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14 References (14 articles) loading Revert Studify

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Prehospital ultrasound detects pericardial tamponade in a pregnant victim of stabbing assault.

Journal Resuscitation
Year 2008
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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The development of handheld, portable ultrasound devices has enabled the use of this diagnostic tool also in the out-of-hospital environment. We report on a pregnant teenager who was found haemodynamically unstable after a stab assault. When she suffered cardiac arrest shortly thereafter, diagnosis of cardiac tamponade was made by portable ultrasound, and immediate pericardiocentesis was performed by the emergency physician. While her baby died after emergency Caesarean section, the teenager survived after thoracotomy and prolonged resuscitation without neurological sequelae.

Primary study

Unclassified

Transcranial ultrasound from diagnosis to early stroke treatment. 1. Feasibility of prehospital cerebrovascular assessment.

Journal Cerebrovascular diseases (Basel, Switzerland)
Year 2008
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: To test whether portable duplex ultrasound devices can be used in a prehospital '911' emergency situation to assess intracranial arteries. METHODS: Non-contrast-enhanced transcranial duplex ultrasound studies were performed either immediately at the site of the emergency (i.e. private home) or after transfer into the emergency helicopter/ambulance vehicle. RESULTS: A total of 25 patients were enrolled. In 5/25 cases, intracranial vessels could not be visualized due to insufficient quality of the temporal bone window. In 20/25 cases, bilateral visualization and Doppler flow measurements of the middle cerebral artery could be assessed in a mean time less than 2 min. CONCLUSION: Emergency assessment of intracranial arteries using portable duplex ultrasound devices is feasible shortly after arrival at the patient's site.

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The use of point-of-care ultrasound by a critical care retrieval team to diagnose acute abdominal aortic aneurysm in the field.

Authors Mazur SM , Sharley P
Journal Emergency medicine Australasia : EMA
Year 2007
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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The potential benefit of point-of-care ultrasound by medical retrieval teams is unclear. In the present case report, the diagnosis of an abdominal aortic aneurysm by a critical care retrieval team equipped with a portable ultrasound machine resulted in significant corrective alteration in patient management and subsequent disposition at the receiving institution.

Primary study

Unclassified

Portable ultrasound in pre-hospital emergencies: a feasibility study.

Authors Busch M
Journal Acta anaesthesiologica Scandinavica
Year 2006
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: Ultrasound plays a central role in the evaluation of both trauma and medical emergencies. The development of portable sonography devices could extent its application into the pre-hospital arena. The aim of our study was to evaluate feasibility of pre-hospital ultrasound in the Norwegian Air Rescue setting. MATERIAL AND METHODS: During a 3-month period, we conducted a prospective study using sonography in pre-hospital patient management. All examinations were carried out by the same ultrasound-certified physician using a Primedic Handyscan in a standardized focused protocol for abdominal and lung sonography and a subcostal 2-chamber long axis view. Inclusion criteria were abdominal/thoracic and obstetric trauma, circulatory/respiratory compromise, pulseless electric activity (PEA) in cardiac arrest, acute abdomen and monitoring during transport. Allowed examination time was restricted to 3 min on the scene. The patient's gender, age, symptoms, trauma mechanism, quality of visualization and diagnose made were recorded. Pre-hospital results were compared with in-hospital findings. RESULTS: Thirty-eight patients were entered into the study. Three patients had to be excluded due to technical difficulties. Nineteen medical, 15 traumas and 1 obstetric patient were included. Good visualization was obtained in 74% (n= 26), moderate in 26% (n = 9). Median examination time was 2.5 min (range 1-3 min). Nine patients (26%) showed positive sonography findings. Sensitivity was 90%, specificity 96%. Diagnostic usefulness was high in undetermined cardiac arrest and hypotension and massive hematoperitoneum. CONCLUSION: Pre-hospital ultrasound when applied by an proficient examiner using a goal-directed, time sensitive protocol is feasible, does not delay patient management and provides diagnostic and therapeutic benefit. Further studies are warranted to identify the exact indications and role of pre-hospital sonography.

Primary study

Unclassified

Usefulness of hand-held ultrasound devices in out-of-hospital diagnosis performed by emergency physicians.

Journal The American journal of emergency medicine
Year 2006
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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OBJECTIVE: To evaluate the usefulness of ultrasonographic examinations as a diagnostic tool for emergency physicians in out-of-hospital settings. METHODS: Prospective study performed in a French teaching hospital. Eight emergency physicians given ultrasound training for out-of-hospital diagnosis of pleural, peritoneal, or pericardial effusion; deep venous thrombosis; and arterial flow interruption. After clinical examination, a probability of diagnosis ("clinical score") was assigned on visual analog scale from 0 (absent lesion) to 10 (present lesion). Clinical score between 3 and 7 was considered as clinically doubtful. After ultrasound examination, a second probability ("ultrasound score") was similarly determined. Potential usefulness of ultrasound examination was evaluated by calculating the absolute difference between clinical and ultrasound scores. Patients were followed up to determine final diagnosis: present or absent lesion. "Ultrasound usefulness score" (USS) was determined attributing a positive (when ultrasonography increased diagnostic accuracy) or a negative (when ultrasonography decreased diagnostic accuracy) value to the absolute difference between clinical and ultrasound scores. RESULTS: One hundred sixty-nine patients were included and 302 ultrasound examinations performed. Median duration of examination was 6 minutes (5-10 minutes). The suspected lesion was found in 45 cases (17%). Mean USS was +2 (0-4). Ultrasonographic examination improved diagnostic accuracy (ie, positive USS) in 181 (67%) cases, decreased it (ie, negative USS) in 22 (8%) cases, and was not contributive (ie, USS was 0) in 67 (25%) cases. When initial diagnosis was uncertain (n = 115), diagnostic performance reached +4 (3-5) and ultrasonographic examination improved diagnostic accuracy in 103 (90%) cases. CONCLUSION: Out-of-hospital ultrasonography increased diagnostic accuracy in out-of-hospital settings.

Primary study

Unclassified

Use of ultrasonography to avoid an unnecessary procedure in the prehospital combat environment: a case report.

Authors Do JR , McManus J , Harrison B
Journal Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
Year 2006
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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The role of ultrasonography in the prehospital combat setting has become a useful tool for triage, diagnosis, and treatment. Recent literature has demonstrated that ultrasonography has a greater sensitivity and specificity than clinical examination and plain radiography for pneumothorax detection in trauma patients, particularly small pneumothoraces. This becomes especially critical in austere and remote environments. Although many pneumothoraces are initially considered non-life-threatening, austere and combat environments possess additional risks of limited supplies, multiple casualties, and prolonged evacuation times that may potentially increase the morbidity of these injuries. This case report discusses the role of ultrasonography in pneumothorax detection in the prehospital combat environment.

Primary study

Unclassified

Prehospital ultrasound imaging improves management of abdominal trauma.

Journal The British journal of surgery
Year 2006
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: Blunt abdominal trauma with intra-abdominal bleeding is often underdiagnosed or even overlooked at trauma scenes. The purpose of this prospective, multicentre study was to compare the accuracy of physical examination and prehospital focused abdominal sonography for trauma (PFAST) to detect abdominal bleeding. METHODS: Six rescue centres took part in the study from December 2002 to December 2003, including 230 patients with suspected abdominal injury. The accuracy of physical examination at the scene and PFAST were compared. Later examinations in the emergency department (ultrasonography and/or computed tomography) were used as the reference standard. RESULTS: The complete protocol and follow-up was obtained in 202 patients. The sensitivity, specificity and accuracy of PFAST were 93 per cent, 99 per cent and 99 per cent, respectively, compared with 93 per cent, 52 per cent and 57 per cent for physical examination at the scene. Scanning with PFAST occurred a mean(s.d.) 35(13) min earlier than ultrasound in the emergency department. Abdominal bleeding was detected in 14 per cent of patients. Using PFAST led to a change in either prehospital therapy or management in 30 per cent of patients, and a change to admitting hospital in 22 per cent. CONCLUSION: In this study, PFAST was a useful and reliable diagnostic tool when used as part of surgical triage at the trauma scene.

Primary study

Unclassified

FAST on operational military deployment.

Authors Brooks AJ , Price V , Simms M
Journal Emergency medicine journal : EMJ
Year 2005
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND AND OBJECTIVE: Handheld ultrasound, because of its light weight, size, rugged design, and relative simplicity of use is ideal for use on operational military deployment. These machines have been used in the diagnosis of a range of traumatic conditions including abdominal, thoracic, and extremity trauma in the hospital environment, yet few data exist on their use during military operations. This paper presents experience of handheld focused assessment with sonography for trauma (FAST) on operational military deployment. METHOD: Over a two month period, handheld FAST was performed by a single surgeon during the circulation phase of the primary survey in trauma patients presenting to the British Military Hospital in Iraq. RESULTS: Fifteen from casualties underwent a FAST examination. Ten were victims of blunt trauma, two had received injuries anti-personnel mines, and three had penetrating injuries from ballistic trauma. There was one positive FAST, confirmed at laparotomy as bleeding from a liver injury. Thirteen scans were negative and remained negative on repeat FAST at 6 hours. One further patient with a negative FAST underwent laparotomy because of transectory, there was no intra-abdominal blood or fluid at surgery. CONCLUSION: Handheld FAST is a valuable technique for investigating abdominal or thoracic bleeding in single or multiple casualty events on operational military deployment.

Primary study

Unclassified

Change in differential diagnosis and patient management with the use of portable ultrasound in a remote setting.

Journal Wilderness & environmental medicine
Year 2005
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: Physicians practicing in remote areas are typically limited in their choice of diagnostic tools. The goal of this study was to determine whether the use of a portable ultrasound (US) device on selected patients in a remote setting would alter physician diagnosis and management. METHODS: This was a prospective observational study of the affects of US on physician decision making deep in the Amazon jungle. A battery-operated Sonosite 180 Plus with 2 interchangeable transducers (4-7-MHz broadband intercavitary transducer and 2-5-MHz broadband abdominal transducer) was used. The patient population consisted of local tribal people. Two of the physicians on the team performed all US examinations. Team physicians requesting US examinations filled out a survey before and after the US examination. Before the US, the referring physician filled out a survey describing the patient's initial complaint, pertinent past medical history and physical findings, and an initial (pre-US) differential diagnosis and planned treatment with expected disposition. After the results of the US were reviewed with the referring physicians, the doctors were asked to fill out the remainder of the survey, allowing comparison of pre- and post-US differential diagnosis, treatment plan, and disposition. RESULTS: A total of 25 US studies were performed during this study (1 trauma US scan, 6 hepatobiliary studies, 5 transabdominal pelvic scans, 7 transvaginal pelvic studies, 3 renal studies, and 3 abdominal aortic scans). The monitor on the US unit experienced a rare failure shortly after being used at 17,000 ft and then 10 times at sea level, and no further US scans could be performed. US scan results dramatically altered the disposition of 7 patients, including 4 patients who avoided a potentially dangerous 2-day evacuation to more definitive medical care. Three patients were found to need rapid referral to the nearest clinic for surgical evaluation. CONCLUSIONS: When used in a remote location, portable US provides a significant benefit that can dramatically alter disposition and treatment.

Primary study

Unclassified

Ultrasound for the air medical clinician.

Journal Air medical journal
Year 2004
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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