Page 26 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

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Chapter 1
Aims and outline of this thesis
Aims
The main aim of this thesis is to explore the impact of ultrasonography in prehospital and emergency medicine.
The first objective is to discuss the current state of literature and evaluate a selection of transducers. The second is to evaluate the implementation and utility of ultrasonography in the ED, in the HEMS, and in the future, and how it impacts the care for both critically ill and injured patients.
Outline
This thesis describes the results of the studies conducted to investigate the implementation, impact, and utility of ultrasonography in prehospital and emergency medicine.
In Part I, we will focus on the background of emergency and prehospital ultrasonography. The aim is to learn from existing knowledge and from existing technology.
In Chapter 2, a narrative review of the literature on prehospital ultrasonography is present- ed. The aim will be to focus on current and future applications of prehospital ultrasonogra- phy, both for diagnostic and therapeutic use. We will highlight ultrasound applications in the emergency department and in other settings such as clinical, military, and wilderness medicine, that also appear to be feasible for future prehospital use. Also, we will highlight some of the pitfalls of prehospital ultrasonography.
Since the introduction of PHUS to the Nijmegen HEMS, we primarily used a 5–1 MHz phased-array cardiac transducer. With a growing interest in new indications for prehospi- tal ultrasonography, the need for applications for the linear-array transducer was also in- creased. In Chapter 3, we describe the difference in performance of three types of ultra- sound transducers for the detection of pneumothorax. We recorded ultrasound video clips in pneumothorax patients (i.e. thoracoscopy patients). The clips were blinded for diagnosis and transducer type and were evaluated by prehospital HEMS physicians and experienced anesthesiology residents. Outcomes are the diagnostic accuracy, speed until final diagnosis, and image quality.
In Part II, we will highlight aspects of the implementation of ultrasonography in the emer-