Manual of Austere and Prehospital Ultrasound

Description

Focuses specifically on ultrasound in prehospital and austere environments Discusses prolonged field care and extended austere operations Accessible not only to medical doctors but also non-physicians who use ultrasound Includes contributions from subject matter experts in prehospital, special operations, and austere environments Introduction to Manual Introduction Contents Contributors Part I: Introduction and Background Physics and Knobs Introduction Principles Image Optimization Probe Selection Depth Gain Focal Zone Artifacts Shadowing Reverberation Mirror Artifact Edge Artifact Posterior Enhancement Aliasing Image Acquisition/Probe Movements Part II: Introduction to Considerations for Specific Environments Ground Emergency Medical Services Introduction Cost Volunteer and Career Considerations Medical Director Oversight Conclusion Helicopter Emergency Medical Services References Military Special Operations and Prolonged Field Care Chapter Content References Considerations for Ultrasound in the Urban Search and Rescue (USAR) Environment Introduction The USAR Medical Team Ultrasound in the USAR Environment Clinical Indications: Undifferentiated Shock Clinical Indications: Renal Perfusion and Crush Syndrome Clinical Indications: Undifferentiated Dyspnea Conclusions References Part III: Introduction to Diagnostic Studies Shortness of Breath Introduction Anatomy Image Acquisition and Interpretation Terminology A-Lines B-Lines Transducer Selection Positioning and Anatomic Considerations Standard Lung Ultrasound Views Pathology Pneumothorax Pulmonary Contusions Pulmonary Edema Pleural Effusions Pneumonia Future Opportunities for Research Chest Pain Introduction Anatomy Image Acquisition and Interpretation Probe Selection Positioning and Anatomic Considerations Standard Echocardiographic Views Parasternal Views Long Axis Short Axis Apical Four Chamber Subxiphoid Suprasternal Pathology Decreased Left Ventricular Ejection Fraction RV Enlargement Pericardial Effusion & Cardiac Tamponade Regional Wall Motion Abnormality Aortic Dissection Pearls and Pitfalls Future Opportunities for Research Works Cited Key Literature Trauma Introduction Image Acquisition Pericardium Lung Right Upper Quadrant Left Upper Quadrant Suprapubic Long Bone Pubic Symphysis Abnormal Images Pericardium Lung Peritoneum Long Bone Fracture Pubic Symphysis (Open Book Pelvis Injury) Limitations of Current Knowledge and Opportunities for Future Research Key Literature Reviewed Undifferentiated Hypotension Introduction Rapid Ultrasound in SHock (RUSH) Deep Venous Thrombosis Aorta Strengths of the RUSH Exam Limitations of the RUSH Exam Fluid Administration Limited by Lung Sonography (FALLS) Protocol: Towards Sonography Driven Interventions Volume Procedures Pressors Transport and Disposition Limitation of Current Knowledge and Future Opportunities Conclusions References Advanced Diagnostic Topic for Austere Providers: Abdominal Pain Topic Discussion Right Upper Quadrant/Gallbladder Indication Image Acquisition Pathology Key Literature Limitations of Current Knowledge and Opportunities for Further Research Kidney Stones (Nephrolithiasis) Indication Image Acquisition Pathology Key Literature Limitations of Current Knowledge and Opportunities for Further Research Abdominal Aortic Aneurysm Indications Image Acquisition Pathology Key Literature Limitations of Current Knowledge and Opportunities for Further Research Small Bowel Obstruction Indications Image Acquisition Pathology Key Literature Limitations of Current Knowledge and Opportunities for Further Research Appendicitis Indications Image Acquisition Pathology Key Literature Limitations of Current Knowledge and Opportunities for Further Research Conclusion References Advanced Diagnostic Topic for Austere Providers: Ocular Introduction Topic Discussion General Strategy Anatomy POCUS Evaluation of the Eye Vitreous Hemorrhage (VH) Posterior Vitreous Detachment (PVD) Retinal Tear and Detachment (RD) Optic Nerve Edema/Elevated Intracranial Pressure Globe Rupture Penetrating Foreign Body Lens Dislocation or Subluxation Discussion of the Literature Limitations of the Current Literature References Advanced Diagnostic Topic for Austere Providers: Obstetric Introduction Topic Discussion General Strategy Anatomy Ultrasound Evaluation for Intrauterine Pregnancy (IUP) Ultrasound Evaluation of Free Fluid in the Pelvis and Abdomen Obtaining Fetal Heart Tones (FHTs) Ultrasound for Determination of Fetal Presentation Key Literature Reviewed Limitations of Current Knowledge and Opportunities for Future Research References Advanced Diagnostic Topic for Austere Providers: Skin and Soft Tissue Introduction Equipment Considerations Technique Cellulitis Abscess Foreign Body Limitations of Current Knowledge and Opportunities for Future Research Key Literature Reviewed Advanced Diagnostic Topic for Austere Providers: Skeletal Trauma Introduction Topic Discussion Basic Musculoskeletal Sonographic Technique Anatomy Diagnosis of Bony Fracture Diagnosis of Muscle/Tendon Injury Diagnosis of Joint Effusions Diagnosis and Reduction of Joint Dislocation Basic Technique Intra-articular Nerve Block Key Literature Reviewed Limitations of Current Knowledge and Opportunities for Future Research References Part IV: Introduction to Monitoring Ultrasound Guidance of Resuscitation in Shock Introduction Discussion Brief Review of POCUS Protocols Used to Determine the Etiology of Shock POCUS for Ultrasound-Informed Resuscitation Limited Cardiac Ultrasound Assessment and Management Pericardial Effusion Assessment and Management Left Ventricular Ejection Function (LVEF) Assessment and Management Right Heart Strain and Management Inferior Vena Cava (IVC) Assessment and Management Lung Assessment and Management FALLS Protocol Advanced POCUS Applications for Assessment of Fluid Responsiveness Passive Leg Raise (PLR) Stroke Volume (SV) and the Left Ventricular Outflow Tract (LVOT) - Velocity Time Integral (VTI) Putting It All Together Integration of Cardiac, IVC, & Lung Ultrasound into Resuscitation of Pre-hospital Patients in Shock Future Directions Artificial Intelligence (AI) 3D IVC Ultrasound Carotid Blood Flow and Corrected Carotid Flow Time Bibliography Endotracheal Tube Placement Introduction Topic Discussion Key Literature Reviewed Limitations of Current Knowledge and Opportunities for Future Research Out-of-Hospital Provider Application Endotracheal Tube Depth References Intracranial Pressure Evaluation References Bladder Volume and Assessment of Hydronephrosis Introduction Topic Discussion Procedure Literature Review References Part V: Introduction to Procedures Vascular Access Introduction Anatomy Procedure Limitations Complications Pediatric Applications Device Selection Conclusion References Pericardiocentesis Introduction Topic Discussion Ultrasound for Recognition of Tamponade Physiology Ultrasound for Procedural Guidance Key Literature Reviewed Limitations of Current Knowledge and Opportunities for Future Research Procedure Performance Indications Contraindications Preparation Procedure Ultrasound Analgesia Needle Insertion & Aspiration Securing the Catheter Repeat Aspiration Pericardiocentesis Catheter (Optional) References Surgical Cricothyroidotomy Introduction Topic Discussion General Strategy Ultrasound Evaluation of the Trachea Site Marking Performing Surgical Cricothyrotomy Review of the Literature Limitations of Current Literature References Advanced Procedure Topic for Austere Providers: Thoracentesis Introduction Discussion Thoracentesis Diagnosis Landmarks Contraindications Equipment Technique Key Literature Reviewed Limitations and Opportunities for Future Research References Advanced Procedure Topic for Austere Providers: Upper Extremity Nerve Blocks Introduction Common Blocks Interscalene Blocks Supraclavicular Block Infraclavicular Axillary Block Median Nerve Block Radial Nerve Block Ulnar Nerve Block Key Literature Reviewed Limitations of Current Knowledge and Opportunities for Future Research References Advanced Procedure Topic for Austere Providers: Lower Extremity Nerve Blocks Lower Extremity Nerve Blocks Introduction Local Anesthetics in Lower Extremity Nerve Blocks Nerve Anatomy of the Lower Extremity: A Primer Femoral Nerve Block Indication and Background Anatomy Probe/Equipment Technique Popliteal Sciatic Nerve Block Indication and Background Anatomy Probe/Equipment Technique Ankle Block Indication and Background Anatomy Tibial Nerve Deep Peroneal Nerve Superficial Peroneal Nerve Saphenous Nerve Sural Nerve Probe/Equipment Technique Tibial Nerve Deep Peroneal Nerve Superficial Peroneal Nerve Saphenous Nerve Sural Nerve Hematoma Block Indication Anatomy Probe/Equipment Technique Key Literature Reviewed Limitations of Current Knowledge and Opportunities for Future Research Part VI: Training Initial Training, Credentialing, and Quality Assurance/Quality Improvement Processes Introduction Initial Training Program Goals and Requirements Credentialing Quality Assurance/Quality Improvement Process Conclusion Key Literature Care of Equipment Device Care and Protection Environmental Operating Conditions: Challenges Posed by the Prehospital Setting Connectivity and Maintaining Application-Based Platforms Protecting Patient Information References Index