Sharon R. Wilson

Trauma ultrasound feasibility during helicopter transport

OBJECTIVE To evaluate the feasibility of performing a standard four-view focused abdominal sonography for trauma (FAST) examination during helicopter transport using a hand-carried ultrasound machine. METHODS In this prospective observational study, actual and simulated trauma patients were evaluated using the SonoSite 180 ultrasound machine by two air transport programs serving Level I trauma centers. FAST examinations were performed in flight by emergency medicine faculty, residents, flight nurses, and ultrasound technologists, who rated the difficulty posed by various factors using Likert scales (0 = not difficult to 5 = impossible). BK 117, Bell 230, and BO 105 medical helicopters flew in all aviating modes. Pilots were queried regarding avionics variations throughout the flights. RESULTS Ten flight sonographers performed 21 FAST examinations on 14 patients (five actual, nine simulated). The median Likert value for each parameter was 0 except for patient position, which was 1 (somewhat difficult). Interquartile ranges were 0-0 for vibration, bedding, IV catheters, monitor cables, and ventilator; 0-0.5 for backboard straps; and 0-1 for sunlight, patient position, spider straps, gurney straps, and clothing. Mean examination duration, was 3.0 minutes (range 1.5 to 5.5 minutes, SD 1.3). Pilots reported no effects on avionics in any flight mode. CONCLUSION The FAST examination using the SonoSite 180 in flight was rated by 10 evaluators to be performed easily. Examinations were conducted quickly and did not interfere with helicopter avionics. This digital ultrasound machine is the first one small enough to be used in most medical helicopters.

Testing for HIV: Current practices in the academic ED

The objective of this study was to determine common practices for testing for Human Immunodeficiency Virus (HIV), particularly in patients with other sexually transmitted diseases (STD) in emergency departments (ED) with residency training in Emergency Medicine. Via mail, 112 directors of academic emergency medicine programs in the United States were surveyed. Surveys from 95 academic institutions were completed, returned, and included in the analysis. Three EDs (3%) routinely tested for HIV in patients with suspected STD. HIV testing was performed in the ED in 54% of responding institutions under special circumstances such as employee testing after occupational exposures (54%), cases of rape (46%), and suspicion of HIV infection by clinical manifestations other than suspected STD (36%). Based on the results it was determined that academic EDs do not routinely test for HIV in patients suspected of having a STD and have variable testing practices and policies regarding other possible HIV exposures.

An initial description of a sonographic sign that verifies intrathoracic chest tube placement

PURPOSE An initial description of a sonographic finding predictive of intrathoracic chest tube placement. METHODS This was a prospective observational study using unembalmed cadaveric models. Chest tubes were randomly placed intra- and extrathoracically and evaluated using ultrasound. Chest tube location was confirmed using blunt dissection followed by tactile and visual confirmation. Sonographers were blinded to chest tube position. Sonographic images obtained in a transverse orientation revealed a subcutaneous hyperechoic arc, created by the chest tube, at the insertion site. The path of the hyperechoic arc was followed cephalad. Disappearance of the hyperechoic arc signified intrathoracic chest tube placement. In contrast, continuation of a subcutaneous hyperechoic arc for the full length of the chest tube signified extrathoracic chest tube placement (the Disappearance/Intrathoracic, Continuation/Extrathoracic sign). RESULTS Ultrasound was used to evaluate 48 chest tube placements. All chest tube locations were identified correctly. In differentiating intra- vs extrathoracic chest tube placement, the Disappearance/Intrathoracic, Continuation/Extrathoracic sign revealed a sensitivity of 100% (95% confidence interval, 83%-100%) and a specificity of 100% (95% confidence interval, 83%-100%). CONCLUSIONS In this small study, bedside ultrasound appears to be highly sensitive and specific in differentiating intra- versus extrathoracic chest tube placement.

Ultrasound-Guided Radial Artery Catheterization and the Modified Allen's Test

In this case report, ultrasound-guided radial artery catheterization and a modified Allens test were performed by Emergency Department (ED) physicians to facilitate the management of an intubated, critically injured patient. Ultrasound was demonstrated to be a valuable tool in determining collateral circulation and guiding radial artery cannulation in a patient unable to cooperate with the traditional Allens test. Ultrasound guidance may reduce the risk of radial artery catheterization in severely injured patients.

Pain Control for Sternal Fracture Using an Ultrasound-Guided Hematoma Block

In this case report, an ultrasound-guided hematoma block was performed in the Emergency Department (ED) for immediate and effective pain control in a patient suffering from a sternal fracture. This technique of anesthesia may allow safer and more effective analgesia and a more rapid discharge from the hospital or ED in selected cases.