Page 215 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

Thirdly, every Dutch emergency physician should be trained in basic eFAST/PREP ultra- sonography and every emergency department should at least have access to an ultrasound machine. Fortunately, in recent years basic ultrasonography has become an integral part of the training curriculum for emergency physicians. However, EPs should make an effort to perform diagnostic and procedural ultrasonography as often as possible to gain experience, maintain their skills, and expand their repertoire of indications. It would be recommendable to keep record of these procedures for certification purposes.
HEMS physicians, among others, should exercise caution in the event of a negative abdomi- nal PHUS. They should be vigilant in blunt abdominal trauma patients, especially when they are scanned shortly after the incident or if physical examination or vital signs are abnormal. A repeated examination—on-scene or during transport—is recommended. The same advice is valid for EPs, but they should probably maintain a low threshold to request a CT scan.
In this thesis, the impact of prehospital ultrasonography on prehospital CPR in the Nijmegen HEMS was discussed. In many patients, it changed or supported the decision to terminate or continue resuscitation. In larger future studies with improved study design, the impact on prehospital—and in-hospital—resuscitation should be evaluated more precisely. Validity, reliability and generalizability must be better. Also, it would be commendable to evaluate other outcome parameters including morbidity and mortality in a larger, multicenter, pop- ulation.
In anticipation of these studies and technological improvements, it could already be spec- ulated that (prehospital) focused cardiac ultrasonography will play a more prominent role in the conduct of advanced life support (ALS). It will be beneficial to detect potentially treatable causes of cardiac arrest such as cardiac tamponade, pulmonary embolism, tension pneumothorax, severe hypovolemia (of any cause), and intra-abdominal bleed. Furthermore, ultrasonography will prove to be useful in the early detection of the return of spontaneous circulation (ROSC).
Maybe even, ultrasonography might someday earn its place in the so-called chain of survival... The chain of survival concept has evolved through decades of research in sudden cardiac arrest.5 It consists of (1) early access—to activate the emergency medical services; (2) early basic life support (BLS)—to slow the rate of deterioration of the brain and heart, and buy time to enable defibrillation; (3) early defibril’lation—to restore a perfusing rhythm; (4) post resuscitation care—to stabilize the patient. For the time being, we provisionally added the fifth element—echocardiography—to the chain (Figure 10.1).
Summary, discussion, and future perspective 213
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