Page 63 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars
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                 resuscitation.
Assessment of intraosseous needle position
Tsung demonstrated the feasibility of US to determine the location of an intraosseous needle in six resuscitation cases. He argues that every intraosseous access should be verified with color doppler because a correct position cannot be accurately confirmed by the aspiration of blood, blood on the stylet tip, the needle being firmly in place, or the absence of soft tissue extravasation.142
Predicting outcomes in resuscitative thoracotomy (RT)
In some countries, a prehospital or ED resuscitative thoracotomy (RT) is performed on pa- tients with a penetrating (sometimes also blunt) thoracic injury decompensating into car- diac arrest. The goal is to treat a cardiac tamponade, major injuries of the heart, control intrathoracic bleeding, clamp the thoracic aorta, or perform direct cardiac massage or de- fibrillation. The RT is an invasive and last-resort treatment. Inaba found that FoCUS was a predictor of futile care in these patients.143 In 187 RT patients only six survived and three were eligible organ donors. All survivors and organ donors had visible cardiac motion before RT was performed. If no cardiac motion or pericardial effusion on US was observed the survival was zero. Thus, utilizing US would have avoided a considerable number of RTs that were ultimately futile.143 Because of these findings, PHUS would be a valuable addition to prehospital RT protocols.
US-guided cannulation for extracorporeal life support (ECLS)
Lamhaut concluded in 2013 that prehospital implementation of ECLS by non-surgeons was safe and feasible.144 Four years later their group described a case of ECLS cannulation in the Louvre museum in Paris in which they used a hybrid surgical/Seldinger technique.145,146 Another future PHUS application might be US-guided percutaneous ECLS cannulation that may be easier, faster, and less invasive. It could be complemented by (contrast enhanced) echocardiography to verify correct placement of the venous catheter tip.147,148
ABCDE of prehospital ultrasonography 61
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