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I admit it - I love Star Trek and all the cool technology imagined for the 23rd century. As a geeky nurse, the technologies to diagnose and treat illness and injury remain my favorite parts of the show. Today, emerging technologies, including EchoNous' KOSMOS and the Butterfly IQ, give us real diagnostic tools only imagined in the 1960s. This column describes point-of-care ultrasound (POCUS) devices that can be used to prepare nurse practitioners (NPs) for the paradigm shift in advanced physical examinations and diagnostic testing.
KOSMOS is a 3-in-1 device that provides ultrasound, electronic stethoscope, and electrocardiogram (ECG) results in real time with interpretation supported by artificial intelligence (AI; Ferng, 2020). The device can help students see and hear the closure of heart valves, making this formerly abstract concept concrete. The ultrasound picture is displayed onscreen with labels, and contextual guidance is given to assist students to improve positioning of the probe. Students learn to recognize the structure of the heart and interpret ejection fraction, stroke volume, cardiac output, and heart rate visually from the ultrasound and numerically from calculated values.
Having a device with three functions and AI support is important, but the real value of KOSMOS is the interpretation of ultrasound images with heart sounds and simultaneous ECG tracings (Ferng, 2020). For example, after completing a focused history and physical exam on an older adult in a cardiology rotation, an NP student can use KOSMOS under the supervision of a faculty member or preceptor. The student will be able to see a stiffened left ventricular wall and reduced filling of the left ventricle on ultrasound, hear an S4 with the electronic stethoscope, and see reduced voltage ECG tracings. By viewing the simultaneous data with AI assistance, the student can make a diagnosis of left ventricular hypertrophy as the etiology of heart failure and record the ejection fraction during the office visit. This POCUS diagnostic ability has been called a paradigm shift because of the accuracy of the focused cardiac ultrasound assessment (Marbach et al., 2020).
POCUS has become a tool for evaluating patients with COVID-19 in emergency departments (Bennett et al., 2021). The Butterfly IQ has been a better diagnostic tool than chest X-rays in the diagnosis of COVID-19 pneumonia (Royer et al., 2020; Walsh et al., 2020). NP students who do rotations in emergency departments or urgent care centers can get experience using the Butterfly IQ or the KOSMOS device for COVID-19 evaluations.
Other diagnostic uses for POCUS technologies show promise, including detection of fractures in pediatric patients (Caroselli et al., 2021), reduction of radial fractures (Smiles et al., 2020), verification of endotracheal tube placement in neonates by critical care transport nurses (Itoh et al., 2020), and evaluation of renal obstructions (Nepal et al., 2020). Using POCUS will likely become common in the next five years because of the low cost and sensitivity/specificity of ultrasound in making medical diagnoses. NP faculty and administrators of nursing programs need to consider POCUS as a vital tool to prepare advanced practice nurses.
REFERENCES
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