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Muzzafer Chaudery, James Clark, Jonathan J Morrison, Mark H Wilson, Duncan Bew, Ara Darzi
BACKGROUND: Torso hemorrhage is the primary cause of potentially preventable mortality in trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been advocated as an adjunct to bridge patients to definitive hemorrhage control. The primary aim of this study was to assess whether contrast-enhanced ultrasonography can improve the accuracy of REBOA placement in the infrarenal aorta (Zone III). METHODS: A fluoroscopy-free "enhanced" Zone III REBOA technique was developed using a porcine cadaver model...
January 2016: Journal of Trauma and Acute Care Surgery
Jessica McCallum, Erik Vu, David Sweet, Hussein D Kanji
OBJECTIVE: Prehospital ultrasound is being applied in the field. The purpose of this systematic review is to describe evidence pertaining to ultrasound curricula for paramedics specifically, including content, duration, setting, design, evaluation, and application. METHODS: Electronic searches of MEDLINE, Embase, CINAHL, and the Cochrane Center Register of Controlled Trials were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines...
November 2015: Air Medical Journal
Sabine Bélard, Francesca Tamarozzi, Amaya L Bustinduy, Claudia Wallrauch, Martin P Grobusch, Walter Kuhn, Enrico Brunetti, Elizabeth Joekes, Tom Heller
The development of good quality and affordable ultrasound machines has led to the establishment and implementation of numerous point-of-care ultrasound (POCUS) protocols in various medical disciplines. POCUS for major infectious diseases endemic in tropical regions has received less attention, despite its likely even more pronounced benefit for populations with limited access to imaging infrastructure. Focused assessment with sonography for HIV-associated TB (FASH) and echinococcosis (FASE) are the only two POCUS protocols for tropical infectious diseases, which have been formally investigated and which have been implemented in routine patient care today...
January 2016: American Journal of Tropical Medicine and Hygiene
Jacob A Quick, Rindi M Uhlich, Salman Ahmad, Stephen L Barnes, Jeffrey P Coughenour
Ultrasound is a standard adjunct to the initial evaluation of injured patients in the emergency department. We sought to evaluate the ability of prehospital, in-flight thoracic ultrasound to identify pneumothorax. Non-physician aeromedical providers were trained to perform and interpret thoracic ultrasound. All adult trauma patients and adult medical patients requiring endotracheal intubation underwent both in-flight and emergency department ultrasound evaluations. Findings were documented independently and reviewed to ensure quality and accuracy...
February 2016: Emergency Radiology
Piergiorgio Lochner, Marika Falla, Francesco Brigo, Michael Pohl, Giacomo Strapazzon
AIMS: Despite extensive research on acute mountain sickness (AMS), the underlying pathophysiology remains unclear. Ultrasonography studies have shown that optic nerve sheath diameter (ONSD) correlates with intracranial pressure (ICP) in critical care patients, and recent studies report elevated ONSD values at high altitude. The aim of this review was to elucidate whether 1. measurement of ONSD could shed light on the pathophysiology of AMS, and 2. ultrasonography of the ONSD could support the diagnosis of AMS...
September 2015: High Altitude Medicine & Biology
Cameron M Bass, Dana R Sajed, Adeyinka A Adedipe, T Eoin West
INTRODUCTION: In low-resource settings it is not always possible to acquire the information required to diagnose acute respiratory distress syndrome (ARDS). Ultrasound and pulse oximetry, however, may be available in these settings. This study was designed to test whether pulmonary ultrasound and pulse oximetry could be used in place of traditional radiographic and oxygenation evaluation for ARDS. METHODS: This study was a prospective, single-center study in the ICU of Harborview Medical Center, a referral hospital in Seattle, Washington, USA...
July 21, 2015: Critical Care: the Official Journal of the Critical Care Forum
Sundeep R Bhat, David A Johnson, Jessica E Pierog, Brita E Zaia, Sarah R Williams, Laleh Gharahbaghian
INTRODUCTION: In the United States, there are limited studies regarding use of prehospital ultrasound (US) by emergency medical service (EMS) providers. Field diagnosis of life-threatening conditions using US could be of great utility. This study assesses the ability of EMS providers and students to accurately interpret heart and lung US images. METHODS: We tested certified emergency medical technicians (EMT-B) and paramedics (EMT-P) as well as EMT-B and EMT-P students enrolled in prehospital training programs within two California counties...
July 2015: Western Journal of Emergency Medicine
Xavier Bobbia, Christophe Pradeilles, Pierre Géraud Claret, Camille Soullier, Patricia Wagner, Yann Bodin, Claire Roger, Guillaume Cayla, Laurent Muller, Jean Emmanuel de La Coussaye
INTRODUCTION: The use of focused cardiac ultrasound (FoCUS) in a prehospital setting is recommended. Pocket ultrasound devices (PUDs) appear to be well suited to prehospital FoCUS. The main aim of our study was to evaluate the interpretability of echocardiography performed in a prehospital setting using a PUD based on the experience of the emergency physician (EP). METHODS: This was a monocentric prospective observational study. We defined experienced emergency physicians (EEPs) and novice emergency physicians (NEPs) as echocardiographers if they had performed 50 echocardiographies since their initial university training (theoretical training and at least 25 echocardiographies performed with a mentor)...
July 7, 2015: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Andrea R Levine, Michael T McCurdy, Marc T Zubrow, Alfred Papali, Haney A Mallemat, Avelino C Verceles
PURPOSE: Intensive care unit telemedicine (tele-ICU) uses audiovisual systems to remotely monitor and manage patients. Intensive care unit ultrasound can augment an otherwise limited bedside evaluation. To date, no studies have utilized tele-ICU technology to assess the quality and clinical use of real-time ultrasound images. We assessed whether tele-intensivists can instruct nonphysicians to obtain high-quality, clinically useful ultrasound images. METHODS: This prospective pilot evaluated the effectiveness of a brief educational session of nonphysician "ultrasonographers" on their ability to obtain ultrasound images (right internal jugular vein, bilateral lung apices and bases, cardiac subxiphoid view, bladder) with real-time tele-intensivist guidance...
October 2015: Journal of Critical Care
Benjamin Dallaudière, Ahmed Larbi, Mathieu Lefere, Anne Perozziello, Olivier Hauger, Florence Pommerie, Bénédicte Fraboulet, Denis Jacob
BACKGROUND: Ultrasound (US) is a good first-line alternative for the diagnosis of bone fractures in adults as well as children. Our study shows that, compared to X-ray, in a resource-constrained environment, on-site US has a high sensitivity (98%) and specificity (96%) in the diagnosis of bone fractures. PURPOSE: To compare the accuracy of on-the-spot US with conventional radiography in the screening for bone fractures during the Paris-Dakar rally raid. MATERIAL AND METHODS: Eighty-three patients (81 men, 2 women) with clinically suspected bone fractures were included in 2013 and 2014...
May 2015: Acta Radiologica Open
Travis C Russell, Paul F Crawford
In the last 10 years, the use of ultrasound has expanded because of its portability, safety, real-time image display, and rapid data collection. Simultaneously, more people are going into the backcountry for enjoyment and employment. Increased deployment for the military and demand for remote medicine services have led to innovative use and study of ultrasound in extreme and austere environments. Ultrasound is effective to rapidly assess patients during triage and evacuation decision making. It is clinically useful for assessment of pneumothorax, pericardial effusion, blunt abdominal trauma, musculoskeletal trauma, high-altitude pulmonary edema, ocular injury, and obstetrics, whereas acute mountain sickness and stroke are perhaps still best evaluated on clinical grounds...
January 2013: Military Medicine
S W Melanson, J McCarthy, C J Stromski, J Kostenbader, M Heller
BACKGROUND: While ultrasound has become an established diagnostic modality in trauma care, no study has evaluated its use in the prehospital setting. OBJECTIVE: To examine the use of the focused abdominal sonography for trauma (FAST) exam in the prehospital setting. METHODS: After a three-hour training session in the FAST exam, the nonphysician flight team of an emergency medical services (EMS) helicopter program attempted a FAST exam on trauma patients to determine the feasibility of such an intervention...
October 2001: Prehospital Emergency Care
Christopher R McNeil, John McManus, Sumeru Mehta
BACKGROUND: Previous literature has shown the ability of ultrasonography technology to accurately assess orthopedic pathology. Over the past two decades, the use of ultrasound in the prehospital setting has become an important tool for triage, diagnosis, and treatment, especially in austere and remote environments that lack appropriate radiography capability and logistical support. The purpose of our study was to assess the accuracy of ultrasound in the austere, combat environment for diagnosis of orthopedic fracture...
January 2009: Prehospital Emergency Care
Jonathan D Monti, Bradley Younggren, Robert Blankenship
BACKGROUND: Prompt recognition and treatment of a tension pneumothorax is critical to reducing mortality in both military and civilian settings. Physician assistants, Special Operations Forces (SOF) and conventional force Medics are often the first medical providers to care for combat trauma patients with penetrating chest trauma and frequently have limited diagnostic capabilities available to them due to mission constraints. The purpose of this study is to examine the potential for non-physician providers to determine the absence or presence of a pneumothorax in a porcine model, with the use of a portable ultrasound machine, after receiving minimal training...
2009: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Justin J Madill
BACKGROUND: Ultrasonography is the only portable imaging modality available in the helicopter medical evacuation environment where physical examination is limited, auscultation is impossible, long transport times may occur, and altitude variations are frequent. Although the use of ultrasonography by aviation medical personnel has been documented, minimal literature exists on the contribution of in-flight ultrasonography to patient management. OBJECTIVES: This case demonstrates an indication for the use of in-flight ultrasonography...
August 2010: Journal of Emergency Medicine
D A T Gay, J V Ritchie, J N Perry, S Horne
Penetrating eye injuries are uncommon in a civilian environment, but unfortunately, very common in a military emergency department. Ultrasound of the eye is quick, reliable, accurate, and easy to learn. This review aims to demonstrate normal anatomy and penetrating injuries of the anterior and posterior compartments of the eye.
January 2013: Clinical Radiology
U Jaffer, M Aslam, V Kasivisvanathan, R Patni, M Midwinter, N Standfield
Tourniquet application has been widely accepted to improve survival for major limb trauma. Colour duplex ultrasound (US) can be used as a non-invasive method of confirming cessation of arterial flow. Participants with no or limited experience of ultrasound were taught to apply the Combat Application Tourniquet with ultrasound guidance. Following this, participants were tested in effective tourniquet application: Blind and with ultrasound guidance. US guidance improved abolition of limb perfusion from 22 to 93 per cent in upper limb; from 25 to 100 per cent in lower limb (p=0...
2012: International Journal of Surgery
Nicole Lunceford, Robert J Scherl, Jonathan Elliot, Brett F Bechtel, Jonathan Auten
The role of bedside ultrasound by physicians with advanced ultrasound training, such as emergency medicine providers, has been clearly established in the austere setting of combat medicine. This highly mobile, noninvasive, and versatile imaging modality has a role in evaluating battle- and nonbattle-related presentations. This case report describes a U.S. Marine reporting to an austere medical facility with the chief complaint of abdominal pain. An ultrasound of the patient's urinary tract revealed abnormalities that suggested right bladder wall thickening and an echo dense layer of sediment as the potential source of his discomfort...
March 2013: Military Medicine
Rex Kinnear-Mellor, K Newton, T Woolley, R Rickard
We report a case of traumatic cardiac arrest in a combat casualty who was resuscitated to return of spontaneous circulation despite asystole and no visible cardiac activity on initial ultrasound examination. This return of spontaneous circulation suggests that survival may be possible in traumatic cardiac arrest due to exsanguination, even when there is no demonstrable cardiac activity on ultrasound. Cardiac ultrasonography was performed for 10 s only. We suggest that cardiac ultrasonography should be performed for a minimum of 1 min during volume resuscitation...
February 2016: Journal of the Royal Army Medical Corps
Wenbo Luo, Hamid Hosseini, Vesna Zderic, Frederick Mann, Grant O'Keefe, Shahram Vaezy
BACKGROUND: Hemorrhage from wounds in the extremities is the leading cause of preventable death on the battlefield. To successfully treat these injuries, the exact source of bleeding must be localized. OBJECTIVE: The purpose of this study was to determine the feasibility of using Doppler ultrasound to precisely detect and localize peripheral vascular bleeding. METHODS: Injuries were produced in common femoral arteries (diameter of ∼5 mm) of 28 pigs in vivo...
July 2011: Journal of Emergency Medicine
2015-06-09 14:11:29
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