[How should anesthesiologists perform ultrasound examinations? Diagnostic use of ultrasound in emergency and intensive care and medicine]

[Introduction of Prehospital Emergency Ultrasound into an Emergency Medical Service Area]

BACKGROUND

Emergency ultrasound as part of the provision of emergency medical services using mobile devices offers great benefits regarding to some important questions related to the management of critically ill and injured patients in the prehospital situation where diagnostic resources are limited. The aim of this study is to determine whether the comprehensive introduction of prehospital emergency ultrasound examinations into a German Emergency Medical Services ("rescue services") area is both feasible and beneficial for patients.

METHODS

All emergency physicians at a rural emergency physician base were trained in emergency ultrasound scanning techniques (FAST, FEEL, 14 h of instruction), followed by regular weekly training sessions of approximately 30 min. Over a period of 12 months, prehospital ultrasound examinations performed during emergency physician callouts at this base were documented and analysed.

RESULTS

A total of 87 emergency ultrasound examinations were performed during 1343 callouts. Among these, focussed assessment with sonography for trauma (FAST) was performed in 35 patients (40.2%) and focused echocardiography in emergency life support (FEEL) in 41 patients (47.1%). In 11 patients (12.6%), ultrasound scans were performed for other indications (e. g. to rule out urinary tract obstruction in a case of flank pain). One trauma patient's life was saved by the decision to transport him to the nearest hospital and once there directly to the operating room, based on the ultrasound finding of significant free intra-abdominal fluid (ruptured spleen and liver).

CONCLUSION

Prehospital emergency ultrasound can be introduced into an emergency medical service area as a diagnostic modality that provides benefits to patients. Emergency physicians have to be specifically trained and to participate in continuous education activities. Especially in rural areas with longer transport routes and journey times, the early diagnosis of for example massive intra-abdominal bleeding is critical for the patient's prognosis.

Holistic ultrasound in trauma: An update

Holistic ultrasound is a total body examination using an ultrasound device aiming to achieve immediate patient care and decision making. In the setting of trauma, it is one of the most fundamental components of care of the injured patients. Ground-breaking imaging software allows physicians to examine various organs thoroughly, recognize imaging signs early, and potentially foresee the onset or the possible outcome of certain types of injuries. Holistic ultrasound can be performed on a routine basis at the bedside of the patients, at admission and during the perioperative period. Trauma care physicians should be aware of the diagnostic and guidance benefits of ultrasound and should receive appropriate training for the optimal management of their patients. In this paper, the findings of holistic ultrasound in trauma patients are presented, with emphasis on the lungs, heart, cerebral circulation, abdomen, and airway. Additionally, the benefits of ultrasound imaging in interventional anaesthesia techniques such as ultrasound-guided peripheral nerve blocks and central vein catheterization are described.