Page 62 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

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Chapter 2
Future applications
Sonothrombolysis
As we have discussed in the interventions section, early prehospital sonothrombolysis in ischemic stroke patients might be safe and effective. The CLOTBUST investigators have developed a hands-free headframe containing 18 ultrasound transducers positioned at the temporal occipital bone windows to deliver operator-independent ultrasound energy direct- ly to the culprit clot. It was successfully applied to and well tolerated by 15 volunteers and is currently evaluated in stroke patients.136 It may facilitate and enhance early thrombolysis because of its portability and that no formal ultrasound training is needed.
Telemedicine
With improving data communication technologies, telemedicine is a promising technique for remotely evaluating ultrasound clips acquired by less-experienced operators. They might even be coached in real-time supported by remotely operating the ultrasound device settings in complex scenarios.137 Kolbe introduced a PoCUS curriculum in a one-room medical clinic in rural Nicaragua. Despite limited resources, after the first introduction the ultrasound instructors used telemedicine to remotely view the ultrasound images in real-time.138 In 2016, Kirkpatrick demonstrated the feasibility of remotely telementoring ultrasound-naïve fire-fighters using trauma ultrasound for free-fluid detection on a phantom.137 Remote tele- mentored ultrasound was feasible to coach untrained and inexperienced nurse practitioners to assess patients for pneumothorax immediately after removal of their tube thoracostomy.139 Rubin demonstrated the feasibility of remote review and interpretation of TCD and carotid ultrasound data in healthy volunteers dubbed teleneurosonology.140
Integrating telemedicine concepts in PoCUS-enhanced disaster triage might be promising and feasible in the light of progressing technological advancements.
Wearable US
Mierzwa developed a flat and flexible 5 MHz US probe designed to wear on a fingertip to aid in US-guided vascular access, for instance. The device can be configured as a linear or curvi- linear transducer array and it can be mounted directly onto the body as an adhesive patch or wearable device. They speculate on many applications such as point-of-care imaging, combat casualty care, ultrasound therapy, and patient monitoring.141 A specific prehospital applica- tion might also be a US patch for continuous cardiac visualization during cardiopulmonary