Pre-hospital assessment with ultrasound in emergencies: implementation in the field  

作　　者：Kevin P. Rooney Sari Lahham Shadi Lahham Craig L. Anderson Bryan Bledsoe Bryan Sloane Linda Joseph Megan B. Osborn John C. Fox 

机构地区：[1]Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan 48202, USA [2]Emergency Medicine, University of California, Irvine, Orange, California 92868, USA [3]Emergency Medicine, University of Nevada School of Medicine, Las Vegas, Nevada 89102, USA

出　　处：《World Journal of Emergency Medicine》2016年第2期117-123,共7页世界急诊医学杂志（英文）

摘　　要：BACKGROUND: Point-of-care ultrasound(US) is a proven diagnostic imaging tool in the emergency department(ED). Modern US devices are now more compact, affordable and portable, which has led to increased usage in austere environments. However, studies supporting the use of US in the prehospital setting are limited. The primary outcome of this pilot study was to determine if paramedics could perform cardiac ultrasound in the fi eld and obtain images that were adequate for interpretation. A secondary outcome was whether paramedics could correctly identify cardiac activity or the lack thereof in cardiac arrest patients.METHODS: We performed a prospective educational study using a convenience sample of professional paramedics without ultrasound experience. Eligible paramedics participated in a 3-hour session on point-of-care US. The paramedics then used US during emergency calls and saved the scans for possible cardiac complaints including: chest pain, dyspnea, loss of consciousness, trauma, or cardiac arrest.RESULTS: Four paramedics from two distinct fire stations enrolled a total of 19 unique patients, of whom 17 were deemed adequate for clinical decision making(89%, 95%CI 67%–99%). Paramedics accurately recorded 17 cases of cardiac activity(100%, 95%CI 84%–100%) and 2 cases of cardiac standstill(100%, 95%CI 22%–100%).CONCLUSION: Our pilot study suggests that with minimal training, paramedics can use US to obtain cardiac images that are adequate for interpretation and diagnose cardiac standstill. Further large-scale clinical trials are needed to determine if prehospital US can be used to guide care for patients with cardiac complaints.BACKGROUND： Point-of-care ultrasound （US） is a proven diagnostic imaging tool in the emergency department （ED）. Modern US devices are now more compact, affordable and portable, which has led to increased usage in austere environments. However, studies supporting the use of US in the prehospital setting are limited. The primary outcome of this pilot study was to determine if paramedics could perform cardiac ultrasound in the field and obtain images that were adequate for interpretation. A secondary outcome was whether paramedics could correctly identify cardiac activity or the lack thereof in cardiac arrest patients. METHODS： We performed a prospective educational study using a convenience sample of professional paramedics without ultrasound experience. Eligible paramedics participated in a 3-hour session on point-of-care US. The paramedics then used US during emergency calls and saved the scans for possible cardiac complaints including： chest pain, dyspnea, loss of consciousness, trauma, or cardiac arrest. RESULTS： Four paramedics from two distinct fire stations enrolled a total of 19 unique patients, of whom 17 were deemed adequate for clinical decision making （89%, 95%C/67%-99%）. Paramedics accurately recorded 17 cases of cardiac activity （100%, 95%C/84%-100%） and 2 cases of cardiac standstill （100%, 95%C/22%-100%）. CONCLUSION： Our pilot study suggests that with minimal training, paramedics can use US to obtain cardiac images that are adequate for interpretation and diagnose cardiac standstill. Further large-scale clinical trials are needed to determine if prehospital US can be used to guide care for patients with cardiac complaints.

关 键 词：Prehospital ultrasound Cardiac ultrasound Emergency ultrasound 

分 类 号：R472.2[医药卫生—急诊医学]