Jump to content


Photo

Handheld Ultrasound In Flight


  • Please log in to reply
9 replies to this topic

#1 SickPuppy

SickPuppy

    Advanced Member

  • Members
  • PipPipPip
  • 116 posts

Posted 18 August 2007 - 03:25 PM

An attending at the trauma center and I were discussing a patient I ahd flown in. He has a strong background doing ultrasounds (he is a guru of sorts) and asked whether we had a Sonosite (hand held ultrasound machine) in our helicopter. One of the helicopters we recently acquired has one that they have never used.

I was wondering if anybody has ever used one in flight, and would it be worth it to "borrow" the Sonosite from the other base (since they don't use it) to play with.

Anybody have any thoughts.
  • 0
"Education is only the further realization of your own ignorance." Albert Einstein

GO GATORS!!!

#2 clearblueskies

clearblueskies

    Advanced Member

  • Members
  • PipPipPip
  • 91 posts

Posted 03 September 2007 - 02:23 PM

They are great!! We don't have one on our A/C (yet) but I use the one in our ER all of the time. They work great for those really, really hard line insertions and many many other things. I think you would like it if you got a chance to play with it.
  • 0

#3 AirMed_RRT-NPS

AirMed_RRT-NPS

    Member

  • Members
  • PipPip
  • 22 posts

Posted 03 September 2007 - 03:09 PM

What would "many many other things" be.
  • 0
Tim Boyd, RRT-NPS
AirMed International

#4 AirMed_RRT-NPS

AirMed_RRT-NPS

    Member

  • Members
  • PipPip
  • 22 posts

Posted 03 September 2007 - 03:24 PM

Unless you have gone to school for many other things, many other things could land you in much trouble when a court of law ask you the question, "Where did you recieve your degree of radiology?"
  • 0
Tim Boyd, RRT-NPS
AirMed International

#5 buffettrn

buffettrn

    Advanced Member

  • Members
  • PipPipPip
  • 78 posts

Posted 06 September 2007 - 08:14 PM

Two years ago there was a lecture at AMTC about field U/S. He was the Medical Director for a program in Texas and I think for the FD. They were utilizing them as an adjunct in OB and trauma. I believe that his point was you not going to fix anything but they showed a decrease time to OR. I would love to have one for the information that you can get.
  • 0
Jeff Fein
"We are right, they are wrong, END OF STORY"

#6 clearblueskies

clearblueskies

    Advanced Member

  • Members
  • PipPipPip
  • 91 posts

Posted 07 September 2007 - 09:36 AM

Many other things :

Use as a Doppler in the A/C for extremity injuries

Useful in helping to confirm the onset of pericardial tamponade while in flight and with ultrasound guided centesis

As noted before me Ob/Trauma situations

Useful in suspected ABD injuries.

Insertion of ART lines.

Assist w/ rapid infuser insertion.




and as far as the "getting yourself in trouble because you aren't a radiologist" Pretty much anywhere in the US, as long as you have been trained properly by a physician.... IE a radiologist in the rudimentary recognition of the above stated and you are approved by your medical direction you are FINE... You aren't diagnosing an injury with the thing you are only using it as an adjunct to pass on info to the surgeon which will help him/her narrow down where to look for things. Using the argument that you could get asked in court " where did you receive your training in radiology" could be the same thing as someone using an ISTAT and being asked "Well where did you get your training as a medical technologist to run lab samples" If someone wants to go after you for using an ultrasound after being properly trained on it and signed of then they aren't coming at you alone your Medical director will be right there with you for allowing it to be used. My 2 cents.

links to training material :
http://www.chall.com/emus.htm
www.remotemedicine.org/Paths/usprogram.pdf
http://www.emergencyultrasound.com/
  • 0

#7 VentMedic

VentMedic

    Newbie

  • Members
  • Pip
  • 4 posts

Posted 07 September 2007 - 01:34 PM

Many other things :

Use as a Doppler in the A/C for extremity injuries

Useful in helping to confirm the onset of pericardial tamponade while in flight and with ultrasound guided centesis

As noted before me Ob/Trauma situations

Useful in suspected ABD injuries.

Insertion of ART lines.


Yes in the ED, this works great. What surgeon is going to take the patient to the OR based on a field US assessment which can be subject to motion errors and poor patient positioning for definitive views? The surgeon is going to want confirmation AGAIN before he/she cuts.

Expensive doppler. How will it pass the "field" tests for bumps, weather, moisture, temperature etc?

A-line insertion? Maybe more hands on practice or a re-assessment of the patient to determine why you are having trouble with the pulses. Did you miss something affecting the BP? Are the arteries clamped from the meds? May a central a-line would be a better approach? How long do you have to stay and play if you have a surgeon back at the trauma center?

I find giving a CLEAR report and stressing certain findings as far as assessment and mechanism will mobilize a surgical team also if the facility has faith in our abilities.


and as far as the "getting yourself in trouble because you aren't a radiologist" Pretty much anywhere in the US, as long as you have been trained properly by a physician.... IE a radiologist in the rudimentary recognition of the above stated and you are approved by your medical direction you are FINE... You aren't diagnosing an injury with the thing you are only using it as an adjunct to pass on info to the surgeon which will help him/her narrow down where to look for things. Using the argument that you could get asked in court " where did you receive your training in radiology" could be the same thing as someone using an ISTAT and being asked "Well where did you get your training as a medical technologist to run lab samples" If someone wants to go after you for using an ultrasound after being properly trained on it and signed of then they aren't coming at you alone your Medical director will be right there with you for allowing it to be used. My 2 cents.


The I-STAT is probably the best example of maintenance, skill, competency and professional standards. Even after well over 10 years of use outside of the hospital, regulations are still fighting its use by everybody. Those who are hospital based still rely on Lab Technologist and/or Respiratory Therapists to do the compliance standards, paperwork and talk to CLIA. So many field personnel may not know what is all involved. If a QC is forgotten, those labs will be flagged and in question. If you treated according to them knowing your machine was not within the standards for lab regulations...well... You had better have great lab person to help clean up your mess. For those who have gotten independent lab licenses can add a large amount of input to the rules, regs and consequences. If anyone is familiar with the new regs for ground crews and lab draws also know that some things are a privilege and a causal "anyone" can do it may not always be that easy.

I am all for technology but only if I can do something definitively and it doesn't distract my focus from total patient care. Technology can also easily make people look stupid as if we haven't learned from the simple little pulse oximeter.
  • 0

#8 BadPieces

BadPieces

    Advanced Member

  • Restricted
  • PipPipPip
  • 55 posts

Posted 10 September 2007 - 01:14 AM

Yes in the ED, this works great. What surgeon is going to take the patient to the OR based on a field US assessment which can be subject to motion errors and poor patient positioning for definitive views? The surgeon is going to want confirmation AGAIN before he/she cuts.

Expensive doppler. How will it pass the "field" tests for bumps, weather, moisture, temperature etc?

A-line insertion? Maybe more hands on practice or a re-assessment of the patient to determine why you are having trouble with the pulses. Did you miss something affecting the BP? Are the arteries clamped from the meds? May a central a-line would be a better approach? How long do you have to stay and play if you have a surgeon back at the trauma center?

I find giving a CLEAR report and stressing certain findings as far as assessment and mechanism will mobilize a surgical team also if the facility has faith in our abilities.
The I-STAT is probably the best example of maintenance, skill, competency and professional standards. Even after well over 10 years of use outside of the hospital, regulations are still fighting its use by everybody. Those who are hospital based still rely on Lab Technologist and/or Respiratory Therapists to do the compliance standards, paperwork and talk to CLIA. So many field personnel may not know what is all involved. If a QC is forgotten, those labs will be flagged and in question. If you treated according to them knowing your machine was not within the standards for lab regulations...well... You had better have great lab person to help clean up your mess. For those who have gotten independent lab licenses can add a large amount of input to the rules, regs and consequences. If anyone is familiar with the new regs for ground crews and lab draws also know that some things are a privilege and a causal "anyone" can do it may not always be that easy.

I am all for technology but only if I can do something definitively and it doesn't distract my focus from total patient care. Technology can also easily make people look stupid as if we haven't learned from the simple little pulse oximeter.



Vent Medic, you made some very, very good points!
But Sick Puppy...seriously now.
1) So if there's an OB emergency..are you going to do a C-Section at alitude?
2) A-lines: If you need an ultrasound to find it..while your digging around, bouncing off radial/medial nerves..are the benefits outweighing the risks?
3) Distal pulses in extremity injuries: seems like a no brainer to me...if it's not there are you going to swap hats and become a vascular surgeon at altitude?
4) Most Trauma Surgeons don't even trust ER Attendings when it comes to game time, they almost always (as any surgeon in his/her right mind would before they put you under the knife) confirm the findings for themselves. If they took your US exam as definitive (and that's a big IF), then that would be very progressive AND do wonders for team building between prehospital-hospital staff...but I'm thinking it would bring forth a whole new handfull of issues and it's not really very plausible.
  • 0
RN, NREMT-P, X, Y, Z

"Impossible is just a big word thrown around by small men who find it easier to live in a world they have been given than to explore the power they have to change it." -Richard Bullock

#9 rfdsdoc

rfdsdoc

    Advanced Member

  • Members
  • PipPipPip
  • 129 posts

Posted 10 September 2007 - 10:55 AM

Hello to the discussion

I agree that prehospital FAST scans have questionable clinical value for retrieval work. If they are going to need a trauma surgeon then they are going to need a trauma surgeon full stop and you don't need a FAST assessment to tell you that.

Portable Ultrasound is just another way of looking inside the body and who would not want to have that ability? If you could have handheld safe portable xray imaging..like the Star trek tricorder..then who would not want that!

In RFDS Cairns base we have 3 machines made by Sonosite and I encourage all my flight doctor colleagues to take them on retrievals. The Australian army has them and used them in East timor and Afghanistan. In fact the Sonosite machine was originally designed for US army specifications.

To me the greatest advantage they offer for aeromedical work is the ability to reliably exclude pneumothorax in a prehospital setting and in the aircraft at altitude. I have had a tension pnuemothorax on a ventilated patient at 26000ft and needled both sides of chest as I could not hear anything with stethoscope, so ended up putting chest tubes bilaterally because of this.

Since I have been trained in using the Sonosite to detect pneumothoraces then I can avoid doing bilateral decompressions as I can now see where the pneumothorax is and how big it is...all in the aircraft or even before I take off from a primary scene.

It has been a traditional teaching of aeromedical retrieval medicine that if you suspect a pneumothorax before you take off then you should insert prophylactic chest drains. Well with portable ultrasound you don't have to do that anymore.

What about a woman with a +ve urine HCG and PV bleeding and pelvic pain...could be a miscarriage or an ectopic...with an USS you could find out ..

But I am not advocating all EMS run out and buy a machine...as they are very expensive, require specific training and regular practice and audit.
  • 0
Minh Le Cong
Medical Officer
MBBS(Adelaide), FRACGP, FACRRM, FARGP, GDRGP, GCMA
RFDS Cairns base , Queensland, Australia

#10 FloridaMedic

FloridaMedic

    Advanced Member

  • Banned
  • PipPipPip
  • 790 posts

Posted 10 September 2007 - 03:32 PM

Portable Ultrasound is just another way of looking inside the body and who would not want to have that ability? If you could have handheld safe portable xray imaging..like the Star trek tricorder..then who would not want that!

In RFDS Cairns base we have 3 machines made by Sonosite and I encourage all my flight doctor colleagues to take them on retrievals. The Australian army has them and used them in East timor and Afghanistan. In fact the Sonosite machine was originally designed for US army specifications.

To me the greatest advantage they offer for aeromedical work is the ability to reliably exclude pneumothorax in a prehospital setting and in the aircraft at altitude. I have had a tension pnuemothorax on a ventilated patient at 26000ft and needled both sides of chest as I could not hear anything with stethoscope, so ended up putting chest tubes bilaterally because of this.


But I am not advocating all EMS run out and buy a machine...as they are very expensive, require specific training and regular practice and audit.


I agree portable USS is an excellent adjunct. Most trauma centers and many rural ERs use it often for a variety of diagnostics. It is rarely, if ever, used in our hospital for peripheral lines, either venous or arterial. If you have to search that long, central will probably be more ideal for a longer term and accommodate more medications.

The equipment we carry has to be chosen carefully for several reasons that include; limited space, ability to store, secure and safety for crew and aircraft, number of times used and ability to do definitive care with the equipment, maintenance contracts of equipment, record keeping, length of transport, possibility of extending transport times through the use and of course BUDGET.

Our Emergency physicians saw where they could enhance their resume by obtaining the training themselves at the manufacturer's regional training centers where they could get the didactic and hands on over a course of several full days....for each body region. The cost of the course is very expensive. For the physicians, it will be a portable skill they will always find some use for. For prehospital personnel, it is an expensive investment in a skill that is not always portable in their career. It will be a long time before this piece of equipment is reality on most civilian US EMS aircraft. Budget and training will be a difficult issue for prehospital personnel. Inside the hospital, besides the ER doctors, they have ARDMS registered technicians that do the ultrasounds and are profitable for the hospital through reimbursement. Many of these ultrasound technicians may have at least a two year degree (eventually a minimum for their certification) and some 4-year degrees specializing in many the many aspects of diagnostic ultrasounds/sonography. Many hospital radiology departments will send their off-hours technicians through the different sonography modules to be readily available throughout the facility. The hospital will make back their investment easily.

The professionals in these departments are also very familiar with the many different regulations and paper work involved in diagnostic equipment maintenance and reliability of results. Knowing how to "point and shoot" a piece of equipment is one thing. But, having the expertise to know when the equipment is misfiring and giving you erroneous readings is another. It may take many, many patients of many different body types to become comfortable with some diagnostic skills. What you are looking for may not always be that obvious and lead you to a false sense of security if you rely heavily on a field USS when you may actually have a true emergency evolving. There could also be many things that you would fail to recognize because your training or experience was not that extensive. I am very familiar with echocardiography but have little knowledge of the abdominal sonography. I just always hear "bladder full or empty" as making a big difference in some diagnostic abdominal sonography.

Nurses do have the option of being trained in sonography for hospital work. This will usually be through OB as an independent skills module. These nurses have great expertise in their field and may utilize these skills daily. As a nurse in a Diagnostics department such as radiology, the nurse may be required to complete 12 - 24 months of training for the additional certification. To be proficient, it may mean working many hours in that department and not ICU/ED.

The people here with military experience probably know the the extensive medical training and skills obtained in the military are difficult to get recognized in civilian life.

This again sounds like another "quick" learn for the EMS professional, but there are other things that still require our proficiency to be maintained to the highest level and these are skills that may be needed almost daily. Sometimes the old saying "Jack of all, master at nothing" can be applied to some EMS providers and not necessarily in a good way.
  • 0