209 Point-of-Care Ultrasound Use Changes Care When Utilized by Flight Medics

Abstract

Point-of-care ultrasound (POCUS) has become a widely used tool in emergency medicine. With it, one can quickly diagnose a wide range of pathologies very quickly. In the most acutely ill, quickly identifying pericardial effusion with tamponade, pneumothorax, or hemoperitoneum can allow for life-saving changes in care. Each of those pathologies can be identified quickly with ultrasound. While now commonplace in emergency departments, the benefits of POCUS are just beginning to be realized in out-of-hospital settings. This is a retrospective study of POCUS use by flight nurses and paramedics after training in identification of pericardial effusion with tamponade, pneumothorax, and hemoperitoneum. The study aims to evaluate feasibility of implementing POCUS with a group of flight nurses and paramedics, and to evaluate adequacy of image acquisition and interpretation. In 2017, the flight nurses and paramedics of Lifelink III were trained by emergency physicians in ultrasound identification of pericardial effusion with tamponade, pneumothorax, and hemoperitoneum. This included bilateral lung, cardiac, and right-upper-quadrant (RUQ) abdominal windows. Qpath E was utilized for quality assurance review by ultrasound-trained emergency physicians. Retrospective chart review of cases in which ultrasound was utilized by the flight personnel was performed for cases between 10/1/2017 and 5/15/2018. Adequacy of images for interpretation, correctness of interpretation, and changes in management were assessed. During the study period, 96 ultrasound exams were submitted and evaluated for quality assurance. Images were adequate for evaluation in 86/96 (89.6%) of studies. Ultrasound was used to confirm return of spontaneous circulation in 2 cases of cardiac arrest, and for pulse checks on another cardiac arrest. Two trauma cases had a unilateral lack of lung sliding resulting in out-of-hospital decompression. Peritoneal fluid was seen in a trauma case, which resulted in tranexamic acid and blood being given. The findings of this study suggest that training flight nurses and paramedics in POCUS can be done successfully. POCUS use by such providers can lead to earlier diagnosis of dangerous pathologies and changes in care as a result of such diagnoses being made.