M. Stier

Accuracy of prehospital focused abdominal sonography for trauma after a 1-day hands-on training course

Objectives To establish a training course for Prehospital Focused Abdominal Sonography for Trauma (P-FAST) and to evaluate the accuracy of the participants after the course and at the trauma scene. Methods A training programme was developed to provide medical staff with the skills needed to perform P-FAST. In order to evaluate the accuracy of P-FAST performed by the students, nine participants (five emergency doctors and four paramedics) were followed during their course and in practice after the course. An assessment was made of 200 ultrasound procedures performed during the course in healthy volunteers and in patients with peritoneal dialysis or ascites. Regular P-FAST performed on-scene by the participants commenced immediately following the course. The results for the nine participants (C-group, course group) were compared with those members of medical staff with more than 3 years of experience in FAST (P-group, professional group). A group of physicians untrained in P-FAST served as a control (I-group, indifferent group). P-FAST findings were further verified by subsequent FAST and CT scans in the emergency department. Results After the training programme the C-group performed 39 P-FAST procedures without any false negative or false positive findings (100% accuracy). In the P-group, 112 procedures were performed with one false positive case. In the I-group there were 2 false negative cases among the 46 procedures performed. Conclusion Following completion of a 1-day P-FAST course, participants were able to perform ultrasound procedures at the scene of an accident with a high level of accuracy.

[Pre-hospital emergency sonography of trauma patients].

ZusammenfassungNeben der schweren Schädel-Hirn-Verletzung sind abdominelle Blutungen die häufigste Ursache der Todesfälle nach Polytraumatisierung. Sie sind schwer zu diagnostizieren, da am Unfallort häufig initial ein kreislaufstabiler Mehrfachverletzter vorgefunden wird. Die Ultraschalldiagnostik spielt seit vielen Jahren eine zentrale Rolle bei der Diagnostik von Notfallpatienten. Sie wird routinemäßig im Schockraum, auf der Intensivstation und im OP eingesetzt, sodass es sinnvoll erschien, die Notfallsonographie auch in der präklinischen Patientenversorgung anzuwenden. Im folgenden Beitrag wird auf die Sonographie traumatologischer Patienten eingegangen, und es werden Indikationsstellung, Untersuchungstechnik sowie spezifische Besonderheiten beim präklinischen Einsatz erläutert. Schließlich werden gerätespezifische Besonderheiten und der Stand der Entwicklung in Deutschland vorgestellt.AbstractBesides severe cerebral trauma, abdominal bleeding is the most frequent cause of death after multiple trauma. Abdominal bleeding is difficult to diagnose because initially at the scene a multiply injured patient with a stable circulation is often encountered. Ultrasound diagnostics have played a central role in the diagnostics of emergency patients for many years. This technique is used both in the emergency room and in the intensive care unit, in the operation center and to an increasing extent in emergency diagnostics during the pre-hospital setting. The following article deals with the ultrasound investigation of injured patients, the indications and examination technique are described, as well as the specific characteristics of using ultrasound at the scene. Finally, device-specific characteristics and the state of development in Germany are presented.Besides severe cerebral trauma, abdominal bleeding is the most frequent cause of death after multiple trauma. Abdominal bleeding is difficult to diagnose because initially at the scene a multiply injured patient with a stable circulation is often encountered. Ultrasound diagnostics have played a central role in the diagnostics of emergency patients for many years. This technique is used both in the emergency room and in the intensive care unit, in the operation center and to an increasing extent in emergency diagnostics during the pre-hospital setting. The following article deals with the ultrasound investigation of injured patients, the indications and examination technique are described, as well as the specific characteristics of using ultrasound at the scene. Finally, device-specific characteristics and the state of development in Germany are presented.

Präklinische Notfallsonographie bei traumatologischen Patienten

ZusammenfassungNeben der schweren Schädel-Hirn-Verletzung sind abdominelle Blutungen die häufigste Ursache der Todesfälle nach Polytraumatisierung. Sie sind schwer zu diagnostizieren, da am Unfallort häufig initial ein kreislaufstabiler Mehrfachverletzter vorgefunden wird. Die Ultraschalldiagnostik spielt seit vielen Jahren eine zentrale Rolle bei der Diagnostik von Notfallpatienten. Sie wird routinemäßig im Schockraum, auf der Intensivstation und im OP eingesetzt, sodass es sinnvoll erschien, die Notfallsonographie auch in der präklinischen Patientenversorgung anzuwenden. Im folgenden Beitrag wird auf die Sonographie traumatologischer Patienten eingegangen, und es werden Indikationsstellung, Untersuchungstechnik sowie spezifische Besonderheiten beim präklinischen Einsatz erläutert. Schließlich werden gerätespezifische Besonderheiten und der Stand der Entwicklung in Deutschland vorgestellt.AbstractBesides severe cerebral trauma, abdominal bleeding is the most frequent cause of death after multiple trauma. Abdominal bleeding is difficult to diagnose because initially at the scene a multiply injured patient with a stable circulation is often encountered. Ultrasound diagnostics have played a central role in the diagnostics of emergency patients for many years. This technique is used both in the emergency room and in the intensive care unit, in the operation center and to an increasing extent in emergency diagnostics during the pre-hospital setting. The following article deals with the ultrasound investigation of injured patients, the indications and examination technique are described, as well as the specific characteristics of using ultrasound at the scene. Finally, device-specific characteristics and the state of development in Germany are presented.Besides severe cerebral trauma, abdominal bleeding is the most frequent cause of death after multiple trauma. Abdominal bleeding is difficult to diagnose because initially at the scene a multiply injured patient with a stable circulation is often encountered. Ultrasound diagnostics have played a central role in the diagnostics of emergency patients for many years. This technique is used both in the emergency room and in the intensive care unit, in the operation center and to an increasing extent in emergency diagnostics during the pre-hospital setting. The following article deals with the ultrasound investigation of injured patients, the indications and examination technique are described, as well as the specific characteristics of using ultrasound at the scene. Finally, device-specific characteristics and the state of development in Germany are presented.

Mandatory elective course in emergency medicine with instructions by paramedics improves practical training in undergraduate medical education

BACKGROUND Due to the complexity of medical emergencies undergraduate medical training in the integrative course on emergency medicine requires education combining knowledge, practical skills, algorithm-driven behavior and soft skills. New State board regulations on education and licensing of physicians demand a practical implementation of these objectives. MATERIALS AND METHODS The medical faculty of Frankfurt medical school has implemented an obligatory prehospital elective course. A retrospective questionnaire assessed the organization, instructional competence of the paramedics and integration of students in the emergency medical teams. RESULTS Out of a total of 486 students the majority rated the longitudinal curriculum as positive (66% very good and 28% good). The practical experience at a scene was evaluated to be reasonable by 86% and 95% of the students stated that integration into the emergency team was rendered without any difficulties. CONCLUSION A prehospital experience supported by paramedics can serve as a valuable tool in an emergency medicine curriculum.

Praktikum im Rettungsdienst mit Anleitung durch Rettungsassistenten

BACKGROUND Due to the complexity of medical emergencies undergraduate medical training in the integrative course on emergency medicine requires education combining knowledge, practical skills, algorithm-driven behavior and soft skills. New State board regulations on education and licensing of physicians demand a practical implementation of these objectives. MATERIALS AND METHODS The medical faculty of Frankfurt medical school has implemented an obligatory prehospital elective course. A retrospective questionnaire assessed the organization, instructional competence of the paramedics and integration of students in the emergency medical teams. RESULTS Out of a total of 486 students the majority rated the longitudinal curriculum as positive (66% very good and 28% good). The practical experience at a scene was evaluated to be reasonable by 86% and 95% of the students stated that integration into the emergency team was rendered without any difficulties. CONCLUSION A prehospital experience supported by paramedics can serve as a valuable tool in an emergency medicine curriculum.

Praktikum im Rettungsdienst mit Anleitung durch Rettungsassistenten@@@Mandatory elective course in emergency medicine with instructions by paramedics improves practical training in undergraduate medical education: Curriculare Lehrveranstaltung im Querschnittsbereich Notfallmedizin

BACKGROUND Due to the complexity of medical emergencies undergraduate medical training in the integrative course on emergency medicine requires education combining knowledge, practical skills, algorithm-driven behavior and soft skills. New State board regulations on education and licensing of physicians demand a practical implementation of these objectives. MATERIALS AND METHODS The medical faculty of Frankfurt medical school has implemented an obligatory prehospital elective course. A retrospective questionnaire assessed the organization, instructional competence of the paramedics and integration of students in the emergency medical teams. RESULTS Out of a total of 486 students the majority rated the longitudinal curriculum as positive (66% very good and 28% good). The practical experience at a scene was evaluated to be reasonable by 86% and 95% of the students stated that integration into the emergency team was rendered without any difficulties. CONCLUSION A prehospital experience supported by paramedics can serve as a valuable tool in an emergency medicine curriculum.

Präklinische Notfallsonographie bei traumatologischen Patienten@@@Pre-hospital emergency sonography of trauma patients

ZusammenfassungNeben der schweren Schädel-Hirn-Verletzung sind abdominelle Blutungen die häufigste Ursache der Todesfälle nach Polytraumatisierung. Sie sind schwer zu diagnostizieren, da am Unfallort häufig initial ein kreislaufstabiler Mehrfachverletzter vorgefunden wird. Die Ultraschalldiagnostik spielt seit vielen Jahren eine zentrale Rolle bei der Diagnostik von Notfallpatienten. Sie wird routinemäßig im Schockraum, auf der Intensivstation und im OP eingesetzt, sodass es sinnvoll erschien, die Notfallsonographie auch in der präklinischen Patientenversorgung anzuwenden. Im folgenden Beitrag wird auf die Sonographie traumatologischer Patienten eingegangen, und es werden Indikationsstellung, Untersuchungstechnik sowie spezifische Besonderheiten beim präklinischen Einsatz erläutert. Schließlich werden gerätespezifische Besonderheiten und der Stand der Entwicklung in Deutschland vorgestellt.AbstractBesides severe cerebral trauma, abdominal bleeding is the most frequent cause of death after multiple trauma. Abdominal bleeding is difficult to diagnose because initially at the scene a multiply injured patient with a stable circulation is often encountered. Ultrasound diagnostics have played a central role in the diagnostics of emergency patients for many years. This technique is used both in the emergency room and in the intensive care unit, in the operation center and to an increasing extent in emergency diagnostics during the pre-hospital setting. The following article deals with the ultrasound investigation of injured patients, the indications and examination technique are described, as well as the specific characteristics of using ultrasound at the scene. Finally, device-specific characteristics and the state of development in Germany are presented.Besides severe cerebral trauma, abdominal bleeding is the most frequent cause of death after multiple trauma. Abdominal bleeding is difficult to diagnose because initially at the scene a multiply injured patient with a stable circulation is often encountered. Ultrasound diagnostics have played a central role in the diagnostics of emergency patients for many years. This technique is used both in the emergency room and in the intensive care unit, in the operation center and to an increasing extent in emergency diagnostics during the pre-hospital setting. The following article deals with the ultrasound investigation of injured patients, the indications and examination technique are described, as well as the specific characteristics of using ultrasound at the scene. Finally, device-specific characteristics and the state of development in Germany are presented.