Re: Ultrasound response.

[Bill Witmer <billemtp2000@yahoo.com>]

I heard there was a grant out there that dealt with
the sonosite for nonprofits any body know if that is
the case
Bill 
--- David Steele <DSTEELE1@mn.rr.com> wrote:
> I will try and answer questions that have been
> asked.
> 
> First off the equipment we have used is the sonosite
> 180.  We have been doing US in the field for 1 year
> and 7 months now.  We recently switched to the
> sonosite I-Look.  We are looking at hard mounting
> this equipment in our aircraft.  You are able to
> save images on both devices for QI purposes however
> with the I-Look you can't hook up a digital recorder
> as of yet.  This is also helpful in QI and we used
> it for one of our studies.
> 
> The flight nurses and flight medics are doing the
> actual procedure.  All of our staff fly full time
> helicopter.  Both the medics and the nurses are
> interpreting the data.  Images are saved to the
> "hard drive" and later QI'd by our Medical Director.
>  Paperwork is filled out on all patients so the MD's
> are able to follow up.
> 
> Our first study looked at training.  The study was
> presented in Sweden and also presented at AAMS (I
> was suppose to be there but my father died of cancer
> the same week).  This study has been submitted for
> publication and frankly I can't remember right now
> which periodical(s) it was sent in to.
> 
> Our training consisted of 4 hours of lecture, 3
> hours of hands on training on each other the 3
> physicians and 1 sonosite rep and then roughly an
> hour was spent on looking at images, both positive
> and negative and identifying structures etc.  We
> then spent 8 hours in a busy level one trauma center
> ED (One of the first to use US in the ED) and
> literally performed US on almost all patients we
> could.  Staff physicians assisted as needed and
> confirmed our readings.  We then took a  written
> test and competency exam given by medical director. 
> This was then repeated in a year (the testing).  
> 
> In a nut shell we found that the training was
> adequate.  Our correct reads were high with a rate
> at about 93%.  WE did find however that we rarely
> got a full FAST exam.  Typically the apical view,
> morrisons pouch were completed , then the pelvic
> view and then splenorenal views.  In part this was
> due to or ship configuration, and time limits.  We
> do most of our procedures in flight so many times,
> IV's meds and intubations are getting done first.
> 
> We are now looking at diagnosis shock states from
> the US.
> 
> The big questions does it affect patient care in our
> environment.  I do agree with Mr.Bulkley's
> sentiments.  We have debated different triage
> approaches based on our US findings.  In particular
> I have found it very helpful in OB (Monitoring FHT's
> and Movement), It is extremely helpful in diagnosis
> a true PEA.  It has been interesting when I have
> thought to felt a pulse (Lots of vibrations and
> motion in the aircraft) and then will do an US and
> the patient will be in a true PEA.  Hypothermia and
> PEA versus cardiac motion has been helpful also.  It
> has also been nice to be able to look at the Aorta
> and differentiate if there is a TAA, AAA, then the
> treatment algorithms change for blood pressure
> control and beta blockade etc.
> 
> I also think that when there is a positive belly
> diagnosed in flight that things move quicker on the
> receiving end as they already know this information
> and are that much more ahead of the ball game.  Not
> that all positive belly's need the OR but at least
> they are ready when they get there if they do.  
> 
> Frankly I was a skeptic of doing US in the field.  I
> have personally benefited from having the device on
> board the A/C.  The more information you glean the
> better your patient care will be.  Once I find out
> which periodical the study is to be published in I
> will let you know.  
> 
> Any other questions please don't hesitate to email
> me direct.  (Hope this makes sense, I am writing it
> after a busy 12 hour shift)
> 
> 
> David Steele
> Flight Nurse
> Life Link III
> 
> dsteele1@mn.rr.com
> 


__________________________________________________
Do you Yahoo!?
Yahoo! Tax Center - forms, calculators, tips, more
http://taxes.yahoo.com/

_______________________________________________
Flightmed mailing list
To unsubscribe or change your email address, go to http://www.pairlist.net/mailman/listinfo/flightmed