Authors: Dr Ankur Masani

Abstract

Background - The first hour of emergency care—the Golden Hour—is critical for patient survival, with the initial five minutes (“Golden Window”) playing a decisive role in identifying life-threatening conditions. Point-of-Care Ultrasound (POCUS) provides rapid, real-time physiological information and has become an essential adjunct to clinical examination. Despite its proven utility in shock, trauma, and acute dyspnea, POCUS is often underutilised or delayed beyond the initial assessment, potentially limiting its impact on early decision-making.

Objective - To evaluate the effect of performing structured POCUS within the first five minutes of emergency assessment on diagnostic accuracy, time to life-saving intervention, and early clinical decision-making in patients with undifferentiated hypotension, trauma, or acute dyspnea.

Methods - A prospective observational study was conducted over three months in a high-volume tertiary emergency department. A total of 150 consecutive adult patients presenting with undifferentiated hypotension, trauma, or acute dyspnea were included. Patients were divided into two groups: Group A, where POCUS was performed within the first five minutes of assessment, and Group B, where POCUS was performed after five minutes or not performed. Structured ultrasound protocols, including RUSH, BLUE, FAST/eFAST, and FEEL, were used. Primary outcome measures included time to diagnosis, time to intervention, diagnostic concordance with final diagnosis, and physician confidence in clinical decision-making.

Results - Early POCUS use was associated with faster identification of critical conditions such as cardiac tamponade, pneumothorax, hypovolemia, and pulmonary embolism. Group A demonstrated reduced time to definitive interventions and higher diagnostic concordance. Physician confidence and team communication during resuscitation were significantly improved with early POCUS integration.

Conclusion - Structured POCUS performed within the first five minutes of emergency assessment improves diagnostic accuracy, expedites life-saving interventions, and enhances clinical confidence. Incorporating “F – Focused Ultrasound” into the ABCDE approach may represent a valuable advancement in early emergency care decision-making.

Keywords: POCUS in First 5 Min -Golden Window POCUS