ClinicalTrials.gov; No.: NCT01654887; URL: www.clinicaltrials.gov.

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

Background/Objectives Pain is universal, undertreated, and impedes recovery in hip fracture. This study compared outcomes for regional nerve blocks to standard analgesics following hip fracture. Design Multi-site randomized controlled trial from 4/2009-3/2013. Setting 3 New York hospitals. Participants 161 hip fracture patients. Intervention 79 patients were randomized to receive an ultrasound-guided single injection femoral nerve block administered by emergency physicians at emergency department admission followed by placement of a continuous fascia iliaca block by anesthesiologists within 24 hours. 82 control patients received conventional analgesics. Measurements Pain (0-10 scale), distance walked on post-operative day (POD) 3, Walking ability at 6 weeks following discharge, opioid side effects. Results Pain scores 2 hours following emergency department presentation favored the intervention group compared to controls (3.5 versus 5.3 respectively, P=.002). Pain scores on POD 3 were significantly better for the intervention as compared to the control group for pain at rest (2.9 versus 3.8, p=.005), with transfers out of bed (4.7 versus 5.9, p=.005), and with walking (4.1 versus 4.8, p=.002). Intervention patients walked significantly further than controls in 2 minutes on POD 3 (170.6 feet (95% CI 109.3, 232) versus 100.0 feet (95% CI 65.1, 134.9) respectively. P=.041). At 6 weeks, intervention patients reported better walking and stair climbing ability (mean FIM locomotion scores of 10.3 (95% CI 9.6, 11.0) versus 9.1 (95% CI 8.2, 10.0), P=0.045. Intervention patients reported significantly fewer opioid side effects (3% versus 12.4%, P=.028) and required 33-40% fewer parenteral morphine sulfate equivalents. Conclusion Femoral nerve blocks performed by emergency physicians followed by continuous fascia iliaca blocks placed by anesthesiologists are feasible and result in superior outcomes.

Objectives: The objective was to determine if 9-1-1 paramedics trained in ultrasound (US) could adequately perform and interpret the Focused Assessment Sonography in Trauma (FAST) and the abdominal aortic (AA) exams in the prehospital care environment.Methods: Paramedics at two emergency medical services (EMS) agencies received a 6-hour training program in US with ongoing refresher education. Paramedics collected US in the field using a prospective convenience methodology. All US were performed in the ambulance without scene delay. US exams were reviewed in a blinded fashion by an emergency sonographer physician overreader (PO).Results: A total of 104 patients had an US performed between January 1, 2008, and January 1, 2009. Twenty AA exams were performed and all were interpreted as negative by the paramedics and the PO. Paramedics were unable to obtain adequate images in 7.7% (8 ⁄ 104) of the patients. Eighty-four patients had the FAST exam performed. Six exams (6 ⁄ 84, 7.1%) were read as positive for free intraperitoneal ⁄ pericardial fluid by both the paramedics and the PO. FAST and AA US exam interpretation by the paramedics had a 100% proportion of agreement with the PO.Conclusions: This pilot study shows that with close supervision, paramedics can adequately obtain and interpret prehospital FAST and AA US images under protocol. These results support a growing body of literature that indicates US may be feasible and useful in the prehospital setting. ACADEMIC EMERGENCY MEDICINE2010; 17:624-630 ª 2010 by the Society for Academic Emergency MedicineKeywords: prehospital ultrasound, paramedic ultrasound, trauma care, and ultrasound P oint-of-care (POC) ultrasound (US) has significantly increased in use over the past 20 years. [1][2][3] Multiple studies have shown the efficacy and efficiency of POC US. Some studies have demonstrated improved morbidity and mortality outcomes.3-5 The use of POC US in the prehospital setting is a relatively new application of this medical technology. Small studies have shown utility in military, ground, and helicopter emergency medical services (EMS) in both Europe and the United States. [5][6][7][8][9][10][11][12][13][14][15][16][17] These studies have largely concentrated on US use for trauma evaluation and involve the application of the Focused Assessment Sonography for Trauma (FAST) or an extended FAST examination. Prehospital US use has been more fully described in Germany, France, and Italy than in the United States.

The use of ultrasound has revolutionized the way in which many acute injuries and conditions are managed in emergency department and critical care areas in hospitals. Emergency departments nationwide are outfitted with ultrasound equipment, allowing acute conditions to be diagnosed within critical seconds. This book is a practical and concise introduction to bedside emergency ultrasound for all critical care physicians. It covers the full spectrum of conditions diagnosed via this modality, both for guiding invasive procedures as well as diagnosis in critical-care settings. It introduces the major applications for emergency ultrasound by using focused diagnostic questions and teaching the image-acquisition skills needed to answer these questions. Images of positive and negative findings for each application (FAST, ECHO, etc.) are presented, as well as scanning tips for improved image quality. Each section also contains a review of the literature supporting each application.

Prehospital ultrasound has been deployed in certain areas of the USA and Europe. Physicians, emergency medical technicians, and flight nurses have utilized a variety of medical and trauma ultrasound assessments to impact patient care in the field. The goal of this review is to summarize the literature on emergency medical services (EMS) use of ultrasound to more clearly define the potential utility of this technology for prehospital providers.

BackgroundOptimal training required for proficiency in bedside ultrasound is unknown. In addition, the value of proctored training is often assumed but has never been quantified.MethodsTo compare different training regimens for both attending physicians and first year residents (interns), a prospective study was undertaken to assess knowledge retention six months after an introductory ultrasound course. Eighteen emergency physicians and twelve emergency medicine interns were assessed before and 6 months after an introductory ultrasound course using a standardized, image-based ultrasound test. In addition, the twelve emergency medicine interns were randomized to a group which received additional proctored ultrasound hands-on instruction from qualified faculty or to a control group with no hands-on instruction to determine if proctored exam training impacts ultrasound knowledge. Paired and unpaired estimates of the median shift in test scores between groups were made with the Hodges-Lehmann extension of the Wilcoxon-Mann-Whitney test.ResultsSix months after the introductory course, test scores (out of a 24 point test) were a median of 2.0 (95% CI 1.0 to 3.0) points higher for residents in the control group, 5.0 (95% CI 3.0 to 6.0) points higher for residents in the proctored group, and 2.5 (95% CI 1.0 to 4.0) points higher for the faculty group. Residents randomized to undergo proctored ultrasound examinations exhibited a higher score improvement than their cohorts who were not with a median difference of 3.0 (95% CI 1.0 to 5.0) points.ConclusionWe conclude that significant improvement in knowledge persists six months after a standard introductory ultrasound course, and incorporating proctored ultrasound training into an emergency ultrasound curriculum may yield even higher knowledge retention.

No abstract