Jump to content
Arctickat

Handheld Ultrasound

Recommended Posts

"Common features in patients who are awake include universal symptoms of chest pain and respiratory distress, with tachycardia and ipsilateral decreased air entry found in 50–75% of cases."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660039/

How comfortable are you with diagnosing a tension pnemo? Location to hospital doesn't matter if your patient requires decompression, but what if you are wrong?

Your US will not make a diagnosis of a tension pneumothorax. It will only identify a pneumothorax. This will quickly turn into one of those situations where someone has a new toy and overuses it. Not all pneumos need a needle or a chest tube. You can bet your ass that if this were introduced, there would be medics putting a needle into every pneumo, regardless of whether it is needed or not. Anyone that gets a needle ends up with a chest tube. You have now given a chest tube to someone who never needed one in the first place. Not to mention that the number of tensions are very small.

Share this post


Link to post
Share on other sites

You're willingness to be so combative in the face of a post you either didn't read or didn't comprehend is telling. A much simpler, and less confrontational, answer existed to the single question I posted to you.

I'm not sure where my post was confrontational but I apologize if it was taken that way. I accept debate and think of it was one of the best ways to research a subject and grow with it. Get to know me more than a single post and we can have an educational discussion on many things! Until then, cheers!

Your US will not make a diagnosis of a tension pneumothorax. It will only identify a pneumothorax. This will quickly turn into one of those situations where someone has a new toy and overuses it. Not all pneumos need a needle or a chest tube. You can bet your ass that if this were introduced, there would be medics putting a needle into every pneumo, regardless of whether it is needed or not. Anyone that gets a needle ends up with a chest tube. You have now given a chest tube to someone who never needed one in the first place. Not to mention that the number of tensions are very small.

While I agree to a degree many people will have the "new toy" stuck in their head and over use it I could say the same thing about nearly any advancement within medicine. With a solid education and quality assurance I think this can be reduced. Any while I agree the whole picture will make a diagnosis (at least I think this is what you are hinting to) a picture is worth a 1000 words. While a positive FAST doesn't always mean blood it can add to the clinical picture to dictate treatment paths.

Share this post


Link to post
Share on other sites

Except when that picture causes the pt to receive an invasive procedure that they didn't need in the first place. There are very few emergency indications for bedside US, even in the ER. I will agree that a FAST exam can change pt care in the field. In the proper setting (ie trauma), fluid in the belly means go to the trauma center. There are not very many services that allow pericardiocentesis. OB, eh. If they are pregnant and have anything that might be OB related you should be going to a properly equipped hospital anyway. Anything else is to reduce length of stay in the ER and not really necessary in the field (gallbladder, DVT, retina, etc).

Share this post


Link to post
Share on other sites

Go ahead, debate with me. I've already answered several questions/opposers on here, jump on in.

I believe that is what Mike is Referring to in his comment. :whistle:

Share this post


Link to post
Share on other sites

I'm with ERDoc on this...and it's my new toy. It's a simple case of treat the patient, not the machine. Just because I might see a Pneumo doesn't mean it'll get a dart. The patient's current presentation is the defining factor in my treatment decisions. I have two reasons for buying the U/S:

  1. Bypass the Doc in the Box direct to a trauma centre (Edit) In situations that warrant such measures, and the criteria are specific.
  2. monitor changes and let the trauma centre see any changes that may have occurred over the two hour transport time.
Edited by Arctickat

Share this post


Link to post
Share on other sites

Come on guys, my popcorn is going to waste here!!!!!

Share this post


Link to post
Share on other sites

Go ahead, debate with me. I've already answered several questions/opposers on here, jump on in.

I believe that is what Mike is Referring to in his comment. :whistle:

It wasn't a malicious intent, I'm welcoming debate, it helps us grow.

Except when that picture causes the pt to receive an invasive procedure that they didn't need in the first place. There are very few emergency indications for bedside US, even in the ER. I will agree that a FAST exam can change pt care in the field. In the proper setting (ie trauma), fluid in the belly means go to the trauma center. There are not very many services that allow pericardiocentesis. OB, eh. If they are pregnant and have anything that might be OB related you should be going to a properly equipped hospital anyway. Anything else is to reduce length of stay in the ER and not really necessary in the field (gallbladder, DVT, retina, etc).

Thats why you must take into account the whole clinical picture. Do you want a technician who says "I see picture, I stick needle" or a clinician who says "I have imaging, a physical exam and a presentation to match this diagnosis, here is my treatment."

I'm with ERDoc on this...and it's my new toy. It's a simple case of treat the patient, not the machine. Just because I might see a Pneumo doesn't mean it'll get a dart. The patient's current presentation is the defining factor in my treatment decisions. I have two reasons for buying the U/S:

  1. Bypass the Doc in the Box direct to a trauma centre (Edit) In situations that warrant such measures, and the criteria are specific.
  2. monitor changes and let the trauma centre see any changes that may have occurred over the two hour transport time.

I think we all agree even if a pt has a pnemo they may not necessarily get a needle decompression.

Share this post


Link to post
Share on other sites
This thread is quite old. Please consider starting a new thread rather than reviving this one.

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...