Walter F. Kuhn

Change in Differential Diagnosis and Patient Management With the Use of Portable Ultrasound in a Remote Setting

Abstract Objective.—Physicians practicing in remote areas are typically limited in their choice of diagnostic tools. The goal of this study was to determine whether the use of a portable ultrasound (US) device on selected patients in a remote setting would alter physician diagnosis and management. Methods.—This was a prospective observational study of the affects of US on physician decision making deep in the Amazon jungle. A battery-operated Sonosite 180 Plus with 2 interchangeable transducers (4–7-MHz broadband intercavitary transducer and 2–5-MHz broadband abdominal transducer) was used. The patient population consisted of local tribal people. Two of the physicians on the team performed all US examinations. Team physicians requesting US examinations filled out a survey before and after the US examination. Before the US, the referring physician filled out a survey describing the patients initial complaint, pertinent past medical history and physical findings, and an initial (pre-US) differential diagnosis and planned treatment with expected disposition. After the results of the US were reviewed with the referring physicians, the doctors were asked to fill out the remainder of the survey, allowing comparison of pre- and post-US differential diagnosis, treatment plan, and disposition. Results.—A total of 25 US studies were performed during this study (1 trauma US scan, 6 hepatobiliary studies, 5 transabdominal pelvic scans, 7 transvaginal pelvic studies, 3 renal studies, and 3 abdominal aortic scans). The monitor on the US unit experienced a rare failure shortly after being used at 17,000 ft and then 10 times at sea level, and no further US scans could be performed. US scan results dramatically altered the disposition of 7 patients, including 4 patients who avoided a potentially dangerous 2-day evacuation to more definitive medical care. Three patients were found to need rapid referral to the nearest clinic for surgical evaluation. Conclusions.—When used in a remote location, portable US provides a significant benefit that can dramatically alter disposition and treatment.

Rapid Assessment of the Neonate With Sonography (RANS) Scan: Point-of-Care Sonography for the Critical Neonate

The use of point‐of‐care sonography in clinical settings such as emergency medicine and intensive care units has increased, but adoption in neonatology has been slow. Unlike the focused assessment with sonography for trauma scan used in adults, a quick bedside scan to rapidly evaluate an acutely deteriorating neonate does not exist. The objective of our article is to introduce a focused bedside ultrasound scan that is easy to learn, rapidly performed, and relatively inexpensive.© 2018 by the American Institute of Ultrasound in Medicine

A Potential Pitfall of Using Focused Assessment With Sonography for Trauma in Pediatric Trauma

Prospective studies have shown sensitivities of 73% to 88% and specificities of 98% to 100% for using the focused assessment with sonography for trauma (FAST) examination to identify free fluid in adult trauma patients. However, the efficacy of FAST examinations for pediatric trauma patients has not been well defined, and studies looking at diagnostic performance have had varied results. We describe 3 cases of the potential pitfalls of the pediatric FAST examination in pediatric trauma patients using an advanced‐processing ultrasound machine. We hypothesize several etiologies for these false‐positive findings in the setting of advanced image‐processing capabilities of point‐of‐care ultrasound. We also discuss the reevaluation of clinical algorithms and interpretation practices when using the FAST examination in pediatric trauma.