Page 27 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

gency department.
To have a better understanding of how emergency physicians experience the implementation of ultrasonography after having received an emergency ultrasonography training, we con- ducted interviews in Dutch emergency physicians who successfully completed the two-day PREP course as discussed above. The focus was on the incentives to start using ultrasonog- raphy, on its practical application, and on the challenges the emergency physicians may have met in the implementation process. In Chapter 4, the results of this qualitative study will be discussed.
HEMS physicians collaborated with emergency physicians and emergency medicine resi- dents to introduce ultrasonography in the emergency department and to develop a training in ultrasound-guided regional anesthesia. In Chapter 5, we describe the implementation and performance of ultrasound-guided femoral nerve blocks by emergency physicians and residents in patients with proximal femoral fractures.
After having focused on the background of emergency and prehospital ultrasonography and on implementation in the emergency department, the next part will focus on ultrasonogra- phy in the Nijmegen HEMS. In Part III, we will focus on the impact of PHUS on the treat- ment of both critically ill and injured patients by the Nijmegen HEMS.
As discussed above, the classic physical examination of both critically ill and injured patients may be challenging in prehospital and emergency medicine. Depending on the diagnosis, for instance pneumothorax or hemothorax, its diagnostic accuracy can be disappointing.10–12
Chapter 6 describes a retrospective evaluation of prehospital chest ultrasonography in 281 patients treated by the Nijmegen HEMS over a four-year period. We focus on the impact of chest ultrasonography on the care for prehospital patients.
The value of physical examination alone in the evaluation of blunt abdominal trauma is also limited.26 To evaluate the impact of prehospital abdominal ultrasonography on pa- tients treated by the Nijmegen HEMS, we conducted a retrospective database analysis. In Chapter 7, we describe the analysis of the management of 1583 patients that were treated in a 10-year period. The aim was to determine the accuracy of abdominal PHUS and its impact on treatment decisions.
Echocardiography is widely regarded as a valuable adjunct to the cardiopulmonary resusci- tation of critically ill or injured patients.27 It improves the diagnostic accuracy of treatable causes of cardiac arrest compared to physical examination alone.28,29 We performed an obser-
Introduction, aims, and outline of this thesis 25
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