Sonokids MILITARY

Imaging equipment deployed with the combat support hospital in Afghanistan represented new technology not previously used in a hostile environment for a prolonged period. In general, the equipment performed well in a stationary location. Having computed tomography and ultrasound scans, in addition to plain radiographs, was very helpful for patient care. Redundancy of digital radiography and ultrasound systems proved prudent. It is recommended that a radiologist continue to be sent with the combat support hospital, particularly when computed tomography and ultrasound systems are in the deployment package...

The complex nature of combat-related injuries requires frequent operative interventions and prolonged analgesic therapy. The application of continuous peripheral nerve block (CPNB) has been an important anaesthetic tool in the management of combat soldiers wounded from the current conflicts. The severe, destructive nature of combat injuries makes placement of CPNB difficult or impossible using more common neurostimulation approaches. The use of ultrasound technology has improved our success in placing CPNB in the presence of such injuries...

OBJECTIVE: The purpose of this study was to evaluate the utility of ultrasound in a combat theater. METHODS: A retrospective review of gynecology visits was evaluated at Camp Doha, Kuwait, from August 2003 through April 2004. Of the 1,737 visits, 237 required pelvic ultrasound. Demographic information, as well as the indications, diagnosis, and disposition of the patients, was compiled. RESULTS: The average age of the patient requiring ultrasound was 28 +/- 8 years...

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...

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...

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...

OBJECTIVE: To assess the ability of Army National Guard combat medics to perform a limited bedside echocardiography (BE) to determine cardiac activity after a brief training module. METHODS: Twelve Army National Guard health care specialists trained to the level of emergency medical technician-basic (EMT-B) underwent an educational session consisting of a 5-minute lecture on BE followed by hands-on practical training. After the training session, each medic performed BEs, in either the subxiphoid (SX) or parasternal (PS) location at his or her discretion, on four healthy volunteers...

Ultrasound (US) is rapid, non-invasive, simple, effective, and presents a viable and practical alternative to conventional radiography (CR) for the Special Forces Medical Sergeant (18D), particularly in the deployed setting. The authors present four cases that illustrate the ability of US used by the 18D to detect fractures in a combat theater. This success invites a debate as to what extent the Special Operations Forces (SOF) community should field US as it demonstrates a number of distinct advantages over the existing gold standard of portable conventional radiography...

This report describes a case of intra-abdominal hemorrhage from body hardening drills in a U.S. soldier during Operation Iraqi Freedom. In body hardening, participants allow themselves to be repeatedly punched and kicked in an effort to impart physical resilience. Portable sonography was used to diagnose hemoperitoneum and to guide the decision for urgent surgical evacuation, ultimately resulting in splenectomy. The case illustrates the risks of body hardening, the medical challenges unique to a prehospital combat environment, and the utility of ultrasound in this setting...

Combat medical care provides unique challenges and opportunities for military medical teams. The austerity of the environment severely limits access to many diagnostic and therapeutic tools. Because of their compact size, handheld ultrasound (US) machines are increasingly being used in these constrained environments. A growing body of literature documents the diagnostic utility of handheld US for trauma encountered in the battlefield. Furthermore, US guidance may assist in the performance of some procedures performed in battlefield medical care...

BACKGROUND: The objective of this retrospective study was to determine the incidence of pulmonary embolism (PE) in casualties of wartime extremity wounds and specifically in casualties with a trauma-associated amputation. METHODS: Records of all combat-wounded evacuated and admitted between March 1, 2003, and December 31, 2007, were retrospectively reviewed. Continuous and categorical variables were studied with the Student's t test, Fisher's exact test or χ² test; multivariate analysis was performed using a stepwise regression logistic model...

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.

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...

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...

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...

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...

OBJECTIVES: The aim of this study was to examine the capability of ultrasound-naïve paramedics to obtain interpretable Focused Assessment With Sonography for Trauma (FAST) images under the remote direction of emergency physicians (EPs). METHODS: Paramedics without experience using ultrasound participated in a 20-minute lecture covering orientation to the ultrasound machine and the FAST examination. The paramedics subsequently performed FAST examinations on a model patient, whereas the EP remained in another room, out of visual contact...

INTRODUCTION: Ultrasound has evolved from a modality that was once exclusively reserved to certain specialities of its current state, in which its portability and durability lend to its broadly increasing applications. OBJECTIVES: This review describes portable ultrasound in the hospital setting and its comparison to gold standard imaging modalities. Also, this review summarizes current literature describing portable ultrasound use in prehospital, austere and remote environments, highlighting successes and barriers to use in these environments...

Nearly all physician specialties currently utilize bedside ultrasound, and its applications continue to expand. Bedside ultrasound is becoming a core skill for physicians; as such, it should be taught during undergraduate medical education. When ultrasound is integrated in a longitudinal manner beginning in the preclerkship phase of medical school, it not only enhances teaching the basic science topics of anatomy, physiology, and pathology but also ties those skills and knowledge to the clerkship phase and medical decision-making...

Prehospital ultrasound use is a relatively new skill set. The military noted the clear advantages of this skill set in the deployed setting and moved forward with teaching their advanced combat trauma medics skills to perform specific examinations. The training curriculum for Special Operations-level clinical ultrasound was created and adapted from training guidelines set forth by the American College of Emergency Physicians with a focus on the examinations relevant to the Special Operations community. Once providers leave the training environment, skill sustainment can be difficult...