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Systematic training in focused cardiopulmonary ultrasound affects decision-making in the prehospital setting - two case reports.

Jakobsen LK, Bøtker MT, Lawrence LP, Sloth E, Knudsen L - Scand J Trauma Resusc Emerg Med (2014)

Bottom Line: We present two cases from the Helicopter Emergency Medical Services (HEMS) in Denmark, in which prehospital physicians trained in cardiac ultrasound (FATE) disclosed significant pathology that induced a radical change for the critical patient's course.

View Article: PubMed Central - HTML - PubMed

Affiliation: Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark. lars.knudsen@dadlnet.dk.

ABSTRACT
We present two cases from the Helicopter Emergency Medical Services (HEMS) in Denmark, in which prehospital physicians trained in cardiac ultrasound (FATE) disclosed significant pathology that induced a radical change for the critical patient's course.

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Related in: MedlinePlus

Subcostal 4-chamber view – pulmonary embolism and normal. A: Subcostal 4-chamber view - pulmonary embolism. Notice the dilated right ventricle and bulging of the septum into the left ventricle in the pathological echocardiogram because of the increased pressure in the right ventricle (arrows). The pattern of the septum can often be seen even when image-quality is low. B: Subcostal 4-chamber view – normal. RA = Right Atrium, RV = Right Ventricle, LA = Left Atrium, LV = Left Ventricle.
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Figure 1: Subcostal 4-chamber view – pulmonary embolism and normal. A: Subcostal 4-chamber view - pulmonary embolism. Notice the dilated right ventricle and bulging of the septum into the left ventricle in the pathological echocardiogram because of the increased pressure in the right ventricle (arrows). The pattern of the septum can often be seen even when image-quality is low. B: Subcostal 4-chamber view – normal. RA = Right Atrium, RV = Right Ventricle, LA = Left Atrium, LV = Left Ventricle.

Mentions: FATE examination disclosed a dilated right ventricle with characteristic septum shift towards the left ventricle in both subcostal and apical 4 chambers views and a D-shaped compromised left ventricle in systole in parasternal cross-section view (Figures 1 and2). These are typical signs of a pulmonary embolism that leads to hemodynamic compromise. Based on the ultrasound examination, a radical change in the course for the patient followed. Prehospital heparinization (10.000 units of standard unfractionated heparin), and triage directly to specialized cardiologic department for thrombolysis was initiated. Shortly after admission to the hospital, computed tomography confirmed the diagnosis. Thrombolytic therapy was initiated within 2 hours after the emergency call to the EMCC. Four hours after the emergency call, the patient was without subjective symptoms and had normalized vital parameters. Long-term anticoagulation therapy was initiated. The patient recovered completely.


Systematic training in focused cardiopulmonary ultrasound affects decision-making in the prehospital setting - two case reports.

Jakobsen LK, Bøtker MT, Lawrence LP, Sloth E, Knudsen L - Scand J Trauma Resusc Emerg Med (2014)

Subcostal 4-chamber view – pulmonary embolism and normal. A: Subcostal 4-chamber view - pulmonary embolism. Notice the dilated right ventricle and bulging of the septum into the left ventricle in the pathological echocardiogram because of the increased pressure in the right ventricle (arrows). The pattern of the septum can often be seen even when image-quality is low. B: Subcostal 4-chamber view – normal. RA = Right Atrium, RV = Right Ventricle, LA = Left Atrium, LV = Left Ventricle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4016794&req=5

Figure 1: Subcostal 4-chamber view – pulmonary embolism and normal. A: Subcostal 4-chamber view - pulmonary embolism. Notice the dilated right ventricle and bulging of the septum into the left ventricle in the pathological echocardiogram because of the increased pressure in the right ventricle (arrows). The pattern of the septum can often be seen even when image-quality is low. B: Subcostal 4-chamber view – normal. RA = Right Atrium, RV = Right Ventricle, LA = Left Atrium, LV = Left Ventricle.
Mentions: FATE examination disclosed a dilated right ventricle with characteristic septum shift towards the left ventricle in both subcostal and apical 4 chambers views and a D-shaped compromised left ventricle in systole in parasternal cross-section view (Figures 1 and2). These are typical signs of a pulmonary embolism that leads to hemodynamic compromise. Based on the ultrasound examination, a radical change in the course for the patient followed. Prehospital heparinization (10.000 units of standard unfractionated heparin), and triage directly to specialized cardiologic department for thrombolysis was initiated. Shortly after admission to the hospital, computed tomography confirmed the diagnosis. Thrombolytic therapy was initiated within 2 hours after the emergency call to the EMCC. Four hours after the emergency call, the patient was without subjective symptoms and had normalized vital parameters. Long-term anticoagulation therapy was initiated. The patient recovered completely.

Bottom Line: We present two cases from the Helicopter Emergency Medical Services (HEMS) in Denmark, in which prehospital physicians trained in cardiac ultrasound (FATE) disclosed significant pathology that induced a radical change for the critical patient's course.

View Article: PubMed Central - HTML - PubMed

Affiliation: Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark. lars.knudsen@dadlnet.dk.

ABSTRACT
We present two cases from the Helicopter Emergency Medical Services (HEMS) in Denmark, in which prehospital physicians trained in cardiac ultrasound (FATE) disclosed significant pathology that induced a radical change for the critical patient's course.

Show MeSH
Related in: MedlinePlus