Point-of-care ultrasound in emergency department sepsis and septic shock: a pragmatic framework for source-oriented assessment and physiologic reassessment

Point-of-care ultrasound (POCUS) is an adjunctive tool in the emergency department for managing sepsis and septic shock. It serves to identify the source of infection and determine whether additional fluids would improve perfusion without risking worsening of pulmonary or systemic edema. Source-oriented ultrasound can support diagnosis of pneumonia, pleural complications, biliary disease, obstructive urinary tract infection, or drainable soft-tissue infection. Physiologic reassessment uses focused cardiac ultrasound, dynamic flow assessment, and serial lung ultrasound to support decisions about fluids and vasopressors. Venous Doppler and the VExUS framework are considered advanced optional assessments, not routine requirements. POCUS should be used as a decision-support tool, not as a stand-alone diagnostic tool or a reason to delay antibiotics and further imaging.