Page 208 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

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Chapter 10
ternatively, a curved-array abdominal transducer has been chosen for all-round use by other Dutch HEMS. There is growing interest in new indications for prehospital ultrasonography, many of which would require a linear-array transducer that is necessary for imaging super- ficial anatomical structures. Moreover, due to the superficial anatomical structures that will be visualized in lung ultrasonography we hypothesized that this transducer might be prefer- able for this purpose.
In Chapter 3, three ultrasound transducers were compared for the diagnosis of pneumo- thorax. In patients scheduled for thoracoscopic lung surgery, we recorded ultrasound video clips before and after the surgeon opened the chest, creating a pneumothorax. These clips were blinded for the transducer type and were evaluated by prehospital HEMS physicians and experienced anesthesiology residents, all with experience in lung ultrasonography. The main findings were that these observers could detect pneumothorax with similar accuracy, regardless of the transducer type. The speed of the diagnosis and perceived image quality were best in the linear-array transducer clips, although the modest time gain probably has no clinical significance. The linear-array transducer’s superior image quality, however, might be of benefit in the diagnostic workup of critically ill and injured patients in the dynamic prehospital environment.
Nevertheless, to be able to make the right diagnosis and initiate proper treatment it is im- portant to focus on producing images that are accurate for their intended purpose rather than images that have great image quality. This was discussed by Fryback and Thornbury.1
The next question that must be answered is how these findings translate to the diagnostic work-up in real-world patients in the prehospital environment.
In Part II, two instances regarding the use of ultrasonography in the emergency department were highlighted.
We conducted semi-structured interviews with eight Dutch emergency physicians (EPs) to gain insight into how they implemented ultrasound in their emergency departments (EDs). At that time, in the Netherlands, no guidelines on ED-implementation, nor reports on the topic existed. We used convenience sampling and requested the PREP course venue to con- tact EPs employed by Level 2 trauma centers and who completed the two-day course 1–4 years prior to the interviews. Data saturation occurred after eight interviews. The aim of this qualitative study was to explore individual experiences of Dutch PREP-trained EPs who started routinely using US in their EDs.
The PREP course is discussed in more detail in the introduction of this thesis and the paper