Page 144 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

Change in treatment decision
Trauma patient
Primary CPR
Total
142
Chapter 6
The HEMS physicians stated that treatment decisions changed in 60 cases (21%) due to in- formation obtained by the US examination. In 9 of 60 patients, the physician decided to stop all treatment based on the US imaging of the heart. The strategy towards administering intravascular fluids changed in 6 patients. In total, 24 chest tubes were inserted. The decision to insert a chest tube or, on the other hand, to refrain from inserting one changed in 13 cases. Of the 15 false-negative US examinations for pneumothorax, no decision to insert a chest tube before (or after) US was made.
In 10 cases, the destination hospital changed. The destination changed more often to a low- er-level hospital than to a Level I trauma center. The relative number of treatment decision changes does not differ between years in our study. All changes are displayed in Table 6.4.
Table 6.4 Change in treatment decisions as a result of ultrasound examination
Cardiac
Initiate inotropic medication Stop resuscitation
More intravascular fluids Less intravascular fluids
Pulmonary
Reposition endotracheal tube Refrain from inserting a chest tube Insert chest tube
Other
Change destination
to a hospital (instead of none) to a lower level hospital
to a level 1 trauma center
Transport
No physician needed Not by helicopter
Order preparations
Prepare operating room
Prepare blood transfusion at ED Personal call to trauma surgeon
Total
2 (3) 4 (7) 2 (3) 4 (7)
1 (2) 10 (17) 3 (5)
10 (17) 1
6
3
4 (7) 3
1
4 (7) 2
1
1
– 5 (8) – –
– – –
–
– –
2 (3) 9 (15) 2 (3) 4 (7)
1 (2) 10 (17) 3 (5)
10 (17) 1
6
3
4 (7) 3
1
4 (7) 2
1
1 60
Percentages of the total number of changes in parentheses; dash, no occurrences. CPR, cardiopulmonary resuscitation; ED, emergency department