Page 28 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

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Chapter 1
vational study on prehospital echocardiography during the cardiopulmonary resuscitation of 56 patients treated by the Nijmegen HEMS. We focused on the impact of echocardiography on treatment decisions. The results are discussed in Chapter 8.
In Part IV, the attention will be directed to the future of prehospital ultrasonography.
Sonographic measurement of the optical nerve sheath diameter (ONSD) is an example of a PHUS application that still is waiting to conquer a solid position in prehospital emergency medicine. In patients suffering from traumatic brain injury (TBI), the intracranial pressure (ICP) may be elevated, often caused by swelling of the brain parenchyma or by space-occu- pying intracranial hematomas. An ICP elevation may also be caused by an impairment of venous drainage from the intracranial space, for instance because of a tightly applied rigid cervical collar. An elevated ICP manifests itself in many ways, but one of them is an in- crease in the ONSD.30 In a collaboration with dr. Maissan from the Rotterdam ErasmusMC and Lifeliner 2 HEMS station, we conducted repeated sonographic ONSD measurements in healthy volunteers. Between measurements, blinded to the researchers, they were randomly donned a rigid cervical collar, to evaluate the impact of this collar on intracranial venous drainage and possibly on the ICP and thus ONSD in healthy subjects. This study and its main findings are discussed in Chapter 9.
Chapter 10 provides a summary of the conclusions of this thesis, discussion and future per- spective; Chapter 11 provides a summary of the conclusions, discussion and future perspec- tive in Dutch.