Page 210 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

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Chapter 10
expert anesthesiologist or an experienced resident in anesthesiology is available to assist or supervise the EPs while performing their first blocks.
In Chapter 5, we evaluated the performance of ultrasound-guided femoral nerve blocks per- formed by EPs and residents in 64 patients with proximal femoral fractures. They achieved effective pain relief in 69% of the patients after 30 minutes and in 83% after 60 minutes. The EPs were equally satisfied. They were all enthusiastic about the training and evaluated the procedure to be easy (score 8/10), successfully carried out (score 9/10), and of added value to patient care (score 9/10). In conclusion, these blocks were feasible and effective in the ED.
The subjects of this study were included through convenience sampling. No power calcula- tion was performed before data collection started because the introduction of UGRA in the ED was evaluated after a certain time frame.
No adverse events occurred in this series of 64 patients. It may suggest that the performance of these US-guided nerve blocks by emergency physicians can be performed safely. However, with an extremely low incidence of adverse effects (intravascular injection, or neurologic damage) a much larger study should be performed in order to come to a definite conclusion regarding the safety of these procedures by nonanesthesiologists.
In the meantime, this training has been adopted and developed further by the Dutch Asso- ciation for Regional Anesthesia (DARA) in collaboration with DEUS Ultrasound Courses and many more Dutch emergency physicians and residents have been and will be trained in UGRA.
In Part III, we focused on the impact of three ultrasound applications on prehospital patient care in the Nijmegen HEMS: ultrasonography of the chest, abdomen, and during cardiopul- monary resuscitation.
In Chapter 6, we presented a retrospective evaluation of 326 prehospital chest ultrasonogra- phy scans in 281 patients treated by the Nijmegen HEMS over a four-year period. We diag- nosed a pneumothorax in 25 patients (9%), and a hemothorax in two patients (1%). Pulmo- nary contusion was only reported in two patients (1%). Based on PHUS, treatment changes were made in 60 patients (21%). Significant changes were: withholding a tube thoracostomy (n = 10 [4%]), while in three (1%) patients a tube thoracostomy was performed. Other changes concerned the patient destination for definitive treatment (n = 10 [4%]), and the termination of resuscitation (n = 9 [3%]).
The data on ten years of prehospital abdominal ultrasonography in critically ill and trauma