3 case studies where prehospital USS aided clinical management
Folks, I love emergency ultrasound and started adopting it in prehospital applications years ago when I had to deal with my first tension pneumothorax on a flight retrieval. Your stethoscope is useless in a noisy aircraft, although the US army have designed a noiseless doppler stethoscope for use on military helicopters! My portable USS is now my super stethoscope !
Quick bow and shout out to the incredible guys Matt and Mike of Ultrasound Podcast
I owe my life and career to these guys as they provide free ultrasound online education and even an iPhone app. This showed me how to be a better doctor with USS and prevented me falling into a fit of depression and slashing my wrists. Sorry that was all a poor attempt at the kind of humour these guys use to make USS learning fun and enjoyable.
Onto the cases :
1.This patient was intubated for pulmonary oedema. We were flying the patient to another ICU and scanned inflight
How did this USS assessment aid our inflight management??
2.This patient was being flown from a rural hospital to a tertiary hospital for assessment of acute abdominal pain. We scanned the patient inflight.
How did this prehospital USS aid the overall management of patient?
3.This patient was seen by myself at a home visit. I was called out during a remote clinic with the complaint that the patient could not walk. The volunteer ambulance driver and I drove to his house where I found him lying on the couch with a sore calf. He told me he had been running around with his kids 2 days ago , felt a sudden pain in his lower calf, then swelling and ongoing pain there since.
I got an USS image of his lower calf here
How did this USS image aid my clinical management?
Prehospital USS will become more and more accepted as standard of care. Paramedics are doing it, doctors are doing it, it wont be long when we will all be doing it.
Minh
PS First to get all three case study answers correctly gets a prize of a brand new Trulite LED disposable MAC 4 laryngoscope!
Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds 
My guesses (and they’re definitely guesses!)
1) contractility looks reasonable but large amounts of pulm oedema on lung US
2) large AAA – likely the cause of the pain
3) calf haematoma (not a DVT no need to Ix further)
Hi Andy
My feedback : 50% correct. You have not described how your USS interpretation has aided the prehospital clinical management in any of the cases. Case 3 is more than a haematoma.
Good on ya for playing!
Thought you might say that. Here’s the guesses then
1) increase the nitrates!
2) activate the surgical team at receiving hospital. control BP
3) haven’t a clue….
Remember case 1 is already ventilated so something else you can do and rescan to assess effect. Case 2 excellent. Case 3 you need to more scanning or do a sports medicine term…its the Olympics month remember!
1) up the PEEP of course!
still lost on 3) so I’ll leave it to the experts. Not enough scanning for me yet. Calf tears are a bit beyond me in USS.
excellent. Just like in the Olympics, you are current top of the leaderboard!
Ireland is leading the PHARM USS Olympics medal tally currently. Go ANDY, go for GOLD!