Inability to Assess Breath Sounds During Air Medical Transport by Helicopter

Hunt, Richard C.; Bryan, D M; Brinkley, V S; Whitley, Theodore W.; Benson, Nicholas H.

doi:10.1001/jama.1991.03460150086029

Cited by 65 publications

(10 citation statements)

References 2 publications

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“…Furthermore, in a prehospital setting, chest radiography is impossible, and auscultation is not always feasible. Therefore, PHUS might be a valuable tool to assess the airway [ 34 ].…”

Section: Diagnostic Applicationsmentioning

confidence: 99%

ABCDE of prehospital ultrasonography: a narrative review

et al. 2018

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Prehospital point-of-care ultrasound used by nonradiologists in emergency medicine is gaining ground. It is feasible on-scene and during aeromedical transport and allows health-care professionals to detect or rule out potential harmful conditions. Consequently, it impacts decision-making in prioritizing care, selecting the best treatment, and the most suitable transport mode and destination. This increasing relevance of prehospital ultrasonography is due to advancements in ultrasound devices and related technology, and to a growing number of applications. This narrative review aims to present an overview of prehospital ultrasonography literature. The focus is on civilian emergency (trauma and non-trauma) setting. Current and potential future applications are discussed, structured according to the airway, breathing, circulation, disability, and environment/exposure (ABCDE) approach. Aside from diagnostic implementation and specific protocols, procedural guidance, therapeutic ultrasound, and challenges are reviewed.Electronic supplementary materialThe online version of this article (10.1186/s13089-018-0099-y) contains supplementary material, which is available to authorized users.

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“…Furthermore, in a prehospital setting, chest radiography is impossible, and auscultation is not always feasible. Therefore, PHUS might be a valuable tool to assess the airway [ 34 ].…”

Section: Diagnostic Applicationsmentioning

confidence: 99%

ABCDE of prehospital ultrasonography: a narrative review

et al. 2018

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“…Noise levels in military and civilian transport helicopters, for example, routinely range from 90 to 111 decibels. 16 Evaluations of both amplified electronic and standard stethoscopes have concluded that breath sounds cannot be heard in flight. 16 Noise levels in many parts of the International Space Station (ISS) also are likely to preclude attempts at auscultation.…”

confidence: 99%

“…16 Evaluations of both amplified electronic and standard stethoscopes have concluded that breath sounds cannot be heard in flight. 16 Noise levels in many parts of the International Space Station (ISS) also are likely to preclude attempts at auscultation. 8 ' 12 Moreover, other monitors, such as capnography, represent more equipment that must be carried or loaded on already space/weight-limited vehicles.…”

confidence: 99%

Where's the Tube? Evaluation of Hand-held Ultrasound in Confirming Endotracheal Tube Placement

Chun¹,

Kirkpatrick²,

Sirois³

et al. 2004

Prehosp. Disaster med.

121

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Introduction:The diagnosis of endotracheal tube (ETT) mal-position may be delayed in extreme environments. Several methods are utilized to confirm proper ETT placement, but these methods can be unreliable or unavailable in certain settings. Thoracic sonography, previously utilized to detect pneumothoraces, has not been tested to assess ETT placement.Hypothesis:Thoracic sonography could correlate with pulmonary ventilation, and thereby, help to confirm proper ETT placement.Methods:Thirteen patients requiring elective intubation under general anesthesia, and data from two trauma patients were evaluated. Using a portable, hand-held, ultrasound (PHHU) machine, sonographic recordings of the chest wall visceral-parietal pleural interface (VPPI) were recorded bilaterally in each patient during all phases of airway management: (1) preoxygenation; (2) induction; (3) paralysis; (4) intubation; and (5) ventilation. Results: The VPPI could be well-imaged for all of the patients. In the two trauma patients, right mainstem intubations were noted in which specific pleural signals were not seen in the left chest wall VPPI after tube placement. These signs returned after correct repositioning of the ETT tube. In all of the elective surgery patients, signs correlating with bilateral ventilation in each patient were imaged and correlated with confirmation of ETT placement by anesthesiology.Conclusions:This report raises the possibility that thoracic sonography may be another tool that could be used to confirm proper ETT placement. This technique may have merit in extreme environments, such as in remote, prehospital settings or during aerospace medical transports, in which auscultation is impossible due to noise, or capnography is not available, and thus, requires further scientific evaluation.

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“…An HEMS physician must be prepared to perform duties routinely performed by ancillary personnel in the ED (starting intravenous access, administering drugs, packaging the patient for transport, ventilator set-up and management). Likewise, providing care in the HEMS environment offers challenges not experienced in the ED: limited space and resources, inability to examine the whole patient, inability to auscultate, 4 and dependency on monitoring and communication equipment. These are all issues for which the resident must be adequately prepared and which are not extensively covered as part of the EM curriculum.…”

Section: Discussionmentioning

confidence: 99%