Ultrasound in HEMS: Its role in differentiating shock states

Accuracy of early rapid ultrasound in shock (RUSH) examination performed by emergency physician for diagnosis of shock etiology in critically ill patients

“…It seems that the examiners are good at finding signs of right ventricular strain in focused ultrasonography, after which they can direct their examination toward finding the possible underlying cause (pneumothorax, tamponade, or massive PTE). [ 2 6 10 ] There was only one case with obstructive shock due to pneumothorax (albeit later found in CT scan but not in supine chest X-ray); the pneumothorax itself was not diagnosed in the initial RUSH examination; however, the examiner could correctly outline that the shock state of the patient had obstructive features in the sonographic study.…”

“…Since ultrasound is becoming widely available in emergency departments (ED), many ultrasonographic protocols have been introduced to evaluate pulmonary or cardiac problems in emergent settings even replacing standard imaging modalities like supine chest X-ray or echocardiography. [ 1 2 3 4 5 6 7 ]…”

Acquisition and interpretation of focused diagnostic ultrasound images by ultrasound-naive advanced paramedics: trialling a PHUS education programme

“…Evidence exists to demonstrate the challenges in differentiating between causes of shock in the prehospital setting and also between cardiac or respiratory causes of breathlessness 30. In addition to pneumothorax assessment, ultrasound has been proved to aid diagnosis in both these scenarios 31 32. It may also be that ultrasound has the potential for assisting paramedics gain peripheral venous access in patient groups in which this proves challenging.…”

Limited bedside echocardiography by emergency physicians for diagnosis of diastolic heart failure

“…Rose et al 17 proposed a limited echocardiographic screening examination by emergency physicians in the evaluation of adult patients with undifferentiated hypotension. Plummer et al 18 showed that emergency physicians could detect pericardial effusion with resulting tamponade in a single view. Similarly, Moore et al 23 concluded that emergency physicians with focused training in echocardiography could accurately determine left ventricular function in hypotensive adult patients.…”