HEMS US Cynthia Griffin D.O., EMT-P University of Wisconsin - PowerPoint PPT Presentation

HEMS US Cynthia Griffin D.O., EMT-P University of Wisconsin Hospital & Clinics MedFlight Fellow 2014 VCU EM Residency Trained Virginia College of Osteopathic Medicine April 22, 2015 CCTMC, Charlotte NC

Objectives • To make you & US BFFs • To review the “Cut by glass method” • To explain the RUSH exam • To review ETT Confirmation using US • To discuss using ONSD for ICP eval • To go over abnormalities in ECHO

@ CMGrffn

AirRescue Volume 2, 2012

• 1 st – you must know anatomy • 2 nd - Probe marker – R or Head • Slice of Glass • Study & Label images

Hemoperitoneum Sns 46% , Spc 94.1% PTX Sns 18.7%, Spc 99.5% RN/EMT Crew w N=293 pts w 211 FAST

• 3 rd rock us

RUSH Protocol

HIMAP

8 9 1 2 3 4 7 5 7 7 6

Simple 90° turn of the probe

S/S Cardiac Tamponade on bedside ECHO: RA diastolic collapse RV diastolic collapse Dilated non-collapsing IVC

100mL

Other Exams w POCUS • Intubation: Direct or Static • Ocular: ONSD, Blowout • Wall motion abnormalities • Fxs

11 studies  969 intubations Sensitivity: 98% (95% C.I. 97-99%) Specificity: 98% (95% C.I. 95-99%) Positive Predictive Value: 99.5% Negative Predictive Value: 93.8% + Likelihood Ratio: 46 - Likelihood Ratio: 0.0157

Tube confirmation 40 s = US 48 s = Auscultation + ETCO2

POCUS = 30 s

↑ ICP

Fx

Case 1 • EMS “ Pt breathing hard all night” • 50 yo M diaphoretic, breathless, confused • HR 120 RR28 BP 88/50 SaO2 90% • What do we do Doctor?

Case 2 • EMS “ Pt breathing hard all night” • 50 yo M diaphoretic, breathless, confused • HR 120 RR28 BP 88/50 SaO2 90% • What do we do Doctor?

Case 3 • EMS “ Pt breathing hard all night” • 50 yo M diaphoretic, breathless, confused • HR 120 RR28 BP 88/50 SaO2 91% • What do we do Doctor?

Case 4 • EMS “ Pt breathing hard all night” • 50 yo M diaphoretic, breathless, confused • HR 120 RR28 BP 88/50 SaO2 90% • What do we do Doctor?

Summary Ultrasound is changing what we do in the ED and the data supports that US should be used in the prehosp environment There are a bunch of websites to help w US edu It takes time, but if you stick with it, it will blow your mind

Thanks for your attention… • Discussion & Questions

Great Refrences for US teaching • http://www.emergencyultrasoundteaching.co m/ • More references to follow