Dr Sanjeev Bhoi Emergency sonography. Empowering resuscitation

1. Emergency sonography. Empowering resuscitation
Brachial pl. Block in ED
Sea-Shore sign

2. 0BJECTIVE
Use of Emergency Sonography in
initial assessment and
management of an injured
person.

3. 0730hrs ED
AUTLS

4. How is EMED US different?
 Highly focused
 Limited Exam
 Goal directed exam
 Critically time dependent
AUTLS

5. Why US in EMED?
TIME CRITICAL
In a disease in which
there is a golden hour,
every minute counts!
AUTLS

6. Primary applications for emergency
ultrasound
ACEP Emergency Ultrasound Guidelines–2001
 Trauma ultrasound
 Emergency ultrasound in pregnancy
 Emergency echocardiography
 Abdominal aortic aneurysm
 Biliary ultrasound
 Renal ultrasound
 Procedural ultrasound AUTLS

7. Primary Application Range of Documented
and Outcome Reviewed
Ultrasound Needed for
Proficiency
Trauma 25 25-50
Emergency cardiac 25 25-50
AAA 25 25
Biliary 25 25-50
Renal 25 25
ACEP recommended training and
proficiency numerical goals per emergency
ultrasound application
AUTLS

8. Lets learn
ABCDE of Trauma
The ultrasound way
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9. Why the ultrasound way?

10. Ralls PW. Sonography in the 21st century.
J Ultrasound Med. 2001;20:87-88.
 It has been typically described as an
extension of the palpating hand and a
“visual” stethoscope during the
physical examination, providing both
anatomic and functional information
complementary to the routine physical
examination.
AUTLS

11. But Why the chain?
A (Airway) kills before B (Breathing)
and
C(Circulation) kills before D(Disability)
so
prioritize order of assessment
with
purpose to treat first that kills first
Emerg Radiol. 2007 July; 14(3): 135–141.
AUTLS

12. Ultrasound Algorithm
AUTLS

14. A
Airway Injuries
Threatened Airway
ET-Tube confirmation
Needle crico-thyroidotomy
Guided Tracheostomy

15. B Pneumothorax
Pleural collection/ Hemothorax
Lung contusion
Pulmonary edema
Pneumonia

16. C Focused ECHO
•Cardiac performance
•Pericardial Tamponde
Pulmonary Embolism
• E-FAST
• VASCULAR
• SOFT TISSUE INJURIES

17. D
E
CRANIAL USG
Pupillary Reflex
ONSD (Raised ICP)
Midline shift
Pediatric Cranial US
Miscellaneous
Fracture detection
Foreign body detection
Nerve Blocks