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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

Reversed apical 4-chamber view – pericardial effusion. Pathological reversed apical 4-chamber view (the transducer is rotated 180 degrees compared to the classical apical 4-chamber view) from patient with aortic dissection and pericardial effusion. E = Effusion (blood), C = Clot, LV = Left Ventricle.
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Figure 3: Reversed apical 4-chamber view – pericardial effusion. Pathological reversed apical 4-chamber view (the transducer is rotated 180 degrees compared to the classical apical 4-chamber view) from patient with aortic dissection and pericardial effusion. E = Effusion (blood), C = Clot, LV = Left Ventricle.

Mentions: Because of the diverging symptoms, a FATE examination was done. Somewhat surprisingly, this disclosed a large pericardial effusion (Figure 3). Based on this finding, aortic dissection was suspected. Because of an obvious need to reduce time to definite treatment, no further efforts were done to visualize the thoracic aorta. Again, based on the ultrasound findings, a radical change in the course for the patient followed. Instead of referral for thrombolysis at a nearby hospital, the patient was admitted to an invasive heart center 130 km away. Echocardiography and computed tomography of the thorax confirmed a dilated aorta that had perforated into the pericardium and dissected up into the right carotid artery. During the 25 minutes transportation time with HEMS, the receiving hospital was able to prepare an operating theater. After supplemental imaging, emergency surgery with replacement of the disrupted part of aorta was performed. The patient was discharged with minimal cognitive dysfunction due to perioperative cerebral ischemia, but with no physical sequelae.


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)

Reversed apical 4-chamber view – pericardial effusion. Pathological reversed apical 4-chamber view (the transducer is rotated 180 degrees compared to the classical apical 4-chamber view) from patient with aortic dissection and pericardial effusion. E = Effusion (blood), C = Clot, 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 3: Reversed apical 4-chamber view – pericardial effusion. Pathological reversed apical 4-chamber view (the transducer is rotated 180 degrees compared to the classical apical 4-chamber view) from patient with aortic dissection and pericardial effusion. E = Effusion (blood), C = Clot, LV = Left Ventricle.
Mentions: Because of the diverging symptoms, a FATE examination was done. Somewhat surprisingly, this disclosed a large pericardial effusion (Figure 3). Based on this finding, aortic dissection was suspected. Because of an obvious need to reduce time to definite treatment, no further efforts were done to visualize the thoracic aorta. Again, based on the ultrasound findings, a radical change in the course for the patient followed. Instead of referral for thrombolysis at a nearby hospital, the patient was admitted to an invasive heart center 130 km away. Echocardiography and computed tomography of the thorax confirmed a dilated aorta that had perforated into the pericardium and dissected up into the right carotid artery. During the 25 minutes transportation time with HEMS, the receiving hospital was able to prepare an operating theater. After supplemental imaging, emergency surgery with replacement of the disrupted part of aorta was performed. The patient was discharged with minimal cognitive dysfunction due to perioperative cerebral ischemia, but with no physical sequelae.

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