Department of Anaesthesia, Intensive Care, Emergency Medicine and Pain Therapy, St.Josefs-Hospital Cloppenburg, Krankenhausstrasse 13, 49661, Cloppenburg, Germany.
Scand J Trauma Resusc Emerg Med. 2018 Jun 18;26(1):49. doi: 10.1186/s13049-018-0519-9.
In the prehospital situation, the diagnostic armamentarium available to the rescue physician is limited. Emergency ultrasound has proven to be a useful diagnostic tool, providing crucial information for the management of critically ill and injured patients. The proportion of performed ultrasound scans in all patients attended to by the rescue service team, the quality of the findings and the ultrasound-related changes in management approach and patient transport were evaluated.
In this prospective 18-month observational study, we documented all missions performed by rescue physicians with special training in emergency ultrasound (expert standard). These data were than analysed with regard to the ultrasound examinations. The ultrasound protocols used comprised Focussed Assessment with Sonography for Trauma (FAST), Prehospital Lung Ultrasound (PLUS) and Focused Echocardiography in Emergency Life support (FEEL). The quality of prehospital examinations was assessed by comparing the findings and diagnoses at the emergency site with those established in hospital. The changes in patient management and transport were documented using a standardized protocol.
A total of 99 (18.1%) emergency ultrasound examinations were performed during 546 callouts. The most common indications for prehospital emergency ultrasound were dyspnoea (n = 38; 38.4%), during cardiac arrest (n = 17/17.2%), fall (n = 12/12.1%) and high-speed trauma (n = 11/11.1%). The combinations of ultrasound examination protocols in the trauma group (n = 31; 31.3%) were: 1. FAST+FEEL+PLUS (n = 17; 54.8%). 2. FAST+PLUS (n = 11; 35.5%) 3. FAST alone (n = 3; 9.7%). In the non-trauma group (n = 68; 68.7%), the following combinations were used: 1. FEEL+PLUS (n = 36; 52.9%), 2. FEEL alone (n = 21/30.9%). 3. PLUS alone (n = 6/8.8%) 4. FAST alone (n = 2; 2.9%) 5. FAST+FEEL+PLUS (n = 2; 2.9%). 6. FAST+FEEL (n = 1/1.5%). The emergency ultrasound findings impaired left ventricular contractile function (sensitivity 89.4%), right ventricular stress (85.7%), lung interstitial syndrome (100%), ruling out pneumothorax (specificity 100%), ruling out intraabdominal fluid (97,1%) were verified at the receiving hospital using ultrasonography, CT scan or x-rays; the prehospital diagnosis was confirmed in 90.8% of cases, the difference between the prehospital and in-hospital findings were not significant(p-values from p = 0.688 to p = 0,99). Ultrasound-related changes in patient management occurred in 49.5% of patients; in 33.3%, these were transported-related.
Emergency ultrasound was as often used in the prehospital situation as it is in hospital. The ultrasound findings correlated well with in-hospital diagnostic results. Significant pathology changed patient-management, without prolonging the mission time.
在院前环境中，救援医师可用的诊断工具有限。急诊超声已被证明是一种有用的诊断工具，可为危重症和受伤患者的管理提供关键信息。评估了在救援服务团队照顾的所有患者中进行的超声扫描比例、检查结果的质量以及与管理方法和患者转运相关的超声检查结果的变化。
在这项前瞻性的 18 个月观察研究中，我们记录了接受过急诊超声（专家标准）特殊培训的救援医师执行的所有任务。然后，根据超声检查来分析这些数据。使用的超声协议包括创伤重点评估超声检查（FAST）、院前肺超声（PLUS）和紧急生命支持下的焦点超声心动图（FEEL）。通过将现场检查结果与医院建立的结果进行比较来评估院前检查的质量。使用标准化协议记录患者管理和转运的变化。
在 546 次呼叫中，共进行了 99 次（18.1%）紧急超声检查。院前紧急超声检查最常见的指征是呼吸困难（n=38；38.4%）、心脏骤停时（n=17/17.2%）、跌倒（n=12/12.1%）和高速创伤（n=11/11.1%）。在创伤组（n=31；31.3%）中，超声检查方案的组合是：1. FAST+FEEL+PLUS（n=17；54.8%）。2. FAST+PLUS（n=11；35.5%）3. FAST 单独（n=3；9.7%）。在非创伤组（n=68；68.7%）中，使用了以下组合：1. FEEL+PLUS（n=36；52.9%），2. FEEL 单独（n=21/30.9%）。3. PLUS 单独（n=6/8.8%）4. FAST 单独（n=2；2.9%）5. FAST+FEEL+PLUS（n=2；2.9%）。6. FAST+FEEL（n=1/1.5%）。在接收医院使用超声、CT 扫描或 X 射线检查证实了紧急超声检查结果显示左心室收缩功能障碍（敏感性 89.4%）、右心室压力（85.7%）、肺间质综合征（100%）、排除气胸（特异性 100%）、排除腹腔积液（97.1%）；院前诊断在 90.8%的病例中得到证实，院前和院内检查结果之间无显著差异（p 值从 p=0.688 到 p=0.99）。在 49.5%的患者中，超声检查结果导致了患者管理的改变；在 33.3%的情况下，这些改变与转运有关。
在院前环境中，急诊超声的使用频率与院内相同。超声检查结果与院内诊断结果相关性良好。显著的病理改变了患者的管理方式，而不会延长任务时间。
