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SonoRounds: 5 ways to save a life with ultrasound

Therese Mead, DO, RDMS, FACEP

Paul Goyt, MD

65 M

“Syncope”

53 M

“Collapsed”

30 M

“Fall off

Ladder”

70 F

“Cardiac Arrest”

18 F

“Bicycle

Accident”

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Image courtesy of: Benoit Mortgathttps://commons.wikimedia.org/wiki/File:Bukit_Golf_Course.jpg

65 Male “Syncope”

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AoIVC

VB

>3cm = abnormal

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Some patients are too unstable for CT

Consider bedside US for AAA

Photo credit to: https://www.flickr.com/people/elrolio/

53 Male “Collapsed”

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CPR is ongoing…you’re bagging, but not confident about the ETT…

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CA CA

CA T

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Image credit to: Dr. M Favot, AliEM https://www.aliem.com/2015/03/ultrasound-for-verification-of-endotracheal-tube-location/

Bullet Sign

T

Double Tract Sign

Image credit to: Dr. M. Favot, ALiEM https://www.aliem.com/2015/03/ultrasound-for-verification-of-endotracheal-tube-location/

T

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Image credit to: Dr. M Favot, AliEM https://www.aliem.com/2015/03/ultrasound-for-verification-of-endotracheal-tube-location/

T

Consider airway ultrasound for ETT confirmation

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30 Male “Fall off Ladder”

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ribrib

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rib rib

…back to our case

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Looking for a Pneumo? Use US!

Photo credit to Michael Gil at https://commons.wikimedia.org/wiki/File:Ambulance_Toronto_March_2010.jpg

70 Female “Cardiac Arrest”

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Video courtesy of Dr. Ben Smith

LALV

RV

Video courtesy of Dr. Ben Smith

LV

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Video courtesy of Dr. Ben Smith

Photo credit to Michael Gil at https://commons.wikimedia.org/wiki/File:Ambulance_Toronto_March_2010.jpg

Coding a patient?

Need a quick look echo!

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18 Female “bicycle accident”

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RV

LV

Liver

Kidney

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Spleen

Kidney

Bladder

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Spleen?

Kidney?

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Suboptimal images = indeterminate study

65 M

“Syncope”

53 M

“Collapsed”

30 M

“Fall off

Ladder”

70 F

“Cardiac Arrest”

18 F

“Bicycle

Accident”

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65 M

“AAA”

53 M

“Intubated”

30 M

“PTX”

70 F

“VFib”

18 F

“Spleen”

Some patients are too unstable for CT

Consider bedside US for AAA

Photo credit to: https://www.flickr.com/people/elrolio/

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Consider airway ultrasound for ETT confirmation

Looking for a Pneumo? Use US!

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Photo credit to Michael Gil at https://commons.wikimedia.org/wiki/File:Ambulance_Toronto_March_2010.jpg

Coding a patient?

Need a quick look echo!

Suboptimal images = indeterminate study

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References

Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12:844–849

Chou, E.H., Dickman, E., Tsou, P.Y.,Tessaro, M., Tsai, Y.M., Ma, M.H., Lee, C.C., Marshall, J., Ultrasonography for Confirmation of Endotracheal Tube Placement: A systematic Reviw and Meta-Analysis. Resuscitation. 2015;90:97-103

Favot,M. Ultrasound for Verification of Endotracheal Tube Placement. Academic Life in Emergency Medicine. https://www.aliem.com/2015/03/ultrasound-for-verification-of-endotracheal-tube-location/

Hahn B, Bonhomme K, Finnie J, Adwar S, Lesser M and Hirschorn D. Does a normal screening ultrasound of the abdominal aorta reduce the likelihood of rupture in emergency department patients? 2016. 40(3)398-401.

Li, J. Capnography Alone is Imperfect for Endotracheal Tube Placement Confirmation During Emergency Intubation. J Emerg Med. 2001;20(3):223-229

MacLeod, B.A., Heller, M.B., Garard, J., Yealy, D.M. Menegazzi, J.J., Verification of Endotracheal Tube Placement with Colorimetric End-Tidal CO2 detection. Ann Emerg Med. 1991 Mar;20(3): 267-70

References

Stewart JA. The prohibition on shocking apparent asystole: a history and critique of the argument. Am J Emerg Med. 2008;26:(5)618-22

Varan, A.J., Morrina, J., Civetta, J.M., Clinical Utility of a Colorimetric End-Tidal CO2 detector in Cardiopulmonary Resuscutation and Emergency Intubation. J Clin Monit. 1991, Oct;7(4):289-93

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Thanks for Scanning! You save lives!