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Recent guidelines from anesthesia societies and recent literature emphasize the use of gastric POCUS for aspiration risk assessment. While the role of gastric POCUS in the emergency department is still being explored, one recent article highlighted its use in assessing patients with upper gastrointestinal bleeding (UGIB).
Performing Gastric POCUS:
Patient Position: Place the patient in the right lateral decubitus position, if unable can perform in supine position.
Probe Selection & Placement: Use a curvilinear probe in the sagittal position at the level of the subxiphoid process, similar to the longitudinal view of the proximal abdominal aorta.
Scanning Technique: Fan the probe left to right to assess the gastric antrum.
Interpretation of Gastric Antrum:
Empty Antrum: Appears as a "bull's eye" or flat, with no visible liquid inside.
Full Stomach: Distended antrum with floating contents.
Intermediate: Shows a small amount of anechoic fluid without floating contents.
Quantitative Evaluation:
It is also possible to perform a quantitative evaluation of the gastric antrum to further assess stomach contents, this may be more useful in patients with intermediate gastric antrum.
For more details, refer to the articles and videos cited.
References
Perlas A, Van de Putte P, Van Houwe P, Chan VW. I-AIM framework for point-of-care gastric ultrasound. Br J Anaesth. 2016 Jan;116(1):7-11. doi: 10.1093/bja/aev113.
Adrian RJ, Alsharif P, Shokoohi H, Alerhand S. Gastric Ultrasound in the Management of Emergency Department Patients with Upper Gastrointestinal Bleeding: A Case Series and Sonographic Technique. JEM 2024. doi.org/10.1016/j.jemermed.2024.07.015
Hot Tip How to Use Ultrasound to Assess the Gastric Antrum GUARD Protocol. https://www.youtube.com/watch?v=VH9VwVFY3yQ