A deep dive into the use of point-of-care
sonography in the field
By Faizan H. Arshad, MD
You’re working on an ALS unit dis- patched to an unconscious patient who is now in cardiac arrest. First
responders work in concert to administer
high-performance CPR.
As you enter the home and lay eyes on your
patient, a colleague gives you a brief report
and concludes that the automated external
defibrillator (AED) advised not to deliver a
shock.
You and your partner quickly ensure that
effective CPR is underway. You gain vascu-
lar access and push epinephrine and, without
compression interruption, establish an advanced
airway. Your end-tidal carbon dioxide is cali-
brating and, during the next rhythm check, you
quickly ascertain that the patient still lacks a
palpable pulse.
High-performance CPR is continued as
you transition the patient to your monitor.
At first glance, you see what appears to be
an organized narrow complex rhythm at a rate
of 95 beats per minute, although your patient
still lacks a palpable pulse.
As your own heart rate begins to rise, you
deftly wipe away the sweat from your brow and
contemplate the next intervention.
How do you organize the limited physiologic and historic data you’ve acquired over
the last few minutes? You decide to refine your
protocol to follow the ACLS algorithm for
pulseless electrical activity (PEA).
After intubating, you notice the left chest
wall isn’t rising. Is this evidence of a tension
pneumothorax from positive pressure ventilation, or could it be a right main-stem intubation? Should you needle decompress?
ULTRASOUND IN THE
RESUSCITATION TOOLKIT
Sonar technology was invented in the early
20th century to guide ships through turbulent waters and to help avoid hitting icebergs.
Today, the technology has evolved into a
highly effective, portable and relatively durable means of gaining otherwise “invisible”
information at the patient’s side. In 2004, the
American Institute of Ultrasound Medicine
(AIUM) held a conference on compact ultrasonography and concluded that an “ultrasound
stethoscope is rapidly moving from theoretical to reality.”
1
Once the exclusive domain of radiology,
cardiology and obstetrics, emergency physicians have brought ulrasound technology to the
bedside of their sickest patients to help answer
Prehospital ultrasound has many clinical applications that may reduce morbidity and potentially improve
outcomes for patients with life-threating conditions. Photo courtesy Centre for Emergency Health Sciences
