations have been expanded to discuss a broader range of species, including exotic species, and a more in‐depth discussion of feline species. Several new chapters have been added, including chapters on the use of ultrasound to evaluate marine mammals and zoo animals. Chapters on the nervous system describe evaluation of the brain and peripheral nerves, as well as performance of ultrasound‐guided nerve blocks. The online video library has been expanded to include over 100 videos of normal and abnormal findings to supplement the book chapters.
For veterinary clinicians seeking to improve their knowledge and skills in point‐of‐care ultrasound, this book has evolved to become a standard reference for its high‐yield chapters, online video content, and practical teaching points written by experts in the field.
Nilam J. Soni, MD, MSc Associate Professor of Medicine Department of Medicine University of Texas Health San Antonio San Antonio, Texas, USA
Preface
POCUS is point‐of‐care ultrasound. Veterinary POCUS (V‐POCUS), which includes FAST ultrasound examinations, is defined as a goal‐directed ultrasound examination(s) performed by a veterinary healthcare provider at the point of care (cageside) to answer a specific diagnostic question(s) or guide performance of an invasive procedure(s).
The translational study from the human to the veterinary patient regarding the focused assessment with sonography for trauma (FAST) exam by Dr Søren Boysen and colleagues in 2004 was a landmark study opening the eyes of the veterinary world to the nonradiologist, noncardiologist use of ultrasound, and that the principle of FAST ultrasound, that the nonradiologist sonographer is able to recognize anechoic triangulations representing free cavitary fluid, was not only achievable but also had the potential to improve patient care and save lives.
The following year, 14 years after graduating from veterinary school, I began my residency training in emergency and critical care in San Antonio, Texas, a city supportive of military training with several bases, and thus a mecca for FAST ultrasound. At the time, my program mentor encouraged me to take on FAST ultrasound as my clinical research requirement. I balked at the idea, having failed a complete abdominal ultrasound course in 1999, six years earlier, and thus concluding that ultrasound was a skill I would never master. However, I finally agreed to read the Boysen et al. study, after which I thought: “This (FAST ultrasound) will improve patient care. And I only have to be able to recognize black (anechoic) triangles. I like anatomy and surgery. I can memorize four views. It’s only four views.”
Thus, I decided that I would give ultrasound one more try. The FAST study intrigued me in the numbers of dogs with occult injury missed with traditional screening tests of physical exam, baseline blood and urine testing and radiography, but captured using FAST ultrasound. The study raised many fascinating questions, including looking past the diaphragm, adding a fluid scoring system to better categorize a positive FAST examination, and exploring the thorax with its own FAST format. Thus, my unimaginable journey began with developing AFAST, its target organ approach and its fluid scoring system; developing TFAST for pneumothorax, pleural and pericardial effusion, and its echo views for cardiac abnormalities; and most recently Vet BLUE (Veterinary Brief Lung Ultrasound Exam). Initially (2005), we combined AFAST and TFAST and referred to the study as “Combo (Combination) FAST” because we quickly realized how important it was to screen both cavities. Combining these three formats circa 2010, the study is now referred to as Global FAST and serves as an extension of the physical exam.
Now, 15 years later, the ultrasound probe is not only used by emergency veterinarians but also other nonradiologist, noncardiologist specialists as well as general practitioners. The use of ultrasound as a first‐line, daily imaging modality has become commonplace globally throughout veterinary medicine, improving patient care and saving lives often by capturing disease otherwise missed with traditional work‐ups without ultrasound and detecting complications earlier in their course. Although there may not be the published evidence, I know how much I missed on a daily basis having practiced the first 13 years of my 28‐year career as a general practitioner and then followed by the first three years in emergency and critical care without ultrasound. Many cases from the pre‐FAST era still haunt me and how I failed my patient and their families by missing conditions easily recognized with the Global FAST approach.
The objectives for POCUS and FAST examinations are to rapidly answer important clinical questions to help rule in and rule out conditions, to see your “problem” list for a more streamlined diagnostic plan; to better decide on medical versus surgical and other interventional cases; and to keep the patient alive for gold standard testing and treatment, with a better chance of survival. “Seeing” your problem list as part of your physical exam provides more evidence‐based information over traditional work‐up paradigm(s). Every clinical specialist, including the internist, oncologist, cardiologist, criticalist, neurologist, surgeon, anesthesiologist, ophthalmologist, dentist, and dermatologist, and the ER veterinarian and general practitioner should make learning the basics of POCUS and FAST ultrasound a core skill and first‐line evaluation (extension of the physical exam) for most if not every patient. The new mantra should be “Physical examination and Global FAST!” as the starting point for every patient, providing an unbiased set of data imaging points in both cavities, the abdomen and thorax, for every veterinarian seeing clinical cases.
In my internship year at the Animal Medical Center in New York City in 1991–1992, our Intern Director, the late Dr Michael Garvey, always emphasized that we should “never send a patient out the door with something you could have easily detected by performing a good physical exam and your quick assessment tests.” The day has come when the Global FAST approach should be part of your quick assessment tests. In other words, Global FAST is “an extension of your physical exam,” a term coined by Rozycki and colleagues over 20 years ago. Importantly, POCUS then follows the Global FAST approach for more targeted evaluations as subsequently explained.
With POCUS examinations now being used in human and veterinary medicine on a daily basis, standardization with clear objectives is imperative not only establishing for validity and a healthy respect among our colleagues but for perfecting your skills. Recording data on goal‐directed templates that demonstrate an organized, well‐defined imaging protocol for answering clinically relevant questions is also key for veterinary medicine as a whole to embrace this movement. These questions must be realistically achievable, often binary, for the nonradiologist, noncardiologist sonographer. In this second edition, we have tried to make POCUS and FAST ultrasound examinations as clear as possible.
However, even with this approach, we think that caution should be exercised in how individual POCUS examinations are applied to patients. For example, a POCUS gallbladder examination may
