Point-of-care ultrasonography in High-Care Internal Medicine.

BACKGROUND: Internal Medicine wards have progressively evolved into high-complexity clinical environments, increasingly managing patients with acute respiratory failure, hemodynamic instability, and multi-organ dysfunction. Within this scenario, point-of-care ultrasonography (POCUS) has emerged as a bedside imaging modality capable of supporting rapid diagnostic reasoning and real-time clinical decision-making. OBJECTIVES: This narrative review aims to critically analyze the role of POCUS in High-Care Medical Areas of Internal Medicine, focusing on diagnostic applications, clinical monitoring, and ultrasound-guided procedures, while addressing limitations and training requirements. METHODS: A narrative review of the literature was conducted, integrating evidence from international guidelines, observational studies, randomized trials, and expert consensus documents regarding the use of POCUS in acutely ill medical patients. Emphasis was placed on multimodal ultrasound approaches consistent with the holistic clinical framework of Internal Medicine. RESULTS: POCUS facilitates early identification of time-dependent conditions such as pulmonary embolism, acute coronary syndromes, acute heart failure, acute respiratory distress syndrome, and septic shock. Lung ultrasound, focused cardiac ultrasound, vascular, and abdominal ultrasound can be integrated to improve diagnostic accuracy and etiological characterization of shock and respiratory failure. Serial POCUS examinations enable dynamic monitoring of disease progression, treatment response, and fluid responsiveness. Furthermore, ultrasound guidance significantly improves the safety and effectiveness of bedside invasive procedures. CONCLUSION: POCUS represents a cornerstone of modern High-Care Internal Medicine, enhancing bedside diagnostic integration, clinical monitoring, and procedural safety. Its effectiveness depends on structured training, awareness of limitations, and appropriate clinical governance. Although evidence of direct mortality reduction remains limited, POCUS consistently improves diagnostic confidence, appropriateness of care, and patient-centered decision-making.