Page 37 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars
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                 Background
Point-of-care ultrasound (PoCUS) refers to a sign or symptom-based ultrasonography (US) examination either at the bedside or wherever patients are being treated.1 The use of Po- CUS by nonradiologists is being adopted in prehospital emergency care. It may help health- care professionals of emergency medical services (EMS) to diagnose or rule out potential life-threatening or otherwise harmful conditions.2–4 Prehospital point-of-care ultrasonogra- phy (PHUS) may have an impact on decision-making in prioritizing initial treatment and choosing the most appropriate hospital and mode of transportation.5,6 Besides deploying PHUS for diagnostic purposes, it is used for procedural and therapeutic interventions.
Although the use of PHUS is increasing, its added value is still under debate. In 2010, Jør- gensen was unable to conclude that PHUS improves treatment of trauma patients.5 Five years later, O’Dochartaigh found only moderate evidence to support the use of PHUS in physician-staffed prehospital systems.6 A recent Cochrane review concluded that, at best, abdominal US has no negative impact on mortality and morbidity, although it might reduce ordered computed tomography (CT)-scans.7 Rudolph et al. found that PHUS may improve patient management with respect to diagnosis, treatment, and hospital referral.8 However, they were unable to assess the effect of PHUS on patient outcomes based on the current body of evidence.
The image quality, size, and weight of portable ultrasound devices are improving. Costs for equipment are decreasing while the number of indications for PHUS is increasing. The result is an exponentially growing body of publications, including some narrative reviews, with varying perspectives.9–11
This narrative review is based on relevant papers selected from an extensive search in the Ovid MEDLINE® database (Appendix A). The search produced 2315 hits. We excluded 1932 papers based on their titles and read 383 abstracts to exclude another 232. We included most of the 151 remaining papers based on their relevance to the subject of this review. Further- more, we added additional papers found in the references and from the authors’ personal libraries.
The aim is to present an overview of the literature on PHUS in a civilian emergency (trauma and non-trauma) setting. The first part deals with current PHUS applications structured ac- cording to the familiar airway, breathing, circulation, disability, and exposure/environment (ABCDE) approach.12 The second part will discuss interventions, procedures, challenges, and potential future applications.
ABCDE of prehospital ultrasonography 35
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