Page 108 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars
P. 108

Chapter 4
pose they find it difficult to draw conclusions from their ultrasound images. That is the hardest part of it, I suppose, because just putting a transducer on somebody is easy!” (p.5)
Multiple participants said every EP should be proficient in emergency US.
“I wanted to sign up for the course because I feel that being an EP means you must be able to do an emergency US examination. And that’s very important.” (p.7)
“I brought up the subject again at our latest meeting. I believe the other consultants should be able to count on us to all have equal high standards and skills.” (p.5)
ŠŠPractical application for US
ঌ Indication for application of the PREP protocol
Some participants felt that US is not always indicated in a patient that sustained high-ener- gy trauma and that it’s more important to let the clinical picture prevail:
“ATLS dictates: assess the patient and based on the clinical picture a US examination is done.” (p.2)
Conversely, participants told that US examinations are performed on patients with minor injury without much pain. It is then regarded as an opportunity to practice US skills, with- out an obvious indication. In fact, this opportunity was regarded as a separate indication. Other reported indications were abdominal pain, cardiovascular instability, distracting in- jury, intoxication, and undifferentiated shock.
One participant only performed US examinations in patients with a low probability of seri- ous injury. In every other case, the radiologist was consulted.
“The bottom line is that on the patients with low suspicion (...) from whom you expect no real injury (...) those cases we use the US on.” (p.1)
ঌ Application of US beyond the scope of the PREP protocol
Several participants describe the PREP course as a stepping stone to start with US in the ED. They were excited about the different US applications they discovered after having com- pleted the course. Deep venous thrombosis (DVT), hypotension, intravenous access, regional anesthesia, hydronephrosis, kidney and gallstones, foreign bodies, Achilles tendon rupture, fracture position (after repositioning), and inferior vena cava (IVC) measurements for vol-

   106   107   108   109   110