Pre-hospital ultrasound

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Prehospital ultrasound is the specialized application of ultrasound by physicians and other [1] emergency medical services [2] (EMS) to guide immediate care and treatment procedures. Like conventional ultrasound, it is a device that produces cyclic sound pressure to penetrate a medium (different body tissues) and reveal details about the inner structure of the medium. [3]

Contents

Differences from conventional ultrasound

Many emergency physicians now view screening ultrasound as a tool, and not a procedure or study. It is primarily used to quickly and correctly ascertain a limited set of internal injuries, specifically those injuries where conventional methods of determining them, such as trauma to the torso or heart, would either take too long, require too much time to prepare, or introduce greater risk to the patient. [4]

While conventional ultrasound can be a lengthy process, and is usually conducted with non-mobile units and advanced image filtering and manipulation built into the unit, emergency ultrasound is supposed to be as simple and quick to operate as possible, focusing on a small set of criteria. [5]

Applications and potential indications

Procedural guiding

In most cases, prehospital providers will employ the use of a portable ultrasound unit. In every instance, an attempt is made to find the area best suited to an ultrasound and utilize bare skin if possible. Resolution is vastly decreased if soundings must be made through any form of clothing. [8]

There are two main areas of emergency ultrasound. The Focused Assessment with Sonography for Trauma (or FAST) focuses on trying to ascertain if there is internal bodily fluid in blunt abdominal trauma, in the areas between organs, which is a sign of severe internal injury. [9] Echocardiography is used to attempt to find valvular disease, clots, cardiomyopathies or penetrations of the heart. Both systems are scanning methodologies, they use identical equipment. [10]

Ultrasound visualization and measurement of the optic nerve sheath diameter (ONSD) has been shown to be useful as a surrogate for more invasive intracranial pressure monitoring, allowing for more advanced monitoring of brain injuries in the field. [11]

Strengths

  1. It images muscle, soft tissue, and bone surfaces very well and is particularly useful for delineating the interfaces between solid and fluid-filled spaces, unlike most other methods of trauma diagnosis, which are little more than educated guesses. [ citation needed ]
  2. It renders "live" images, where the operator can dynamically select the most useful section for review, and narrows down the problem area, rather than having to wait until the patient is at the hospital.
  3. It has no known long-term side effects and rarely causes any discomfort to the patient.

Weaknesses

  1. Sonographic devices have trouble penetrating bone. For example, sonography of the adult brain is very limited. This means that in terms of trauma diagnosis involving brain injury, sonography will be difficult and requires high-end ultrasound machines. [ citation needed ]
  2. The depth penetration of ultrasound is limited, making it difficult to image structures deep in the body, especially in obese patients.[ citation needed ]
  3. The method is operator-dependent. A high level of skill and experience is needed to acquire good-quality images and make accurate diagnoses, which is one more skill that a limited EMS team must develop. Since most EMS teams are small and have high turnover, retaining qualified personnel can be difficult.[ citation needed ]
  4. Pre-hospital ultrasound like every exam or procedure taken out in the pre-hospital environment carries the risk to delay patient transfer to a place where more accurate diagnosis and definitive care can be given, e.g. a hospital.

See also

Related Research Articles

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References

  1. ↑ Bonadonna, Peter. "Paramedic Ultrasound" . Retrieved 12 May 2011.
  2. ↑ von Foerster, Nicholas; Radomski, Marek A.; Martin-Gill, Christian (2 January 2024). "Prehospital Ultrasound: A Narrative Review". Prehospital Emergency Care. 28 (1): 1–13. doi:10.1080/10903127.2022.2132332.
  3. ↑ Emergency Ultrasound Made Easy. Justin Bowra, Russell E. McLaughlin. Elsevier Churchill Livingstone, 2006 ISBN   0-443-10150-7, ISBN   978-0-443-10150-2 [ page needed ]
  4. ↑ Emergency Ultrasound: Principles and Practice. Romolo Joseph Gaspari, J. Christian Fox, Paul R. Sierzenski. Mosby, 2005. ISBN   0-323-03750-X, 9780323037501[ page needed ]
  5. ↑ Atlas of Emergency Medicine. Kevin J. Knoop, Lawrence B. Stack, Alan B. Storrow. McGraw-Hill Professional, 2002. ISBN   0-07-135294-5, ISBN   978-0-07-135294-9 [ page needed ]
  6. ↑ Kundra, Pankaj; Mishra, SandeepKumar; Ramesh, Anathakrishnan (2011). "Ultrasound of the airway". Indian Journal of Anaesthesia. 55 (5): 456–462. doi: 10.4103/0019-5049.89868 . PMC   3237144 . PMID   22174461.
  7. ↑ "EMS Pre-Hospital Ultrasound".
  8. ↑ Thomas, Bruce; Falcone, Robert E.; Vasquez, Donald; Santanello, Steven; Townsend, Michael; Hockenberry, Scott; Innes, Jeffrey; Wanamaker, Steven (March 1997). "Ultrasound Evaluation of Blunt Abdominal Trauma: Program Implementation, Initial Experience, and Learning Curve". The Journal of Trauma: Injury, Infection, and Critical Care. 42 (3): 384–390. doi:10.1097/00005373-199703000-00004. PMID   9095104.
  9. ↑ Introduction To Emergency Ultrasound: A Review Of Justifications, Indications And Significant Findings. Steven A. Godwin M.D. March, 1999. Jacksonville Medicine Journal. http://www.dcmsonline.org/jax-medicine/1999journals/march99/ultrasound.htm
  10. ↑ Mateer, James R.; Ogata, Masaaki; Kefer, Michael P.; Wittmann, Dietmar; Aprahamian, Charles (June 1995). "Prospective Analysis of a Rapid Trauma Ultrasound Examination Performed by Emergency Physicians". The Journal of Trauma: Injury, Infection, and Critical Care. 38 (6): 879–885. doi:10.1097/00005373-199506000-00009. PMID   7602628.
  11. ↑ Boitnott, J. Optic Nerve Sheath Ultrasound. EMSPOCUS. http://emspocus.com/2015/12/07/optic-nerve-sheath-ultrasound/
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