Table 1.

Source-oriented ED POCUS framework: scan targets, action-supporting findings, immediate implications, and escalation triggers.

Domain	Clinical trigger and focused scan target(s)	Action-supporting findings (examples)	Immediate ED implication	If negative/indeterminate but concern persists
Lung and pleura	Suspected respiratory source, hypoxemia/dyspnea, abnormal chest examination, discordant CXR, or pleural complication; 8-12-zone LUS	Focal consolidation with dynamic air bronchograms; complex pleural effusion; diffuse B-lines or pleural abnormalities suggesting edema/ARDS-like or interstitial pattern	Treat respiratory source as a working diagnosis only when clinically concordant; reassess oxygenation/ventilation; consider pleural drainage planning or CT escalation when complicated effusion is suspected	Chest radiography and/or CT when respiratory source remains likely, shock persists, or pleural complication cannot be excluded
Right upper quadrant/biliary system	Right upper quadrant pain, jaundice, cholestatic tests, recent biliary intervention, or suspected cholangitis; gallbladder +/- common bile duct when feasible	Gallstones with shadowing, wall thickening, pericholecystic fluid, sonographic Murphy sign	Suspect biliary source; expedite formal biliary imaging and GI/surgical consultation	Formal biliary imaging and urgent specialist input when cholangitis, obstruction, or complicated cholecystitis remains a concern
Kidney/urinary tract	Suspected urinary source with flank pain, AKI, oliguria, urinary retention, stone history, recurrent UTI, or persistent instability; kidneys and bladder	Hydronephrosis, obstruction pattern, urinary retention	Suspect obstructive urinary source; expedite urologic consultation, CT, and decompression planning	CT and further urologic evaluation when instability, organ dysfunction, or concern for complicated infection persists
Skin and soft tissue	Focal pain, swelling, erythema, equivocal fluctuance, failed therapy, or concern for deep infection; area of concern	Drainable abscess; fascial fluid tracking; subcutaneous gas	Proceed toward drainage when appropriate; urgent escalation if necrotizing infection is suspected	Surgical consultation +/- CT when necrotizing infection remains a concern; do not let ultrasound delay operative evaluation in high-risk patients

AKI, acute kidney injury; ARDS, acute respiratory distress syndrome; CT, computed tomography; CXR, chest radiography; ED, emergency department; GI, gastroenterology; LUS, lung ultrasound; POCUS, point-of-care ultrasound; UTI, urinary tract infection.