Premier niveau de compétence pour l’échographie clinique en médecine d’urgence. Recommandations de la Société française de médecine d’urgence par consensus formalisé

Duchenne, J.; Martinez, M.; Rothmann, C.; Claret, Pierre‐Géraud; Desclefs, Jean-Philippe; Vaux, J.; Miroux, Patrick; Ganansia, O.

doi:10.1007/s13341-016-0649-5

Cited by 32 publications

(17 citation statements)

References 72 publications

(82 reference statements)

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“…Although it was initially considered as marginal, ultrasound has become an indispensable diagnostic tool for the emergency physician of today and most likely for the general practitioner of tomorrow. There are abundant scientific publications regarding its use in civilian emergency medicine9–13 and military medicine14–18 over the past 10 years; therefore, some colleges of emergency medicine have published official recommendations19 20 to define indications and levels of competence required for its use. In fact, the training of non-specialist physicians was quite disparate until recently.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of point-of-care ultrasound in military medical emergencies performed by young military medicine residents

Perrier¹,

Leyral

Thabouillot

et al. 2019

BMJ Mil Health

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IntroductionTo evaluate the usefulness of point-of-care ultrasound (POCUS) performed by young military medicine residents after short training in the diagnosis of medical emergencies.MethodsA prospective study was performed in the emergency department of a French army teaching hospital. Two young military medicine residents received ultrasound training focused on gall bladder, kidneys and lower limb veins. After clinical examination, they assigned a ‘clinicaldiagnostic probability’ (CP) on a visual analogue scale from 0 (definitely not diagnosis) to 10 (definitive diagnosis). The same student performed ultrasound examination and assigned an ‘ultrasounddiagnostic probability’ (UP) in the same way. The absolute difference between CP and UP was calculated. This result corresponded to the Ultrasound Diagnostic Index (UDI), which was positive if UP was closer to the final diagnosis than CP (POCUS improved the diagnostic accuracy), and negative conversely (POCUS decreased the diagnostic accuracy).ResultsForty-eight patients were included and 48 ultrasound examinations were performed. The present pathologies were found in 14 patients (29%). The mean UDI value was +3 (0–5). UDI was positive in 35 exams (73%), zero in 12 exams (25%) and negative in only one exam (2%).ConclusionPOCUS performed after clinical examination increases the diagnostic accuracy of young military medicine residents.

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Section: Discussionmentioning

confidence: 99%

Usefulness of point-of-care ultrasound in military medical emergencies performed by young military medicine residents

Perrier¹,

Leyral

Thabouillot

et al. 2019

BMJ Mil Health

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“…Les médecins bénéficient également d'un stage d'apprentissage de l'échographie durant lequel sont appris l'eFAST (extended focused assessment with sonography for trauma) et des notions utiles pour gérer les urgences médicales en milieu isolé correspondant au premier niveau de compétence en échographie clinique [4,5]. L'échographie, que ce soit pour un patient isolé ou dans le cas de situations multivictimes avec nécessité d'un triage médical, a su s'imposer dans la médicalisation de l'avant dans les derniers théâtres d'opérations où l'étendue géographique des zones de conflit augmente les délais d'évacuation.…”

Section: éChographie En Médecine Militaireunclassified

“…Le diagnostic repose essentiellement sur l'échographie cardiaque transthoracique en analysant le péricarde en coupe sous-xyphoïdienne. Cet examen, qui a une excellente valeur diagnostique [5], met en évidence en cas de tamponnade un épanchement circonférentiel responsable d'abord d'une compression des cavités droites pouvant aller jusqu'au swinging heart [26]. Le collapsus de l'oreillette droite constitue un signe de prétamponnade.…”

Section: Tamponnade Péricardiqueunclassified

Intérêt de l’échographie dans la prise en charge du blessé de guerre dyspnéique

Martin

Fogelman

Dubecq³

et al. 2018

Ann. Fr. Med. Urgence

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La médecine militaire s'adapte aux dernières évolutions médicales, et l'échographie s'inscrit désormais dans les algorithmes de prise en charge des blessés de guerre. Grâce à la plus-value apportée à la clinique dans l'évaluation des blessés associée à l'amélioration des performances et à la miniaturisation des appareils, le positionnement de l'échographie en médecine de guerre a évolué pour trouver sa place « à l'avant », parfois dans des conditions sanitaires très dégradées. Après avoir rappelé les principes du secourisme au combat pour le blessé de guerre dyspnéique, cet article replace l'intérêt diagnostique et thérapeutique de l'échographie dans la « médecine de l'avant » en détaillant la sémiologie échographique des principales pathologies du blessé de guerre dans la phase de réanimation préhospitalière. L'article souligne aussi l'importance opérationnelle qu'occupe l'échographie, que ce soit sur le terrain lors des évacuations sanitaires ou lors d'afflux massif de victimes. Certains aspects de la doctrine militaire d'emploi pourraient s'adapter à la pratique en préhospitalier ou lors des situations d'exception en métropole. Mots clés Échographie • Blessé de guerre • Réanimation préhospitalière Abstract Military medicine follows medical evolutions in order to optimize the management of war-wounded patients. The ultrasound device is a powerful tool capable of providing additional information to the clinical examination. Its performance and miniaturization permit to transfer it at the battle field and to include it in the "forward medicalization". This article reminds principles of tactical combat casualty care for patient with a dyspnea and, explain the place that sonography can take to confirm a diagnosis. It explains the ultrasound semiology of main pathologies and underlines the operational impact of sonography during a large influx of injured patients and during the medical evacuation. This military practice can be adapted to prehospital care or to an uncommon situation like terrorism attack.

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“…Venous limited compression ultrasonography (VLCU) is recommended by the American College of Emergency Physicians [1] and by other Societies like the French Society of Emergency Medicine [2] in the evaluation of suspicion of deep venous thrombosis (DVT). This simplified exam coupled with d-dimer testing was successfully evaluated versus whole leg color-coded Doppler ultrasonography (WLCU) in a randomized controlled trial [3].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of short training session for venous limited compression ultrasonography: prospective multicenter study

Javaudin

Seon²,

Bastard

et al. 2020

Ultrasound J

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Background: Venous limited compression ultrasonography (VLCU) is recommended in case of suspicion of deep venous thrombosis (DVT). Current training pathways are rather long and include experiential phase. This aim of this study was to investigate the efficacy of a short training session for VLCU without experiential phase. The training session was applied in residents without previous ultrasound skills. Program included operation of ultrasound device and interpretation of venous images. Included patients were older than 18 years and had a suspicion of DVT. After realization of VLCU using usual technique, residents reported the dynamic compressibility of the femoral and popliteal veins, the presence or not of a visible thrombus, self-reported difficulty and duration. Patients then underwent a whole leg ultrasonography (WLCU) in the local laboratory which was blinded to VLCU results. The main criterion was the negative-predictive value (NPV) of VLCU for the absence of proximal DVT diagnosed with WLCU. Secondary criteria were VLCU diagnostic performances, rate of inability to conclude, difficulty and duration. For a NPV of 95 ± 6%, the needed number of patients was 96. This study was approved by the ethical committee. Results: 102 patients were analyzed. 46 residents were trained. A DVT was diagnosed by WLCU in 18 patients (prevalence of 17.6% [95% CI 11-26%]). VLCU detected 15 DVT (NPV of 96% [95% CI 89-99%]). The positive likelihood ratio was 9.9, the negative likelihood ratio 0.19 and Cohen's Kappa 0.62 [95% CI 0.52-0.71]. The sensitivity was 83% [CI 95% 60-94%] and specificity 88% [CI 95% 79-93%]. The mean number of VLCU by residents was 2.3 ± 2.1, median 2 (minimum 1, maximum 8). Mean duration was 3.4 min, difficulty was 3.7 ± 2. Conclusion: The principal objective, NPV 96% [95% CI 89-99%], was achieved. However, this short training session was inadequate to allow ruling-out a DVT with sufficient security. Thus, the experiential phase seems to be essential.

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Premier niveau de compétence pour l’échographie clinique en médecine d’urgence. Recommandations de la Société française de médecine d’urgence par consensus formalisé

Cited by 32 publications

References 72 publications

Usefulness of point-of-care ultrasound in military medical emergencies performed by young military medicine residents

Usefulness of point-of-care ultrasound in military medical emergencies performed by young military medicine residents

Intérêt de l’échographie dans la prise en charge du blessé de guerre dyspnéique

Evaluation of short training session for venous limited compression ultrasonography: prospective multicenter study

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