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Katarzyna Kasia Hampton, William N Vasios, Paul E Loos
Point-of-care ultrasonography has been recognized as a relevant and versatile tool in Special Operations Forces (SOF) medicine. The Special Operator Level Clinical Ultrasound (SOLCUS) program has been developed specifically for SOF Medics. A number of challenges, including skill sustainment, high-volume training, and quality assurance, have been identified. Potential solutions, including changes to content delivery methods and application of tele-ultrasound, are described in this article. Given the shift in operational context toward extended care in austere environments, a curriculum adjustment for the SOLCUS program is also proposed...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Lauren Oliveira, Matthew Lawrence
BACKGROUND: Peripheral intravenous (PIV) access is a common procedure in the emergency department (ED). However, conditions such as obesity and hypovolemia can often make access difficult by the traditional landmark technique. The use of ultrasonography has improved the success of PIV placement in this setting. OBJECTIVES: A novel Ultrasound (US)-Guided PIV Access program was initiated in our ED to train emergency nurses, U.S. Navy corpsmen, and physicians. METHODS: This was an observational study of emergency providers performing US-guided PIV placement...
March 2016: Military Medicine
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...
2015: Critical Care: the Official Journal of the Critical Care Forum
Changsun Kim, Bo Seung Kang, Hyuk Joong Choi, Tae Ho Lim, Jaehoon Oh, Youngjoon Chee
PURPOSE: We investigated the effectiveness of tele-mentored ultrasonography between emergency medicine (EM) residents and remote experts in diagnosing acute appendicitis. METHODS: This prospective observational study was performed in an academic emergency department. Beginning in June 2014, the EM residents performed the initial ultrasonography for suspected pediatric acute appendicitis; then, the remote experts observed/mentored the residents' practice using the tele-ultrasonography system; and finally, an onsite expert verified the diagnosis...
October 2015: American 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)...
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
N Cazes, F Desmots, Y Geffroy, A Renard, J Leyral, K Chaumoître
PURPOSE: To evaluate the feasibility of "accelerated" training for military doctors in front line ultrasound. To establish the number of ultrasounds required to validate the doctor's training. To assess the average acquisition time for each ultrasound target. MATERIALS AND METHODS: Prospective study on 10 novice generalist military doctors to assess training for five urgent ultrasound targets: focused assessment with sonography in trauma (FAST), pleura, bladder, abdominal aorta and gallbladder...
November 2013: Diagnostic and Interventional Imaging
Stephanie Hightower, Eric J Chin, Jason D Heiner
Increases in intracranial pressure (ICP) may damage the brain by compression of its structures or restriction of its blood flow, and medical providers my encounter elevated ICP in conventional and non-conventional medical settings. Early identification of elevated ICP is critical to ensuring timely and appropriate management. However, few diagnostic methods are available for detecting increased ICP in an acutely ill patient, which can be performed quickly and noninvasively at the bedside. The optic nerve sheath is a continuation of the dura mater of the central nervous system and can be viewed by ocular ultrasound...
2012: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Timothy Nydam, Steve Tanksley
Incorporation of point-of-care ultrasound into the skill set of Special Operations medical providers should come with an appreciation of the potential limitations of the technology. We present a case of a U.S. Army Special Forces Soldier who suffered traumatic monocular vision loss after being struck in the eye during a combatives tournament. Evaluation in the emergency department (ED) included an unremarkable ocular ultrasound, despite a high clinical suspicion of intraocular pathology. Ophthalmologic consultation was obtained emergently...
2013: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
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
Christofer A Strode, Bernard J Rubal, Robert T Gerhardt, Frank L Christopher, James R Bulgrin, E Sterling Kinkler, Terry D Bauch, Sheri Y N Boyd
OBJECTIVES: Focused assessment with sonography in trauma (FAST) can define life-threatening injuries in austere settings with remote real-time review by experienced physicians. This study evaluates vest-mounted microwave, satellite, and LifeLink communications technology for image clarity and diagnostic accuracy during remote transmission of FAST examinations. METHODS: Using a SonoSite, FAST was obtained on three patients with pericardial and intraperitoneal effusions and two control subjects in a remotely located U...
December 2003: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
David M Stamilio, Tamara McReynolds, Joseph Endrizzi, Robert C Lyons
This case report describes a novel diagnostic approach for ectopic pregnancy in a combat environment. We diagnosed a ruptured ectopic pregnancy at our combat support hospital by using the SonoSite 180 Plus ultrasound device (SonoSite, Bothell, WA). The live ectopic pregnancy was immediately identified and the entire pelvic anatomy was easily assessed within 5 minutes. The SonoSite ultrasound device proved to be easy to use, durable, and reliable. It produced high-quality images in a variety of applications...
September 2004: Military Medicine
Thomas A Rozanski, Jeffrey M Edmondson, Sheila B Jones
Military medical units must be flexible and mobile to keep up with maneuver units on the modern battlefield. The requirements for unit mobility and maneuverability preclude bulky advanced radiologic imaging support, such as computed tomography or magnetic resonance imaging systems. Portable sonography is rapid, reliable, efficient, and user-friendly; it markedly expanded the diagnostic capability of our forward-deployed combat support hospital during Operation Iraqi Freedom. More than 400 ultrasound studies were performed during the first 6 months of hospital operations in Iraq...
February 2005: Military Medicine
2015-06-09 14:24:29
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