Handheld Ultrasound

[ERDoc]

"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.

[MCSOU]

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.

[ERDoc]

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).

[Just Plain Ruff]

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.

[Arctickat]

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 May 20, 2015 by Arctickat

[Just Plain Ruff]

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

[MCSOU]

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.

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.