PEARLS for an Ultrasound Physical and Its Routine Use as Part of the Clinical Examination

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At present, there is no consensus on what a routine examination that uses ultrasound (US) should look like. Point-of-care US (POCUS) is poised to be as important a clinical skill as palpation and auscultation; however, the expansive list of potential applications can be intimidating to the beginner. In this article we propose using a PEARLS (Parasternal, Epigastric, Anterior Lung [and/or Apical], Right upper quadrant, Left upper quadrant, and Suprapubic) mnemonic as an approach to a core physical examination augmented with POCUS for routine use. Numerous US protocols for trauma, shock, and respiratory failure have been published, and it is no coincidence that many have evolved overlapping views. These views have numerous uses and applications and should not be confined to only critically ill patients. The PEARLS examination is for both primary care and inpatient settings and is scalable for POCUS beginners and advanced users. From the generalist’s perspective, we describe our philosophy on the initial foundation and provide a framework to grow one’s POCUS skills.

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