Emergency Point-of-Care Ultrasound

Featuring contributions from internationally recognized experts in point-of-care sonography, Emergency Point-of-Care Ultrasound, Second Edition combines a wealth of images with clear, succinct text to help beginners, as well as experienced sonographers, develop and refine their sonography skills.

The book contains chapters devoted to scanning the chest, abdomen, head and neck, and extremities, as well as paediatric evaluations, ultrasound-guided vascular access, and more. An entire section is devoted to the syndromic approach for an array of symptoms and patient populations, including chest and abdominal pain, respiratory distress, HIV and TB coinfected patients, and pregnant patients. Also included is expert guidance on administering ultrasound in a variety of challenging environments, such as communities and regions with underdeveloped healthcare systems, hostile environments, and cyberspace.

Each chapter begins with an introduction to the focused scan under discussion and a detailed description of methods for obtaining useful images. This is followed by examples of normal and abnormal scans, along with discussions of potential pitfalls of the technique, valuable insights from experienced users, and summaries of the most up-to-date evidence.

Emergency Point-of-Care Ultrasound, Second Edition is a valuable working resource for emergency medicine residents and trainees, practitioners who are just bringing ultrasound scanning into their practices, and clinicians with many years of sonographic experience.

James A. Connolly, MBBS, FRCS (ed), FRCS (Glas), FCEM, CFEU is a Consultant in Emergency Medicine at Great North Trauma and Emergency Care Centre, Newcastle upon Tyne, UK.

Anthony J. Dean, MD is a Professor of Emergency Medicine and of Emergency Medicine in Radiology; and the Director of the Division of Emergency Ultrasonography at the University of Pennsylvania, Philadelphia, PA, USA.

Beatrice Hoffmann, MD, PhD, RDMS is Associate Professor of Emergency Medicine, Ultrasound Division Director, and Emergency Physician at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Robert D. Jarman, MBBS, MSc(Medical Ultrasound), FRCS(Ed), FRCEM(UK), FRCP(Ed), CFEU is a Consultant in Emergency Medicine at Royal Victoria Infirmary, Newcastle upon Tyne, UK; Visiting Professor and MSc Point-of-Care Ultrasound Lead at University of Teesside, Middlesbrough, UK.

List of Contributors x

About the Companion Website xvii

Introduction: What is Point-of-Care Ultrasound? 1
James A. Connolly, Anthony J. Dean, Beatrice Hoffmann and Robert D. Jarman

Part 1 Physics 5

1 How Does Ultrasound Work? 7
Heather Venables

Part 2 Ultrasound by Region 13

Thorax 14

2 Evaluation of the Chest Wall, Pleura and Lung 15
Gebhard Mathis and Anthony J. Dean

3 Point-of-Care Ultrasonography of the Thoracic Aorta 32
R. Andrew Taylor and Christopher L. Moore

4 Anatomy/Ultrasonography of the Heart 39
Conn Russell

5 Basic Point-of-Care Echocardiography: Interpretation and Haemodynamic Assessment 47
Craig Morris

6 Beyond Basic Point-of-Care Echocardiography 56
Sean Bennett

Abdomen 69

7 Ultrasound Assessment of the Abdominal Aorta in the Acute Setting 71
Simon Richards

8 Focussed Assessment with Sonography in Trauma – The FAST Exam 83
Rajat Gangahar

9 Advanced Gastrointestinal Ultrasound: Identifying Appendicitis, Pneumoperitoneum, Intussusception and Diverticulitis 101
Beatrice Hoffmann and Sara Damewood

10 Intravascular Volume Assessment by Ultrasound Evaluation of the Inferior Vena Cava 115
Anthony J. Dean

11 Emergency Ultrasound in First-Trimester Pregnancy 126
Andrew M. Kestler and John L. Kendall

12 Second- and Third-Trimester Pregnancy 143
Elena Skomorovsky, John Gullett and David C. Pigott

13 Gynaecological Ultrasound in Emergency Medicine: The Non-Pregnant Female Patient with Abdomino-Pelvic Pain 152
Martha Villalba and Michael Lambert

14 Focused Hepatobiliary Ultrasound 162
Resa Lewiss

15 Renal Ultrasound 175
Lisa Munro Davies

16 Ultrasound Evaluation of the Acute Scrotum 194
J. Matthew Fields

Extremities 203

17 The Lower Limb and the Upper Limb 205
David Lewis and John Gullett

18 Ultrasonography of Deep Venous Thrombosis 221
Joshua S. Rempell and Vicki E. Noble

19 Transcranial Doppler 233
John Gullett

20 Ocular Ultrasound 241
Anumeha Singh and Dietrich von Kuenssberg Jehle

21 Airway/Ear, Nose and Throat (ENT) Sonography 251
Barton Brown and Srikar Adhikari

Part 3 Paediatrics 259

22 Paediatric Musculoskeletal Point-of-Care Ultrasound 261
Paul Atkinson and Peter Ross

23 Point-of-Care Ultrasound in Paediatric and Neonatal Intensive Care 270
Mahmoud A. Elbarbary

24 Paediatric Abdominal Ultrasound 280
Jennifer R. Marin

Part 4 Adjunct to Practical Procedures 287

25 Ultrasound-Guided Vascular Access 289
Nova L. Panebianco

26 Pericardiocentesis, Paracentesis and Thoracentesis 296
David B. Richards

27 Suprapubic Aspiration and Catheterisation 302
Fernando Silva

28 Ultrasound in the Management of Fractures 307
Paul Atkinson and Peter Ross

29 Ultrasound-Guided (USG) Peripheral Nerve Block (PNB) 314
Jens Børglum and Kenneth Jensen

30 Foreign Body and Abscess 331
Erskine J. Holmes

31 Ultrasound of the Airway 337
Christopher T. Wall, Seth R. Strote, Liberty V. Caroon and Robert F. Reardon

Part 5 Syndromic Approach 347

32 Chest Pain and Dyspnea 349
Lawrence A. Melniker

33 Bedside Ultrasound as an Adjunct in the Evaluation and Management of Critically Ill Patients 355
Anthony J. Dean and Sarah A. Stahmer

34 Point-of-Care Ultrasound in Resuscitation and Cardiac Arrest: The FEEL Protocol 371
Elena Costantini, Peter M. Zechner, Frank Heringer, Colleen Cuca, Felix Walcher and Raoul Breitkreutz

35 Non-Invasive Haemodynamics 375
Erik Sloth, Christian Alcaraz Frederiksen and Peter Juhl-Olsen

36 Doppler Assessment of Haemodynamics 379
Brendan E. Smith and Veronica M. Madigan

37 Algorithmic Bedside Approach to the Major Trauma Patient in Extremis 386
Robert Arntfield and Andrew W. Kirkpatrick

38 A Syndromic Approach with Sonography to the Patient with Abdominal Pain 392
Jonathan Fischer and Pablo Aguillera

39 A Syndromic Approach to the Pregnant Patient 400
Joseph Wood

40 The Use of Ultrasound in Evaluating Dyspnoea/Respiratory Distress in Infants and Children 404
Roberto Copetti and Luigi Cattarossi

41 Point-of-Care Ultrasound for Human Immune-Deficiency Virus (HIV) and Tuberculosis (TB) Co-Infection: The FASH Scan 410
Hein Lamprecht

42 Fever and Ultrasound 418
Gabriel Simon and Beatrice Hoffmann

Part 6 Different Environments 423

43 The Role of Ultrasound in Pre-Hospital Care 425
Tim Harris, Adam Bystrzycki and Stefan M. Mazur

Appendix A1: Selected Protocols for Cardiac and Critical Care Ultrasound 440

44 Use of Ultrasound in Extreme or Hostile Environments (Online only) 454
Kenton Anderson

45 Setting Up an Ultrasound Programme in Underdeveloped Healthcare Systems (Online only) 462
Hein Lamprecht and John Sloan

Part 7 Administration (Online only) 471

46 Best Practice and Future Developments in Point-of-Care Ultrasound (Online only) 473
Robert D. Jarman

47 The Role of Phantoms and Simulation in Teaching Ultrasound Skills in Emergency Medicine (Online only) 479
Mike Wells and Lara Goldstein

48 Ultrasound in Undergraduate Medical Education (Online only) 487
Richard A. Hoppmann

49 Departmental Implementation: Setting up an Ultrasound Training Programme for Medical Students - Experience of Two Universities (Online only) 493
David C. Wherry and Mark W. Bowyer

50 Future of Point-of-Care Ultrasound (Online only) 503
Michael Blaivas

Appendix A2: Normal Ultrasound Values (Online only) 506
Phil Johnstone

Index 511

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