Bradley Waterman, Kristine Van Aarsen, Michael Lewell, Homer Tien, Frank Myslik, Michael Peddle, Sean Doran
BACKGROUND: The Focused Assessment with Sonography in Trauma (FAST) exam is a rapid ultrasound test to identify evidence of hemorrhage within the abdomen. Few studies examine the accuracy of paramedic performed FAST examinations. The duration of an ultrasound training program remains controversial. This study's purpose was to assess the accuracy of paramedic FAST exam interpretation following a one hour didactic training session. METHODS: The interpretation of paramedic performed FAST exams was compared to the interpretation of physician performed FAST examinations on a mannequin model containing 300ml of free fluid following a one hour didactic training course...
September 2020: CJEM
Bradley Waterman, Kristine Van Aarsen, Michael Lewell, Frank Myslik, Michael Peddle, Sean Doran
BACKGROUND: Point of care ultrasound (POCUS) is an essential tool for physicians to guide treatment decisions in both hospital and prehospital settings. Despite the potential patient care and system utilization benefits of prehospital ultrasound, the financial burden of a "hands-on" training program for large numbers of paramedics remains a barrier to implementation. In this study, we conducted a prospective, observational, double-blinded study comparing paramedics to emergency physicians in their ability to generate usable abdominal ultrasound images after a 1-hour didactic training session...
September 2020: CJEM
William Teeter, Daniel Haase
Evaluating and treating traumatic cardiac arrest remains a challenge to the emergency medicine provider. Guidelines have established criteria for patients who can benefit from treatment and resuscitation versus those who will likely not survive. Patient factors that predict survival are penetrating injury, signs of life with emergency medical services or on arrival to the Emergency Department, short length of prehospital cardiopulmonary resuscitation, cardiac motion on ultrasound, pediatric patients, and those with reversible causes including pericardial tamponade and tension pneumothorax...
November 2020: Emergency Medicine Clinics of North America
Cecil J Simmons, Lisa D Mack, Aaron J Cronin, Jonathan D Monti, Michael D Perreault, Brian J Ahern
OBJECTIVE: On-scene prehospital conditions and patient instability may warrant a during-transport ultrasound (US) exam. The objective of this study was to assess the effect of ambulance turbulence on the performance of the Focused Assessment with Sonography in Trauma (FAST) with a handheld US device. METHODS: This was a randomized controlled trial in which participants were randomized to perform a FAST in either a stationary or an in-motion military ambulance. Participants were physicians and physician assistants (PAs) with previous FAST training...
August 26, 2020: Prehospital and Disaster Medicine
Michael Joyce, Jordan Tozer, Michael Vitto, David Evans
INTRODUCTION: The Advanced Cardiac Life Support (ACLS) guidelines were recently updated to include ultrasound confirmation of endotracheal tube (ETT) location as an adjunctive tool to verify placement. While this method is employed in the emergency department under the guidance of the most recent American College of Emergency Physicians (ACEP; Irving, Texas USA) guidelines, it has yet to gain wide acceptance in the prehospital setting where it has the potential for greater impact. The objective of this study to is determine if training critical care medics using simulation was a feasible and reliable method to learn this skill...
August 25, 2020: Prehospital and Disaster Medicine
Steinar Einvik, Andreas Jorstad Kruger, Sven Erik Gisvold
BACKGROUND: Drowning is the third leading cause of unintentional injury death worldwide, with the highest rates of fatality among young children. To decide how to treat these patients prehospitally could be challenging in certain situations when uncertain about the adequacy of the patent's circulation. METHODS/CASE REPORT: We describe a 2 year old boy surviving a 15 min hypothermic submersion in a cold river. In spite of the presence of some vital signs, we decided to do full cardiopulmonary resuscitation to the hospital...
August 20, 2020: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Christopher B Mercer, Matthew Ball, Rebecca E Cash, Madison K Rivard, Kirsten Chrzan, Ashish R Panchal
Background: Trauma is a leading cause of death in the United States. Ultrasound use in the prehospital environment has the potential to change trauma management. Although ultrasound use for prehospital trauma is increasing, the role of this modality is not clearly defined. Objectives: We examined the use of prehospital ultrasound (PHUS) for trauma patients and the use by different provider types. Specific factors of interest were if prehospital ultrasound has been shown to improve providers' ability to recognize conditions that can be managed in the prehospital setting, treat these conditions, change transport destination, or improve overall mortality rates for trauma patients...
August 20, 2020: Prehospital Emergency Care
Colton B Amaral, Daniel C Ralston, Torben K Becker
Point-of-care ultrasound at the bedside has evolved into an essential component of emergency patient care. Current evidence supports its use across a wide spectrum of medical and traumatic diseases in a variety of settings. The prehospital use of ultrasound has evolved from a niche technology to impending widespread adoption across emergency medical services systems internationally. Recent technological advances and a growing evidence base support this trend. However, concerns regarding feasibility, education, and quality assurance must be addressed proactively...
2020: SAGE Open Medicine
Ann Kaminski, Nkechi O Dike, Kerry Bachista, Michael Boniface, Conrad Dove, Leslie V Simon
Objectives Airway ultrasound is now possible in the prehospital setting due to advances in ultrasound equipment portability. We questioned how well prehospital providers without prior experience could determine both esophageal and tracheal placement of an endotracheal tube in cadavers after a brief training course in ultrasound.  Methods This educational prospective study at the Simulation Center in Mayo Clinic Jacksonville Florida enrolled 50 prehospital providers. Demographic and practice background information was obtained through surveys...
June 18, 2020: Curēus
Alexandra Murray, Heidi Hutchison, Madalyn Popil, William Krebs
Cardiac point-of-care ultrasound (POCUS) is a quick and accurate tool to assess a patient's cardiovascular and hemodynamic status by measuring the E-point septal separation (EPSS) and left ventricular ejection fraction. The case presented here highlights the potential for increased use of POCUS to guide resuscitation in the prehospital setting and during critical care transport. A 56-year-old male presented to a rural emergency department with chest pain and was found to have an inferior STelevation myocardial infarction (STEMI)...
May 2020: Air Medical Journal
Takaaki Mori, Hirokazu Takei, Osamu Nomura, Takateru Ihara, Yusuke Hagiwara
BACKGROUND: Nasogastric tube (NGT) placement is commonly performed in pediatric emergency care and is classically confirmed by any one of several methods, among which auscultation or aspiration and radiography comprise the currently recognized as the reference standard. Point-of-care ultrasound (POCUS) is used to confirm NGT insertion, especially in adults or prehospital patients, but reports of its use in the pediatric emergency department (ED) are still scarce. We report a case of successful POCUS-guided NGT placement in a pediatric ED...
August 2020: Journal of Emergency Medicine
Patrick G A Duncan, J Mackey
INTRODUCTION: The past 20 years have seen a rapid increase in point-of-care ultrasound (POCUS) use in the prehospital sphere. However, in the British Army there is no POCUS capability in the Defence Primary Healthcare (DPHC) or deployed Role 1 setting. POCUS can improve diagnostic capability, influence management decisions and transfer destination, and is a useful triage tool in mass casualty management. METHOD: A survey on POCUS use was sent to 279 clinicians working in the Role 1, civilian prehospital and Defence Primary Healthcare environments...
May 20, 2020: BMJ military health
William J Ibbotson, Randall Greenberg, Peter Brendt
Pain management for patients with chest trauma in aeromedical prehospital and retrieval medicine is important in order to maintain respiratory function. However, it can be challenging to achieve with opioids alone due to side effects including sedation, respiratory depression, and nausea.Reported are two trauma patients with uncontrolled pain despite multiple doses of opioids managed with a single-injection erector spinae plane block (ESB).The sono-anatomy and performance of the block, indications, and possible complications associated with the ESB are described...
August 2020: Prehospital and Disaster Medicine
Chiara Piliego, Alessandro Strumia, Michael Benjamin Stone, Giuseppe Pascarella
No abstract text is available yet for this article.
April 27, 2020: Anesthesia and Analgesia
Andrew Guy, Anthony Bryson, Stephen Wheeler, Neilson McLean, Hussein D Kanji
OBJECTIVE: Point-of-care ultrasound is a nascent and growing area of prehospital care. Most previously described ultrasound curricula for paramedics examine a single type of ultrasound scan. Here, we describe the implementation and evaluation of a prehospital ultrasound curriculum using a blended model of traditional didactics and hands-on experience with online prereading. METHODS: We recruited a prospective convenience sample of critical care paramedics without prior ultrasound experience to take part in a 2-day ultrasound course...
November 2019: Air Medical Journal
Anna Sedlakova, Paul Olszynski, Philip Davis, John Froh
OBJECTIVES: Evidence suggests that prehospital point of care ultrasound (POCUS) may change patient management. It serves as an aid in triage, physical examination, diagnosis, and patient disposition. The rate of adoption of POCUS among aeromedical services throughout Canada is unknown. The objective of this study was to describe current POCUS use among Canadian aeromedical services providers. METHODS: This is a cross-sectional observational study. A survey was emailed to directors of government-funded aeromedical services bases in Canada...
May 2020: CJEM
Prudence Oliver, Peter Bannister, Duncan Bootland, Richard M Lyon
OBJECTIVE: Up to 20% of major trauma patients may sustain a pneumothorax. Traumatic pneumothoraces can be difficult to diagnose on scene. Although the use of handheld ultrasound (HHUS) is becoming increasingly widespread, there remains uncertainty about its efficacy as a diagnostic tool in the prehospital setting. The aim of this study was to determine the diagnostic performance of prehospital chest HHUS in trauma patients. METHOD: Retrospective review of trauma patients who received a prehospital chest HHUS and subsequently conveyed to the Royal Sussex County Hospital (RSCH) between 1 July 2013 and 24 September 2018...
June 2020: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Jay Joseph Doucet, Paula Ferrada, Sarah Murthi, Ram Nirula, Sara Edwards, Emily Cantrell, Jinfeng Han, Daniel Haase, Andrew Singleton, Yekaterina Birkas, Giovanna Casola, Raul Coimbra
BACKGROUND: Identification of occult hypovolemia in trauma patients is difficult. We hypothesized that in acute trauma patients, the response of ultrasound-measured minimum inferior vena cava diameter (IVCDMIN), IVC Collapsibility Index (IVCCI), minimum internal jugular diameter (IJVDMIN) or IJV Collapsibility Index (IJVCI) after up to 1 hour of fluid resuscitation would predict 24-hour resuscitation intravenous fluid requirements (24FR). METHODS: An NTI-funded, American Association for the Surgery of Trauma Multi-Institutional Trials Committee prospective, cohort trial was conducted at four Level I Trauma Centers...
January 2020: Journal of Trauma and Acute Care Surgery
Laura van der Weide, Zar Popal, Maartje Terra, Lothar A Schwarte, Johannes C F Ket, Fabian O Kooij, Aristomenis K Exadaktylos, Wietse P Zuidema, Georgios F Giannakopoulos
INTRODUCTION: Emergency ultrasound methods such as Focused Assessment with Sonography in Trauma (FAST) are a widely used imaging method. This examination can be performed to examine the presence of several life-threatening injuries. Early diagnosis may lead to better outcome, but the effect of timely diagnosis in the prehospital setting is not yet clear. Therefore, the aim is to determine the diagnostic accuracy and the effect of prehospital ultrasound performed in (poly)trauma patients...
December 2019: Injury
Amy Moore, James K Aden, Ryan Curtis, Mohamad Umar
BACKGROUND: The laryngeal handshake method (LHM) may be a reliable standardized method to quickly and accurately identify the cricothyroid membrane (CTM) when performing an emergency surgical airway (ESA). However, there is currently minimal available literature evaluating the method. Furthermore, no previous CTM localization studies have focused on success rates of military prehospital providers. This study was conducted with the goal of answering the question: Which method is superior, the LHM or the traditional method (TM), for identifying anatomical landmarks in a timely manner when performed by US Army combat medic trainees? METHODS: This prospective randomized crossover study was conducted at Ft Sam Houston, TX, in September 2018...
2019: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
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