Page 213 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

Conclusions of this thesis
1. A linear-array transducer is preferable for nonradiologists who perform lung ultraso- nography for the diagnosis of pneumothorax. Its diagnostic accuracy for pneumothorax is similar to other transducers. However, the diagnosis is made slightly faster and it yields the best image quality.
2. Dutch emergency physicians have met challenges implementing ultrasonography in their emergency departments because of a lack of: incentives to start, confidence in their skills, ultrasound devices, or sufficient cooperation with radiologists. In present day, however, most of these hurdles have been overcome.
3. The Nijmegen emergency physicians and emergency medicine residents have successful- ly implemented ultrasound-guided regional anesthesia. In the emergency department, they now use ultrasound-guided regional anesthesia to achieve effective pain relief in patients with proximal femoral fractures.
4. Chest ultrasonography in the Nijmegen Helicopter Emergency Medical Service impacts treatment in 21% of patients. Most importantly, it has led to decisions to abstain from tube thoracostomies and it has impacted the mode and destination of patient transport for definitive treatment.
5. Abdominal ultrasonography in the Nijmegen Helicopter Emergency Medical Service impacts treatment in 12.6% of the patients. Most frequently, it allows the Helicopter Emergency Medical Service team to provide the destination hospital with additional relevant information to consider in their preparation. We found low sensitivity for free intraperitoneal fluid. This suggests that a negative abdominal ultrasound scan should al- ways be interpreted in perspective to the clinical assessment of the patient and warrants repeated ultrasound scans in selected cases.
6. Focused echocardiography during cardiopulmonary resuscitation in the Nijmegen He- licopter Emergency Medical Service impacts treatment in 88% of the patients. Most frequently, it supports the decision to terminate the resuscitation.
7. Sonographic measurement of the optic nerve sheath diameter is feasible in healthy sub- jects and shows an increase in diameter if a rigid cervical collar is applied.
Summary, discussion, and future perspective 211
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