“POCUS at the Bedside: Rapidly Differentiating CHF from COPD Exacerbations” — Southern Medicine Podcast is Now Available

In this episode, Tatiana Havryliuk, MD, and Randy Glick, BSB/PM, MCP, examine how point-of-care ultrasound (POCUS) can help primary care providers differentiate between congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) exacerbations in real-time. They discuss a compelling case that highlights how POCUS led to rapid diagnosis and appropriate treatment, avoiding unnecessary delays and hospitalizations.

Dr. Tatiana Havryliuk is an emergency physician and founder of Hello Sono. With 15 years of experience using POCUS in diverse settings, from urban EDs to Everest Base Camp, she is dedicated to extending its benefits to more patients. With Hello Sono, she and her team support practices in building compliant, high-quality, and profitable POCUS programs through tailored education and implementation.

New Physicians-In-Training Podcast is Available: USC-Columbia’s Vertically Integrated Trainee Program

The Vertically Integrated Trainee Program (VITP), now rebranded as MedConnect, at the University of South Carolina School of Medicine - Columbia, is transforming the pathway for premedical students by fostering mentorship, reducing disparities, and creating sustainable opportunities for those without traditional connections to the field. 

This episode of SMA’s Physicians-in-Training Podcast explores the program’s mission, vision, and guiding principles, as well as the unique aspects that set it apart. Moderated by Donald DiPette, MD, FACP, FAHA, Logan Hitchcock, BS; Greyson Fox Tran, BS; Buckley McCall, BS, MD; and Jaron Pettis, MD, share insights on the origins of VITP, the role of mentorship in preventing burnout, and the evolving direction of MedConnect as it expands into new academic and clinical spaces. Listen as they discuss the challenges facing today’s premedical students, the program’s long-term sustainability, and the impact it has had on aspiring physicians.

About the Guests
Logan Hitchcock, BS
MD Candidate/Class of 2027
University of South Carolina School of Medicine - Columbia

Greyson Fox Tran, BS
MD Candidate/Class of 2026
University of South Carolina School of Medicine - Columbia

Buckley McCall, BS, MD
PRISMA Health - Upstate
Chair, SMA's Physicians-in-Training Committee

Jaron Pettis, MD
Northwest Health General Surgery

Donald DiPette, MD, FACP, FAHA
University Of South Carolina School of Medicine - Columbia
SMA President, 2017-2018

Questions about MedConnect?
Email Logan Hitchcock, BS, at Logan.Hitchcock@uscmed.sc.edu.

Questions about SMA’s Physicians-in-Training Program?
Visit sma.org/physicians-in-training or email Dr. Buckley McCall at buckley.mccall@prismahealth.org.

From Planning to Patient Care: How to Launch a Thriving Medical Practice

Starting a medical practice is a significant challenge that demands a blend of clinical expertise and business acumen. As healthcare professionals venture into this entrepreneurial path, they must equip themselves with the necessary skills and knowledge to thrive in a competitive environment. From understanding the economic landscape to mastering legal requirements, each step is crucial in laying a solid foundation for a successful practice.

Evaluating Locations for Your Practice

Choosing the right location for your medical practice is vital for its long-term success. Consider the economic potential of your chosen area by analyzing factors like local employment rates and population growth. For instance, areas experiencing population increases and rising incomes might present more opportunities for attracting patients and expanding your practice. Additionally, understanding the competitive landscape, such as the number of existing medical facilities and their specialties, can help you identify market gaps that your practice could fill. Thorough research in these areas can lead to informed decisions that enhance the sustainability and profitability of your medical practice.

Understanding Employment Laws

Navigating the legal landscape of hiring and managing staff is essential when starting a practice. Employment contracts should clearly define workers' rights and benefits to prevent disputes. Familiarize yourself with federal laws like the Fair Labor Standards Act and the Family and Medical Leave Act, which establish minimum wage and leave entitlements. State laws may add requirements such as mandatory breaks or sick leave. Additionally, the Occupational Safety and Health Act mandates a safe working environment. Addressing these legal aspects thoroughly can shield your practice from legal issues and promote a positive workplace.

Managing Forms and Records

Effective records management is crucial for a well-organized office, ensuring patient information is accurate, accessible, and secure. Streamlining check-ins, disclosures, and informed consent documents with digital solutions can enhance efficiency and reduce paperwork delays. One way to simplify this process is to create a fillable PDF, allowing patients to complete necessary forms electronically before their appointment. This saves time for staff and patients and minimizes errors and ensures compliance with regulatory requirements.

Building a Financial Safety Net

Creating a financial buffer is helpful for maintaining the stability of your practice amidst unexpected challenges. By setting aside a dedicated cash reserve, you can manage unforeseen expenses like equipment repairs or sudden staff shortages without disrupting operations. This proactive strategy shields your practice from financial shocks and helps prevent debt accumulation. Consider automating your savings and forecasting potential worst-case scenarios to maintain resilience and financial security. Understanding the importance of an emergency fund can further enhance your practice's financial health.

Promoting Effective Team Communication

Establishing clear communication channels within your team fosters a transparent and collaborative atmosphere. Setting expectations for response times ensures that urgent issues are addressed promptly while allowing time for more thoughtful replies when necessary. Regular check-ins, whether daily or weekly, provide structured opportunities for team members to share updates, discuss challenges, and receive feedback, keeping everyone aligned with ongoing issues. Additionally, creating a centralized hub for information can significantly reduce information gaps, ensuring that all team members have access to the latest updates and relevant documents. This approach enhances efficiency and builds a culture of trust and respect, as team members feel heard and valued, ultimately boosting morale and engagement.

Creating a Patient Referral Program

Implementing a patient referral program can help you organically grow your client base while fostering a sense of community and trust. Offering incentives for successful referrals motivates your current patients. Additionally, a well-structured referral system can lead to cost savings. This strategy attracts new patients and strengthens the loyalty of existing ones, contributing to the overall success and sustainability of your practice.

Launching a medical practice is a multifaceted endeavor that requires a strategic approach to both business and healthcare. Focusing on critical areas such as economic evaluation, legal compliance, and financial planning, practitioners can build a robust foundation for their practice. These efforts ensure the delivery of high-quality patient care and foster a resilient and adaptable business model. As the healthcare landscape continues to evolve, staying informed and proactive will be key to sustaining growth and success.

Explore the wealth of resources and opportunities offered by the Southern Medical Association to support your medical journey and stay informed with the latest in healthcare advancements.

As a healthcare professional, Janice Russell knows the importance of balance in life.  While her days are filled with overcoming challenges in the healthcare industry, she believes the only way to survive parenthood while taking care of the sick is to find the humor in it.  She created Parenting Disasters so that parents would have a go-to resource whenever they needed inspiration.

Image via Pexels

Did You Know? POCUS Can Help Detect Increased Intracranial Pressure

Case Presentation

A 42-year-old female presents to her primary care provider with complaints of persistent headaches for the past two weeks. She describes the headaches as intermittent, worsening in the morning, and occasionally associated with transient blurry vision. She has a history of similar headaches over the past year, prompting an emergency department (ED) visit five months ago, where a CT scan of the head was unremarkable. She is overweight but has no other significant medical history.

Her vital signs are normal. On examination, her neurological exam is non-focal. However, fundoscopic examination is challenging due to poor visualization of the retina and optic disc. Her visual acuity is 20/20 in both eyes. Given concern for idiopathic intracranial hypertension (IIH), her provider decides to perform ocular point-of-care ultrasound (POCUS) to assess the optic nerve sheath diameter (ONSD), which correlates with intracranial pressure (ICP) (Figure 1). 

What do you see and what is the diagnosis?

Figure 1. Ocular POCUS image demonstrating an optic nerve sheath diameter (ONSD) of 6.0 mm, suggestive of elevated intracranial pressure (ICP).

The optic nerve sheath, which distends in response to increased ICP, was measured at 6.0 mm—a finding consistent with elevated intracranial pressure.

Ocular POCUS Findings in IIH

1. Increased optic nerve sheath diameter:

Ocular POCUS can be an invaluable tool in evaluating headaches, particularly when increased ICP is a concern. In this case, the provider performed a bilateral ONSD measurement 3 mm posterior to the globe. 

An ONSD measurement of greater than 5.0 mm (some sources suggest a cutoff of 5.5 mm) correlates with increased ICP, supporting the diagnosis of IIH or another cause of increased pressure [1-3]. Figure 2 below shows a normal ocular ultrasound with ONSD measurements under 5mm. The optic nerve sheath is normally oval in shape, with a clearly defined border and no bulging or excessive distention. A normal ONSD on POCUS strongly suggests that the patient does not have clinically significant intracranial hypertension at that moment. Figure 3 shows annotated anatomy of the eye on ultrasound. 

Figure 2. Ocular POCUS image demonstrating ONSD of 4.07mm, measured 3mm behind the globe, suggestive of normal ICP.

Figure 3. Anatomy of the eye on ultrasound.

2. Papilledema:

In some cases, papilledema can be visualized on ultrasound. A classic POCUS finding is the “crescent sign,” which appears as a hypoechoic (dark) crescent-shaped area at the posterior aspect of the optic nerve head, representing optic disc elevation due to increased intracranial pressure. [4] However, papilledema without an increased ONSD is not indicative of elevated ICP and may be due to other conditions such as optic neuritis, hypertensive retinopathy, or other retinal pathologies. 

Ocular POCUS to Detect Other Pathology

Ocular POCUS could also help diagnose the following conditions:

• vitreous hemorrhage
• retinal detachment
• lens dislocation
• posterior vitreous detachment
• intraocular foreign bodies. 

These conditions can be identified based on characteristic ultrasound findings, aiding in the rapid diagnosis and management of ocular complaints in a primary care setting.

Evidence 

• Studies have demonstrated a strong correlation between ONSD measurements and invasive ICP monitoring, making ocular POCUS a non-invasive alternative for screening.
• Using ONSD cut-offs between 5.0 and 5.7 mm, studies have found sensitivities of 90% and above for detecting ICP >20 mmHg. [1-3]
• In addition, ocular POCUS is relatively easy to learn. Novice users can perform ONSD measurements accurately after a 4-hour session. [5]

Case Resolution

Recognizing the abnormal ONSD measurement, the provider refers the patient for urgent ophthalmologic and neurology evaluations. A subsequent lumbar puncture confirms elevated opening pressure, consistent with idiopathic intracranial hypertension. The patient is started on acetazolamide, advised on weight management, and scheduled for close follow-up.

Impact of POCUS

In this case, ocular POCUS enabled a rapid, bedside assessment of suspected elevated intracranial pressure, guiding appropriate next steps. Without this tool, the provider may have had to rely solely on clinical suspicion, potentially delaying diagnosis and management, or sending the patient to the ED unnecessarily. 

POCUS benefits in headache evaluation include:

• Rapid, bedside assessment of ONSD to detect increased ICP.
• Non-invasive screening tool to help determine urgency for further imaging or lumbar puncture.
• Avoidance of unnecessary CT scans in recurrent headache patients without red flag symptoms.
• Potential for detecting papilledema when the direct fundoscopic exam is limited.

Conclusion

Point-of-care ultrasound (POCUS) is a valuable addition to the primary care provider's toolkit for evaluating headaches. In cases where idiopathic intracranial hypertension or increased ICP is suspected, ocular POCUS provides a fast, reliable method to assess ONSD and guide the next steps. With minimal training, providers can improve diagnostic accuracy, reduce unnecessary imaging, and expedite appropriate care.

References

1. Koziarz A, Sne N, Kegel F, et al. Point-of-care ultrasound for intracranial hypertension: A systematic review and meta-analysis. Neurology. 2019;92(7):e664-e675.
2. Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Academic Emergency Medicine. 2008;15(2):201-204.
3. Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocritical Care. 2011;15(3):506-515.
4. Bhosale A, Shah VM, Shah PK. Accuracy of crescent sign on ocular ultrasound in diagnosing papilledema. World J Methodol. 2017 Sep 26;7(3):108-111. 
5. Potgieter DW, Kippin A, Ngu, F, McKean C. Can Accurate Ultrasonographic Measurement of the Optic Nerve Sheath Diameter (a Non-Invasive Measure of Intracranial Pressure) be Taught to Novice Operators in a Single Training Session? Anaesthesia and Intensive Care 2011 39:1, 95-100

About the Author

Dr. Havryliuk is an emergency physician with over 15 years of clinical point-of-care ultrasound (POCUS) experience, a past Emergency Ultrasound Director at Brooklyn Hospital in NY, and the founder of Hello Sono. She is on a mission to empower clinicians with POCUS to take better and more efficient care of their patients by addressing two key barriers, lack of competency and infrastructure. 

LinkedIn: https://www.linkedin.com/in/tatiana-havryliuk-md/
Email: tatiana@hellosono.com

*POCUS images and graphics provided courtesy of Hello Sono.

“The Ins and Outs of Point-of-Care Ultrasound for DVT Evaluation in Primary Care” — Southern Medicine Podcast is Now Available

Point-of-care ultrasound (POCUS) is a transformative tool for diagnosing deep vein thrombosis (DVT) in primary care. After this podcast, during which Tatiana Havryliuk, MD, and Randy Glick, BSB/PM, MCP discuss this important element of care, you will understand the benefits of POCUS for DVT rule-out, basic techniques, and strategies to mitigate liability.

Dr. Tatiana Havryliuk is an emergency physician and founder of Hello Sono. With 15 years of experience using POCUS in diverse settings, from urban EDs to Everest Base Camp, she is dedicated to extending its benefits to more patients. With Hello Sono, she and her team support practices in building compliant, high-quality, and profitable POCUS programs through tailored education and implementation.

Nominations for the 2025 Moreton Award Are Now Being Accepted

“Pneumonia Diagnosis at the Bedside” — Southern Medicine Podcast is Now Available

In this episode of SMA's Southern Medicine Podcast, Tatiana Havryliuk, MD, and Randy Glick, BSB/PM, MCP, dive into a real-life case where a primary care doctor used POCUS to diagnose pneumonia in a patient with a cough, leading to quick and effective treatment. They discuss the evidence behind lung ultrasound, what the ultrasound revealed in this case, and how it made a difference for the patient Join them to explore how POCUS is making primary care more efficient, accurate, and patient-focused.

Dr. Tatiana Havryliuk is an emergency physician and founder of Hello Sono. With 15 years of experience using POCUS in diverse settings, from urban EDs to Everest Base Camp, she is dedicated to extending its benefits to more patients. With Hello Sono, she and her team support practices in building compliant, high-quality, and profitable POCUS programs through tailored education and implementation.

This topic is important because it shows how POCUS can help primary care providers make quicker, more accurate diagnoses, like catching pneumonia right at the bedside. It’s a game-changer for patients, reducing delays, avoiding unnecessary tests, and ensuring they get the right treatment faster.

A New Member Benefit is Available: Concierge Real Estate and Relocation Program

The Southern Medical Association (SMA) is pleased to announce a new member benefit -- a Concierge Real Estate and Relocation Program. 

Through the OnePoint Advantage program, SMA members and their families have access to a range of real estate and relocation services. Members can enjoy various discounts, rebates, and contract pricing on these services while receiving guidance from an advisor throughout the entire process. Whether you are relocating locally or across the country, you will receive the dedicated attention you deserve.     

• Home Buying and Selling – 10% cash-back on each transaction.
• Rental Assistance – Personalized rental tours – fees vary by location and duration.
• Lending – Mortgage or Refinancing – Up to 1% of the loan amount (Maximum $10,000).
• Moving Services – Van lines, containers, storage, move labor, truck rental, auto shipping – 10-15% off.
• Hotel Stays – Discounts vary by location.
• Utility Connection Service – No Charge.

There is no cost or obligation associated with utilizing the services and guidance provided by this program. We encourage you to register today to review the available services, resources, and discounts. 

To Register:  Go to OnePointAdvantage.com 

Call:  615-312-5377 between 9:00am – 5:30pm Central Standard Time

Email: relo@woodmontrealty.com

Real estate photo by Binyamin Mellish.

Highlights from SMA’s 5th Annual Physicians-in-Training Leadership Conference

The Southern Medical Association’s (SMA’s) 5th Annual Physicians-in-Training Leadership Conference took place February 7-9, 2025, at the University of Alabama at Birmingham’s Heersink School of Medicine. The weekend brought together medical students, residents, and fellows for an engaging experience focused on leadership, professional development, and research.

The conference kicked off Friday evening with a lively Trivia Night, where teams competed in pub-style rounds for monetary prizes while enjoying a fun and interactive start to the weekend.

Saturday’s schedule featured presentations on providing care in low-resource settings and essential financial principle. A highlight of the conference was the oral and poster abstract sessions, where trainees showcased their original research. “With more than 80 oral and poster presentations, medical students, residents, and fellows had the opportunity to showcase their original research,” said SMA’s Physicians-in-Training Committee Chair, Buckley McCall, MD. “By sharing their work, participants not only gained valuable experience in scientific communication but also received feedback and insights from peers and seasoned professionals.” The day concluded with an informal networking event, allowing attendees to connect and build relationships with fellow trainees and mentors.

The conference concluded Sunday with a presentation on emerging challenges in physician leadership, followed by the presentation of the oral and poster abstract awards. Reflecting on the weekend, SMA Executive Director Randy Glick noted, “It was incredibly exciting to see these physicians-in-training engage in discussions, share their research, and connect with one another. The conference provided an opportunity for learning, collaboration, and professional growth. From informative presentations to interactive sessions and networking events, the enthusiasm and dedication of the participants were evident. I foresee these trainees making a significant impact in the future.”

Dr. McCall echoed this sentiment, emphasizing the value of the abstract sessions in fostering meaningful discussion. “It was a truly exceptional weekend that gave trainees the opportunity to connect, share their research, and learn more about the Southern Medical Association,” he added.

SMA thanks everyone who participated in this year's conference, including our valued partner, Birmingham Medical News, and our generous sponsors—Prestige Medical Group; SouthState Bank, NA; and Vindex Financial Partners, LLC. Their support helped make this event a success.

We also celebrate the physicians-in-training who presented abstracts and appreciate the medical schools and residency programs that supported their participation. This year, $6000 in abstract awards was made possible through generous donations to SMA's Research and Education Endowment Fund, furthering our commitment to advancing medical education and professional growth.

“I am specifically grateful to my SMA PIT Committee members and Caroline Branche for helping to organize and run this conference," Dr. McCall aid. "This was a great start to 2025 for SMA, and I am looking forward to seeing everyone at the 6th Annual PIT Conference next year!"

SMA also looks forward to continuing this annual tradition of bringing together the next generation of physician leaders for learning, networking, and collaboration.

A New Physician Member Benefit is Available: Exclusive Access to POCUS Solutions

The Southern Medical Association (SMA) is pleased to offer our physician members an exciting new benefit—exclusive access to point-of-care ultrasound (POCUS) solutions through SMA's partnership with Hello Sono.

Hello Sono is a leading provider of comprehensive POCUS solutions, helping primary and urgent care practices, as well as residency programs, establish high-quality, compliant, and profitable POCUS programs. Their services include:

• On-site, custom CME workshops
• Remote exam review (preceptorship)
• Implementation support, including protocol design, clinical pathways, workflow optimization, software/device selection, and reimbursement guidance

Exclusive SMA Member Benefit

• Complimentary 30-minute consultation with a POCUS expert
• 10% discount on POCUS workshops, remote exam reviews, and implementation support services

These benefits are designed to help SMA members integrate POCUS into their practice, enhancing patient care while maintaining efficiency. 

How to Redeem Your Benefit

Use the discount code POCUSISLIFE and provide your SMA member ID when contacting Hello Sono at info@hellosono.com. For more information, visit Hello Sono.

Congratulations to the Abstract Winners from SMA’s 5th Annual Physicians-in-Training Leadership Conference

The Southern Medical Association (SMA) extends its gratitude to all of the physicians-in-training who presented abstracts at the 5th Annual Physicians-in-Training Leadership Conference, held February 7-9, 2025, at UAB’s Heersink School of Medicine in Birmingham, Alabama. SMA also appreciates the medical schools and residency programs that supported their participation. In total, $6,000 was awarded to this year’s abstract winners, made possible through contributions to SMA’s Research and Education Endowment Fund.

 

Congratulations to the winners of this year's Abstract Competition!

Photos of the abstract winners with SMA Physicians-in-Training Committee Chair Buckley McCall, MD, are provided by Haleigh Duke.

 

Orals

1st Place
Luke Anderson, BS
“The Use of Infrared Thermal Imaging
During Revision Palatoplasty
with Buccinator Myomucosal Flaps”
UAB Heersink School of Medicine

 

2nd Place
Benjamin Loftis, BS
“A Rare Presentation of Epiphyseal Stippling in a Neonate with a Likely Pathogenic CASR Mutation”
Frederick P. Whiddon College of Medicine

 

3rd Place
Amy Jasani, MPH
“Miller Fisher Syndrome Variant: An Anti-GQ1b Antibody Positive Patient with
Multiple Atypical Features” 
UAB Heersink School of Medicine 

 

Posters

1st Place
Ankit Tomar, MD
“Diffuse Infiltrating Retinoblastoma:
A Multicenter,International,
Data-sharing Study”
Tulane University School of Medicine

 

2nd Place
Aimee Knott, BS
“A Case Report of An Emerging Phenotype Associated with 6p Chromosomal Duplication”
Frederick P. Whiddon College of Medicine

 

3rd Place
Ishika Patel, MS, BS
“The Role of Diet in Hidradenitis Suppurativa”
UAB Heersink School of Medicine

 

Exhibitor and Sponsorship Opportunities Available at SMA’s Annual Scientific Assembly in New Orleans

Now that registration is open for attendees, SMA is excited to share that exhibitor and sponsorship opportunities are also available for the 117th Annual Scientific Assembly in New Orleans! This premier event will bring together healthcare professionals across specialties and disciplines to advance oncology care and prevention.

SMA offers a variety of exhibitor and sponsorship packages designed to connect your company with influential healthcare leaders. From exhibit booths and sponsored sessions to networking events and website advertising opportunities, our packages provide valuable exposure tailored to your goals.

Download the 2025 Exhibitor Prospectus to explore all available opportunities and secure your spot at this must-attend medical conference!

For more information, contact SMA's Director of Outreach, Caroline Branche.

Mohammed Afraz Pasha, MD, Appointed to SMA’s Education Committee

The Southern Medical Association (SMA) is pleased to announce that Mohammed Afraz Pasha, MD, has been appointed to the Association’s Education Committee.

Dr. Pasha is an internal medicine physician currently practicing hospital medicine at ECU Health Beaufort Hospital in Eastern North Carolina.

As a resident, Dr. Pasha was actively involved with the Physicians-in-Training Committee’s Outreach Subcommittee. During his association with the committee, he assisted with planning conferences, judging abstracts, and fostering partnerships with organizations to create more opportunities for medical students.

Passionate about hospital medicine and compassionate patient care, Dr. Pasha became a member of SMA's Education Committee, in part, to make an impact on the next generation of healthcare professionals. "Mentoring young minds is an excellent channel to give back to the healthcare community and, to the society as a whole," he said. "I believe in promoting wider opportunities for medical students and residents through avenues such as scientific meetings and competitions to demonstrate their abilities and in mentoring the path to their success."

Annual Assembly Registration is Open – 20% Discount Through April 30

Make plans now to attend SMA's 117th Annual Scientific Assembly taking place November 13-15, 2025 in New Orleans. Register by April 30 and receive 20% off of your meeting registration. 

With expert-led discussions on cutting33-edge medical topics and insightful sessions exploring the latest trends and innovations in oncology care and prevention, SMA’s Annual Scientific Assembly is an event you won’t want to miss!

Earn CME Credits, ABIM MOC Points, and Nurse Contact Hours while engaging with leading experts and peers in one of the South’s most vibrant cities.

Through this year’s sessions, you’ll have the opportunity to:

• Analyze the latest advancements in oncology research, including innovative treatments and technologies for improved patient outcomes.
• Implement evidence-based strategies for cancer prevention, early detection, and risk reduction across diverse patient populations and settings. Enhance interdisciplinary collaboration among healthcare providers to optimize comprehensive care for cancer patients and their families.
• Expand your expertise and enhance your practice with the knowledge and connections you’ll gain.

Here’s a glimpse at some of the key topics featured at this year’s Assembly:

• Disparities in Care
• Emerging Therapeutic Strategies
• Mental Health and Well-Being
• Treatment Options
• Screening and Detection
• Palliation
• Survivorship
• Top 20 Physicians-in-Training Abstract Session

In addition to educational sessions, there will also be social events including the SMArt Bowl, which is a medical student and resident medical trivia competition, as well as SMA’s Farewell Dinner and Presidential Inauguration.

Join SMA in New Orleans for the opportunity to expand your knowledge and connect with colleagues and peers!

If you have any questions about SMA’s Annual Scientific Assembly, please email customerservice@sma.org or call 800-423-4992.

POCUS in Primary Care: A Game-Changer for Differentiating CHF from COPD Exacerbations

Distinguishing between congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) exacerbations can be challenging in the primary care setting, as both conditions present with similar symptoms: dyspnea and wheezing. Traditional diagnostic tools, such as chest X-rays (CXR) and BNP testing, may not always be readily available or conclusive. Point-of-care ultrasound (POCUS) has emerged as a highly sensitive and cost-effective tool to aid in this differentiation, allowing for more precise diagnosis and timely treatment.

Case Presentation

A 72-year-old female with a history of CHF with an ejection fraction of 40% and COPD presents to her primary care physician with worsening shortness of breath, weight gain, and mild wheezing over the past few days. Her oxygen saturation is 90%, down from her baseline of 92%. She has minimal edema of the feet. The physician is uncertain whether her symptoms stem from a COPD exacerbation or fluid overload from CHF. Both require vastly different treatments. The physician performs POCUS of the patient’s lungs and inferior vena cava (IVC) to elucidate the etiology of the patient's symptoms.

Below are the representative clips of the patient's lungs (Clip 1) and IVC (Clip 2).

What do you see and what is the diagnosis?

Clip 1. View of right lung apex demonstrating confluent B-lines, abnormal vertical lines initiating from the pleura that signify interstitial fluid or thickening.

Clip 2. View of IVC draining into the right atrium demonstrating low respiratory variation.

Within 5 minutes, POCUS reveals diffuse B-lines (abnormal vertical lines initiating from the pleura that signify interstitial fluid or thickening) in both lungs and a dilated inferior vena cava (IVC) with minimal respiratory variation, findings consistent with CHF exacerbation. Based on these results, the physician initiates diuretic therapy and schedules close follow-up, effectively managing her condition without the need for an emergency department visit.

Utilizing POCUS to Differentiate Between COPD and CHF Exacerbations

Lung Ultrasound

• The presence of B-lines is a hallmark of pulmonary edema, strongly suggestive of CHF exacerbation. In addition, the more B-lines there are, the more severe the fluid overload. 
• The absence of B-lines may indicate an alternative cause of dyspnea, such as a COPD exacerbation.
• Other causes of dyspnea that can be accurately diagnosed with lung ultrasound are pneumonia, pleural effusion, and pneumothorax. Refer to a prior post on pneumonia here.

Clip 3. Patient’s lung with annotations demonstrating the location of the confluent B-lines, pleura, and rib shadows.

Clip 4. View of a normal lung demonstrating A-lines (horizontal lines), pleural sliding, and lack of B-lines, thus ruling out pulmonary edema and pneumothorax.

IVC Assessment

• A dilated IVC with reduced collapsibility with respiration suggests elevated central venous pressure, supporting a CHF diagnosis.
• A normal or highly collapsible IVC may indicate volume depletion or a non-cardiogenic cause of dyspnea.

Clip 5. Patient’s IVC with annotations demonstrating the location of the IVC, hepatic vein, and right atrium (RA). Note the lack of collapsibility of the IVC 2 cm from the RA, or just beyond confluence with the hepatic vein.

Clip 6. View of an IVC with high collapsibility with respirations suggesting low fluid volume status.

Cardiac Views

• Assessment of left ventricular function can help identify systolic dysfunction. In this case, the physician already knew that the patient had CHF with moderate systolic dysfunction and chose not to perform a cardiac ultrasound. 
• In addition, cardiac POCUS could help rule out pericardial effusion or significant right heart strain.

Evidence

Numerous studies support the diagnostic accuracy of POCUS in assessing pulmonary congestion:

• Lung ultrasound has a sensitivity and specificity range of 88-97% and 90-98%, respectively for identifying pulmonary edema [1-3].
• Compared to CXR, lung ultrasound is more sensitive in detecting pulmonary edema, making it a superior tool for CHF evaluation in outpatient settings. A 2019 meta-analysis found that the sensitivity of POCUS was 88%, while that of CXR was 73%. [3]

Impact 

Timely and Accurate Diagnosis

• POCUS allows for immediate bedside differentiation between COPD and CHF exacerbations, leading to prompt, condition-specific treatment.
• It avoids unnecessary delays associated with ordering additional imaging or laboratory tests.

Enhanced Patient Experience

• Patients benefit from reduced uncertainty and immediate diagnosis.
• POCUS eliminates the need for additional testing or referrals, reducing patient burden and inconvenience.
• POCUS enhances shared decision-making, as patients can visualize their condition in real-time.

Reduction in Healthcare Costs

• The average annual cost of caring for a patient with CHF in the United States is nearly $30,000. Emergency department visits and admissions contribute significantly to this number. [4] POCUS can make a big impact by detecting CHF exacerbations promptly and starting earlier interventions in outpatient settings. 
• POCUS also decreases reliance on costly diagnostic tools such as comprehensive echocardiograms and CT.

Conclusion

Incorporating POCUS into primary care practice enhances clinicians' ability to accurately differentiate between COPD and CHF exacerbations, leading to faster and more effective treatment. Given its high sensitivity in detecting pulmonary edema, its positive impact on patient experience, and its cost-effectiveness, POCUS is an invaluable tool for managing dyspnea in outpatient settings. As healthcare continues to move toward value-based care models, adopting POCUS can lead to improved patient outcomes, reduced hospitalizations, and overall cost savings.

References

1. Wang Y, Shen Z, Lu X, Zhen Y, Li H. Sensitivity and specificity of ultrasound for the diagnosis of acute pulmonary edema: a systematic review and meta-analysis. Med Ultrason. 2018 Feb 4;1(1):32-36. doi: 10.11152/mu-1223. PMID: 29400365.
2. Al Deeb M, Barbic S, Featherstone R, Dankoff J, Barbic D. Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: a systematic review and meta-analysis. Acad Emerg Med. 2014 Aug;21(8):843-52. doi: 10.1111/acem.12435. PMID: 25176151.
3. Maw AM, Hassanin A, Ho PM, McInnes MDF, Moss A, Juarez-Colunga E, Soni NJ, Miglioranza MH, Platz E, DeSanto K, Sertich AP, Salame G, Daugherty SL. Diagnostic Accuracy of Point-of-Care Lung Ultrasonography and Chest Radiography in Adults With Symptoms Suggestive of Acute Decompensated Heart Failure: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019 Mar 1;2(3):e190703. doi: 10.1001/jamanetworkopen.2019.0703. PMID: 30874784; PMCID: PMC6484641.
4. Heidenreich PA, Fonarow GC, Opsha Y, Sandhu AT, Sweitzer NK, Warraich HJ; HFSA Scientific Statement Committee Members Chair. Economic Issues in Heart Failure in the United States. J Card Fail. 2022 Mar;28(3):453-466. doi: 10.1016/j.cardfail.2021.12.017. Epub 2022 Jan 24. PMID: 35085762; PMCID: PMC9031347.

About the Author

Dr. Havryliuk is an emergency physician with over 15 years of clinical point-of-care ultrasound (POCUS) experience, a past Emergency Ultrasound Director at Brooklyn Hospital in NY, and the founder of Hello Sono. She is on a mission to empower clinicians with POCUS to take better and more efficient care of their patients by addressing two key barriers, lack of competency and infrastructure. 

LinkedIn: https://www.linkedin.com/in/tatiana-havryliuk-md/
Email: tatiana@hellosono.com

*POCUS images and graphics provided courtesy of Hello Sono.

“Sports Medicine Talk on Hand & Upper Extremity Part I” Now Available on YouTube

In this episode, David Netscher, MD, details common sports injuries affecting the hand and upper extremity. Dr. Netscher  discusses evidence-based diagnostic techniques and management strategies and reviews the latest advancements and rehabilitation protocols in treating hand and upper extremity injuries.

Michael Angel, MA, MD, Appointed to SMA’s Education Committee

The Southern Medical Association (SMA) is pleased to announce that Michael Angel, MA, MD, has been appointed to the Association’s Education Committee.

Dr. Angel is Board certified in plastic surgery/ENT and completed his fellowship training in hand/micro and craniofacial surgeries. Additionally, he holds an MA in psychology and has clinical exposure in psychiatry. 

A recent member of SMA, Dr. Angel is committed to clinical care, training and research addressing a wide range topics. "I want to fulfill my responsibility of contributing to the education of the next generation composed of multiple disciplines, he said of his appointment to the Education Committee. "Echoing Newton, we stand on the shoulders of giants."

February 4 is World Cancer Day

Today, on World Cancer Day, the Southern Medical Association (SMA) recognizes the ongoing efforts to raise awareness, promote education and prevention, and advance cancer care. Established in 2000 and led by the Union for International Cancer Control, World Cancer Day serves as a reminder of the important work being done to lessen the impact of cancer worldwide.

SMA is proud to contribute to these efforts through our 117th Annual Scientific Assembly, which will take place in New Orleans in November 13-15, 2025. With a focus on "Advancing Oncology Care and Prevention," this year’s conference will highlight the latest innovations, research, and strategies to improve cancer outcomes.

Together, we can make a difference in the fight against cancer. 

Advancing Oncology Care: Understanding Alpelisib-Induced Hyperglycemia in PIK3CA+ Breast Cancer Patients

Aligning with the theme of SMA’s 117th Annual Scientific Assembly—Advancing Oncology Care and Prevention—the February issue of the SMA's peer-reviewed Southern Medical Journal features a timely review, "Alpelisib-Induced Hyperglycemia in PIK3CA+ Breast Cancer Patients".

This article highlights the incidence and risk factors of alpelisib-induced hyperglycemia in greater depth, offering valuable insights for oncology care providers. To support continued learning and discussion, SMA is making this article available to both members and non-members for a limited time. Click here to read the full article.

Stay connected as we explore critical advancements in oncology leading up to SMA’s 2025 Annual Scientific Assembly in New Orleans, November 13-15!

January SMJ Highlights: Dr. Loftus’ Presidential Address and PIT Abstracts from SMA’s 116th Assembly

In case you missed them, two key highlights from SMA's 116th Annual Scientific Assembly in Atlanta are featured in the January 2025 issue of the Southern Medical Journal:

Dr. Loretta Loftus' Presidential Address
The inspiring Presidential Address delivered by Dr. Loretta Loftus, 2024-2025 SMA President, at the Assembly is now available here.

Top 20 Physicians-in-Training Abstracts
The Top 20 abstracts presented by physicians-in-training during the Assembly were also published in this issue and are available here.

Both articles are accessible to SMA members and non-members.