Page 58 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars
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Chapter 2
Interventions
Hereabove, many diagnostic applications of PHUS have been discussed. Besides its diagnos- tic applications, PHUS has been shown to be potentially valuable guiding interventions or as a therapeutic intervention in its own right.
Interventions – Airway
Emergency percutaneous cricothyrotomy may be unsuccessful or produce a tear in the pos- terior tracheal wall. Siddiqui et al. compared anatomical orientation by either digital pal- pation or US for performing a percutaneous cricothyrotomy with the Portex® device. In cadavers in which palpation of the cricothyroid ligament is difficult, US increased the prob- ability of a correct device insertion by 5.6 times and reduced the incidence of laryngeal and tracheal injury from 100% to 33%. A possible disadvantage of US may be the prolonged time to airway insertion.105
In the emergency prehospital setting the open cricothyroidotomy is the preferred approach in invasive airway management. Whether a US-guided percutaneous technique should be used in an emergency at all, is a matter of debate. Nevertheless, Curtis et al. found a US-guid- ed bougie-assisted open cricothyroidotomy to be a rapid and reliable technique. Cricothy- roidotomy was successful in 20 of 21 cadavers, with a median time to completion of 26.2 s.106
Interventions – Breathing
Medical patients with severe symptomatic pleural effusion might require early pleural as- piration in the prehospital setting. Pleural US is useful in the diagnosis and localization of fluid. US-guided thoracentesis is a safer and more effective method to relieve symptoms than a blind approach.107,108
Interventions - Circulation
To guide interventions, PHUS is most frequently used for (central) venous access. It was the second most used PHUS application overall (after assessment of blunt abdominal trauma) in an Australian retrieval team.47 Intraosseous access is the most appropriate approach in time-critical emergencies. However, for less urgent but difficult to obtain peripheral intra- venous access, US-guidance is faster and more effective than traditional catheter insertion.109
 Symptomatic pericardial effusion might need prompt treatment in the prehospital setting.
 






















































































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