Pre-hospital assessment with ultrasound in emergencies: implementation in the field

Rooney, Kevin; Lahham, Sari; Lahham, Shadi; Anderson, Craig L.; Bledsoe, Bryan E; Sloane, Bryan; Joseph, Linda; Osborn, Megan Boysen; Fox, J. Christian

doi:10.5847/wjem.j.1920-8642.2016.02.006

Cited by 40 publications

(43 citation statements)

References 30 publications

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“…The FoCUS approach, providing a limited number of evidence‐based targets ( Table ), requires less training and expertise than full echocardiography study . Moreover, recent prospective studies show that paramedics were successful in obtaining point‐of‐care cardiac ultrasound scans in the field …”

Section: Imaging In the Urgent Phase: Heart Failure‐oriented Focused mentioning

confidence: 99%

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Imaging in patients with suspected acute heart failure: timeline approach position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Čelutkienė

Lainščak

Anderson

et al. 2019

European J of Heart Fail

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Acute heart failure is one of the main diagnostic and therapeutic challenges in clinical practice due to a non‐specific clinical manifestation and the urgent need for timely and tailored management at the same time. In this position statement, the Heart Failure Association aims to systematize the use of various imaging methods in accordance with the timeline of acute heart failure care proposed in the recent guidelines of the European Society of Cardiology. During the first hours of admission the point‐of‐care focused cardiac and lung ultrasound examination is an invaluable tool for rapid differential diagnosis of acute dyspnoea, which is highly feasible and relatively easy to learn. Several portable and stationary imaging modalities are being increasingly used for the evaluation of cardiac structure and function, haemodynamic and volume status, precipitating myocardial ischaemia or valvular abnormalities, and systemic and pulmonary congestion. This paper emphasizes the central role of the full echocardiographic examination in the identification of heart failure aetiology, severity of cardiac dysfunction, indications for specific heart failure therapy, and risk stratification. Correct evaluation of cardiac filling pressures and accurate prognostication may help to prevent unscheduled short‐term readmission. Alternative advanced imaging modalities should be considered to assist patient management in the pre‐ and post‐discharge phase, including cardiac magnetic resonance, computed tomography, nuclear studies, and coronary angiography. The Heart Failure Association addresses this paper to the wide spectrum of acute care and heart failure specialists, highlighting the value of all available imaging techniques at specific stages and in common clinical scenarios of acute heart failure.

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Section: Imaging In the Urgent Phase: Heart Failure‐oriented Focused mentioning

confidence: 99%

“…[14][15][16] Moreover, recent prospective studies show that paramedics were successful in obtaining point-of-care cardiac ultrasound scans in the field. 17,18 In an urgent situation with minimal time, critically ill patients and challenging conditions, it is difficult to completely avoid both…”

Section: Imaging In the Urgent Phase: Heart Failure-oriented Focused mentioning

confidence: 99%

Imaging in patients with suspected acute heart failure: timeline approach position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Čelutkienė

Lainščak

Anderson

et al. 2019

European J of Heart Fail

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“…The pre-hospital time for trauma victims was shortened through the development of the coordinated statewide Emergency Medical Systems (EMS) [7]. Results from ultrasound (US) scans, especially FAST are limited by a first responder's limited training and by interpretation of the images necessary to initiate treatment or decide which hospital(s) within the EMS provide sufficient services to address the patient's injuries causing the hemorrhage and volume loss [17].…”

Section: Figure 1: Fast Scan Positionsmentioning

confidence: 99%

Evaluation of Control Strategies for a Tele-manipulated Robotic System for Remote Trauma Assessment

Mathur¹,

Topiwala²,

Saeidi³

et al. 2019

2019 Proceedings of the Conference on Control and Its Applications

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Unintentional injury or trauma is among the leading causes of death in the United States with up to 29% of the prehospital trauma deaths attributed to uncontrolled hemorrhages. This paper reports and analyzes control strategies for a tele-manipulated robotic system to enable remote Focused Assessment with Sonography for Trauma (FAST) en route to the hospital. We compare a hybrid telemanipulation technique which combines conventional position and rate control techniques to a position-based telemanipulated system. We also evaluate the performance of a force activated virtual fixture (VF) as an addition to the tele-manipulation system to expand the potential of robotic trauma care towards rapidly initializing lifesaving diagnostics and treatment procedures. From human subject trials, it was found that the final tele-manipulated system allows the operators to easily position the probe in 25% less time than the position-based system, as well as perform a FAST exam while smoothly sweeping the probe at 70% smoother sweep velocities with a consistent contact force having a 150% lower standard deviation than a system without the VF.

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“…Rooney et al performed a small prospective educational study on cardiac standstill detection with four paramedics after a three-hour training session [42]. Training consisted of two hours of didactic training and one hour hands-on training of the subxiphoid, apical four chamber and left parasternal long axis view on human subjects [42]. For a scan to be judged as adequate, a minimum score of four on a six-point structural assessment scale was required [42].…”

Section: Ultrasound In Cardiac Standstillmentioning

confidence: 99%

Research: Emergency medicine residents’ acquisition of point-of-care ultrasound knowledge and their satisfaction with the flipped classroom andragogy

Bashir¹,

Azad²,

Farook³

et al. 2018

POCUS

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Background: One of the traditional approaches for knowledge transfer in medical education is through face-to-face (F2F) teaching. We aimed to evaluate the acquisition of knowledge about point-of-care ultrasound (POCUS) and learner’s satisfaction with the flipped classroom (FC) teaching approach. Methods: This was a prospective, mixed-method, crossover study and included 29 emergency medicine (EM) residents in current training program. Over a period of three months, each resident was exposed to F2F and FC teaching models in a crossover manner. There was a multiple-choice questions (MCQ) test before and after each educational intervention (F2F & FC). Two months after each educational intervention a final MCQ test was administered to assess the retention of knowledge between the two approaches. After each educational approach feedback was sought from a selected group of residents concerning the acceptability of the two educational approaches through a semi structured interview. Results: A total of 29 EM residents participated in this study. The numbers of residents by year of post-graduation training were seven (24.14%) PGY-1, eight (27.59%) PGY-2, six (20.69%) PGY-3, and eight (27.59%) PGY-4. The baseline mean score was 15.82 using MCQs test mean scores. For the face-to-face teaching model, the difference between pre and post-intervention scores was 2.7 (95% CI 2.1 to 3.3, p=0.001); whereas, for the flipped classroom teaching model, the difference was 3.93 (95% CI 3.2 to 4.5, p= 0.001). At two months post-intervention, for face-to-face teaching model, the MCQ assessment showed an increase of 1.7 (95% CI 1.1 to 2.2, p= 0.001) mean scores when compared to the pre-intervention mean scores; whereas, for the flipped classroom model this difference was significantly higher, recorded as 4.48 (95% CI 3.7 to 5.1, p= 0.001). Finally, the difference between mean scores for F2F and FC teaching models was 2.75 (95% CI 1.87 to 3.64, p=0.001) at two months post-intervention. Overall, the participants expressed a preference for the FC teaching methodology. Conclusion: Both F2F and FC teaching methods resulted in significant and sustained improvements in POCUS knowledge base. The FC teaching method accomplished higher test scores than the F2F teaching method both at the end of the teaching and after two months of completing the educational program.

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Pre-hospital assessment with ultrasound in emergencies: implementation in the field

Cited by 40 publications

References 30 publications

Imaging in patients with suspected acute heart failure: timeline approach position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Imaging in patients with suspected acute heart failure: timeline approach position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Evaluation of Control Strategies for a Tele-manipulated Robotic System for Remote Trauma Assessment

Research: Emergency medicine residents’ acquisition of point-of-care ultrasound knowledge and their satisfaction with the flipped classroom andragogy

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