No abstract

Quantifying Quality in Ultrasound Imagingltrasound has been proven in multiple studies to improve physician clinical performance through a wide range of potential applications, including diagnostic and procedural applications. 1 With the approval of American Medical Association policy H-230.960 in 1999, the scope of practice for physicians performing ultrasound examinations increased dramatically beyond traditional indications. 2 Individual specialties have since been responsible for determining the ultrasound scope of practice within their individual field. For example, the American College of EmerDavid P. Bahner, MD, RDMS, Eric J. Adkins, MD, MSc, Rollin Nagel, PhD, David Way, MEd, Howard A. Werman, MD, Nelson A. Royall, MD Received April 14, 2011, ORIGINAL RESEARCHObjectives-Ultrasound image interpretation and education relies on obtaining a highquality ultrasound image; however, no literature exists to date attempting to define a high-quality ultrasound image. The purpose of this study was to design and perform a pilot reliability study of the Brightness Mode Quality Ultrasound Imaging Examination Technique (B-QUIET) method for ultrasound quality image assessment.Methods-A single sonologist performed a Trinity hypotensive ultrasound protocol on 3 participants of varying body types. Each participant's ultrasound examination was repeated in 4 locations; static clinic location, mobile ambulance, airplane, and helicopter. Images were reviewed by a sonographer, radiologist, and emergency medicine physician using the B-QUIET method and underwent statistical analysis using generalizability theory for reliability of the assessments using the tool.Results-The B-QUIET method showed high reliability of most subscale items. Approximately two-thirds of the reviewed images had complete inter-rater reliability on 90% of the items. There was relatively low inter-rater reliability for the Identification/ Orientation subscale items. The inter-rater reliability κ value was calculated as 0.676 overall for the method.Conclusions-The need for a standardized method to evaluate the quality of an ultrasound image is well documented. The B-QUIET method represents the first attempt to quantify the sonographer component of ultrasound images. Further reliability and validation studies of this method will be needed; however, it represents a tool for standardized ultrasound interpretation, ultrasound training, and institutional quality assessment.

The state of Ohio is the first state to develop evidence-based geriatric-specific field-destination criteria using data from its state-mandated trauma registry. Further analysis of these criteria will help determine their effects on over-triage and under-triage of geriatric victims of traumatic injuries and the impact on the overall mortality in the elderly.

Retrospective analysis was not able to demonstrate any benefit to direct transport from the scene to a trauma center. Hospital stabilization before transfer by air ambulance may improve survival and shorten ICU stays for patients with major trauma.

Although epinephrine has been shown to improve myocardial blood flow during cardiopulmonary resuscitation (CPR), the effects of standard as well as larger doses of epinephrine on regional myocardial blood flow have not been examined. In this study we compared the effects of various doses of epinephrine on regional myocardial blood flow after a 10 min arrest in a swine preparation. Fifteen swine weighing greater than 15 kg each were instrumented for regional myocardial blood flow measurements with tracer microspheres. Regional blood flow was measured during normal sinus rhythm. After 10 min of ventricular fibrillation, CPR was begun and regional myocardial blood flow was determined. Animals were then randomly assigned to receive 0.02, 0.2, or 2.0 mg/kg epinephrine by peripheral injection. One minute after drug administration, regional myocardial blood flow measurements were repeated. The adjusted regional myocardial blood flows (ml/min/100 g) for animals given 0.02, 0.2, and 2.0 mg/kg epinephrine, respectively, were as follows: left atrium, 0.9, 67.4, and 58.8; right atrium, 0.3, 46.2, and 38.5; right ventricle, 0.7, 82.3, and 66.9; right interventricular septum, 1.7, 125.5, and 99.1; left interventricular septum, 2.8, 182.8, 109.5; mesointerventricular septum, 16.8, 142.2, and 79.2; left ventricular epicardium, 19.2, 98.5 and 108.7; left ventricular mesocardium, 22.8, 135.0, and 115.8; and left ventricular endocardium, 2.5, 176.1, and 132.9). All comparisons between the groups receiving 0.02 and 0.2 mg/kg epinephrine were statistically significant (p < .05). Comparisons between the groups receiving 0.02 and 2.0 mg/kg epinephrine were also statistically significant except for the right ventricle, right interventricular septum, left interventricular septum, and mesointerventricular septum. No statistically significant differences were noted for the animals receiving 0.2 and 2.0 mg/kg. This study suggests that epinephrine in doses larger than currently recommended during CPR is capable of improving regional myocardial blood flow over flows achieved with standard doses of epinephrine after a prolonged cardiac arrest. Circulation 75, No. 2, 491-497, 1987. EPINEPHRINE has been shown to improve regional myocardial blood flow during cardiac resuscition.'The optimal dose of epinephrine to be used during closed-chest cardiopulmonary resuscitation (CPR) to augment regional myocardial blood flow has not been determined. The present American Heart Association guidelines recommend a dose of 0.5 to 1.0 mg of epinephrine in adults.