Post on 09-Jul-2020
2013 International Trauma Life Support Conference Vancouver, BC
Critical Ultrasound for pre-H trauma management
Is it about time?
2013 International Trauma Life Support Conference Vancouver, BC
Gianluca Ghiselli, MD Emergency Medicine Professor, Turin University Emergency Room Medical Director, Asti Hospital
WHO consultant for EMS restructuring project Italian Ministry of Health Intern. Dept. Consultant for
European EMS project
ITLS Board of Directors Member ITLS Italian Chapter Medical Director
No significant conflicts of interest or financial relationships to disclose
Critical Ultrasound for pre-H trauma management
2013 International Trauma Life Support Conference Vancouver, BC
That Helps to quickly identify life-treatening conditions as occult bleeding,
pnx Portable on ambulance,
HEMS, combact field, pts house….
No side effects
Easy to use
What if there was something:
2013 International Trauma Life Support Conference Vancouver, BC
The Big Questions
2013 International Trauma Life Support Conference Vancouver, BC
IS THERE SOME LIFE -THREATENING
CONDITION?
WHAT IS THE BEST HOSPITAL FOR THIS
PATIENT?
SCOOP AND RUN?
The Big Questions
STAY AND PLAY?
The probability of death increase approximately 1%
for every 3 minutes in the ED
Clarke, J Trauma, 2002
2013 International Trauma Life Support Conference Vancouver, BC
Hemorrhagic Shock remains the major cause of preventable death in trauma patients
Stopping hemorrhage remains a mainstay of
trauma care
Abdominal bleeding is the “big boss”
Critical Ultrasound for trauma
2013 International Trauma Life Support Conference Vancouver, BC
2013 International Trauma Life Support Conference Vancouver, BC
IDENTIFYING AND TREATING REVERSIBLE CAUSES OF
CARDIOPULMONARY ARREST
2013 International Trauma Life Support Conference Vancouver, BC
EMERGENCY ULTRASOUND GUIDELINES 2008
ATLS® 2004, 7a ed. â
FAST included in trauma
algorithms
2013 International Trauma Life Support Conference Vancouver, BC
A Prospective Study of Surgeon-Performed Ultrasound as the Primary Adjuvant Modality for
Injured Patient Assessment. Rozycki GS, Ochsner M, Gage M, et al, Journal of Trauma, 39(3):492-500,1995.
2013 International Trauma Life Support Conference Vancouver, BC
Cardiac Arrest and Hypotension US protocols
2013 International Trauma Life Support Conference Vancouver, BC
2013 International Trauma Life Support Conference Vancouver, BC
The RUSH Exam: Rapid Ultrasound in SHock in the Evaluation of the Critically Ill
Phillips Perera, T.Mailhot, D. Riley, D. Mandavia
THE “PUMP” THE “TANK” THE “PIPES”
2013 International Trauma Life Support Conference Vancouver, BC
2013 International Trauma Life Support Conference Vancouver, BC
2013 International Trauma Life Support Conference Vancouver, BC
Accuracy of prehospital focused abdominal sonography for trauma after a 1-day hands-on training course
F. Walcher, T. Kirschning, R. Breitkreutz et al, Emerg Med J 2010;27:345-349
Ultrasound in pre-hospital care Knudsen L, Sandberg M, Acta Anaesthesiol Scand 2011;55:377-378
Optimized management of polytraumatized patients by prehospital ultrasound Walcher F, Kortum S, Kirschning T, Weihgold N, Marzi I. Unfallchirurg.2002;105:986-94
Additional Studies
2013 International Trauma Life Support Conference Vancouver, BC
ONCE UPON A TIME…
CARDIAC ULTRASOUND
HEPATOBILIARY ULTRASOUND NECK
ULTRASOUND
RENAL ULTRASOUND
VEIN ULTRASOUND
PELVIC ULTRASOUND
2013 International Trauma Life Support Conference Vancouver, BC
RESPIRATORY DISTRESS
SHOCK ABDOMINAL
PAIN
TRAUMA
SYNCOPE
CHEST PAIN
ULTRASOUND IN…
2013 International Trauma Life Support Conference Vancouver, BC
GOAL-DIRECTED ABDOMINAL ULTRASONOGRAPHY: IMPACT ON REAL-TIME DECISION MAKING IN THE EMERGENCY DEPARTMENT D. Bassier, et all. J. Emerg Med , 24 :4, 2003
LOW CERTAINTY OF DISEASE 50 MODERATE CERTAINTY OF DISEASE HIGH CERTAINTY OF DISEASE
LOW CERTAINTY OF DISEASE
MODERATE CERTAINTY OF DISEASE 108
HIGH CERTAINTY OF DISEASE
LOW CERTAINTY OF DISEASE
MODERATE CERTAINTY OF DISEASE
HIGH CERTAINTY OF DISEASE 42
92
CLINICAL EVALUATION +“EU” CLINICAL EVALUATION (200 Paz.)
39
4
7
52
8
1
4
52
33
2013 International Trauma Life Support Conference Vancouver, BC
2013 International Trauma Life Support Conference Vancouver, BC
“ABCDE”
VISUAL MANAGEMENT vs
BLIND MANAGEMENT