to every patient as part of the initial evaluation process, the pericardial effusion, poor systolic function (dilated cardiomyopathy), low‐grade peritonitis or small‐volume hemoabdomen would not have been missed or delayed in its detection. In other words, the Global FAST approach should be considered your baseline imaging test with POCUS examinations considered as adjuncts. This imaging strategy prevents “satisfaction of search error” to which POCUS examinations by themselves are prone. Global FAST prevents the picking and choosing of whichever POCUS examination helps fulfill your preconceived clinical bias by providing a mandated, standardized set of imaging data points of the abdomen and thorax.
In another example, the POCUS heart provides an overview for cardiac information but is too focused, missing lung abnormalities and comorbidities within the patient's abdominal cavity. Through a Global FAST approach plus the add‐on of a POCUS heart, the enlarged caudal vena cava suggesting right‐sided heart congestive failure is detected, or the splenic mass or small‐volume ascites is not missed, that was not even considered by the clinician but found as an unexpected comorbidity. Lastly, an unremarkable POCUS heart exam on a coughing dog, without an integrated approach with Global FAST, misses the widespread small lung nodules or the aspiration pneumonia that are inapparent on thoracic radiography. The “POCUS only” analogy would be similar to a selective physical examination, in which only the abdomen is palpated in a vomiting cat, or only the heart and lung ausculted in a coughing dog, or only the limb evaluated in a limping older dog. Most of us are aware of missing major problems when doing incomplete physical exams.
You may have or soon will have the epiphany of how powerful a tool first‐line ultrasound is. The same epiphany has occurred in human medicine with similar stories of how first‐line medical personnel are capturing aortic dissections in patients who have recovered and compensated, ectopic pregnancies with internal intermittent bleeding, and pulmonary thromboembolism as life‐saving examples that historically would have been delayed or completely missed (possibly resulting in death). Capturing these traditionally problematic life‐threatening conditions is now possible on initial evaluation within minutes of presentation by “seeing” the problem.
In this second edition, we provide additional knowledge on what we have learned since the first edition, with more chapters and additional topics. These include additional chapters on eye and musculoskeletal exams as well as ultrasound‐guided procedures, including the thoracic procedures and nerve blocks. Moreover, we devote an entire chapter to cats. We continue to push the envelope with the addition of more species including exotic companion mammals, marine mammals, birds, and reptiles. Personally, after performing thousands more exams, publishing numerous clinical studies, and through training over 1000 veterinarians in these techniques, we also share what we have learned using the Global FAST approach. We also welcome not only our previous chapter authors, who have also learned much since the first edition, but also a new set of thought‐leading authors sharing their expertise in their respective chapters.
And, finally, as I prepared this second edition, reading through lists and lists of references, it became even more apparent that this paradigm change would not be possible without the many sonographers, veterinarians, residents, radiologists, and cardiologists who have painstakingly worked through untold hours of scientific research and clinical studies that have laid the foundation, for where veterinary diagnostic ultrasound is today. We extend a big thank you!
So let's get on with it. We welcome feedback by email at [email protected] and via our Facebook page, www.facebook.com/FASTVet, or our website www.FASTVet.com. Your stories and experiences as general practitioners, emergency and critical care veterinarians, and clinical specialists are awaited. Your stories and experiences help keep the POCUS and FAST train moving forward, helping with advancements in training, perfecting imaging techniques, and their clinical applications.
Acknowledgments
The following are acknowledged for their illustrative contributions: Suji Park, Englewood Cliffs, New Jersey (www.sujisuji.com); Dr Judy Brown, DVM, Dipl. ACVECC, Toronto, Canada; Hannah M. Cole, Adkins, Texas; Nancy Place, MS, Association of Medical Illustrators, San Antonio, Texas; Alice MacGregor Harvey, Medical Illustrator, North Carolina State University; and Randi Taggart, Richmond, Virginia.
Dr Karin Vomend, MVZ, Cuernavaca, Mexico, for editorial help and Dr William A. Seleen Jr, Bemus Point, New York, who read the entire manuscript and provided editing and content suggestions that helped improve the manuscript.
The entire Wiley team, including Erica Judisch, Commissioning Editor, and Jayadivya Saiprasad, Project Editor, and her staff, Holly Regan‐Jones, freelance editor, for their expertise, patience, and encouragement throughout the construction and editing of the second edition, which became far bigger than originally foreseen.
The chapter authors from the United States and internationally, who not only believe in the potential for point‐of‐care and FAST ultrasound to make a positive impact in veterinary medicine but also generously gave their time and expertise in making this second edition possible.
Lastly, Drs Kelly Mann, DVM, DACVR, and Geoff Fosgate, DVM, PhD, DACVPM, University of Pretoria, who have helped me generously since my residency training with publishing clinical research; Dr Søren Boysen for his help, support, and friendship throughout the years; and my wife, Dr Stephanie C. Lisciandro, DVM, Dipl. ACVIM, who with her support, sacrifice, and dedication over the past decade has made it possible for me to invest the tremendous amount of time and effort needed to accomplish this task. I am forever grateful.
About the Companion Website
Don’t forget to visit the companion website for this book: www.wiley.com/go/lisciandro/ultrasound2
There you will find valuable material designed to enhance your learning, including:
Video clips
Scan this QR code to visit the companion website.
Chapter One POCUS: Introduction
Gregory R. Lisciandro
Veterinary POCUS (V‐POCUS) Defined
POCUS is point‐of‐care ultrasound.
FAST is focused assessment with sonography for trauma, triage, and tracking (Lisciandro 2011).
Veterinary POCUS (V‐POCUS), which includes FAST examinations, is defined as a goal‐directed ultrasound examination(s) performed by a healthcare provider at point of care (cageside) to answer a specific diagnostic
