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Welcome to Wikipedia: check out the Teahouse!

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Hello! Dmresop, you are invited to the Teahouse, a forum on Wikipedia for new editors to ask questions about editing Wikipedia, and get support from peers and experienced editors. Please join us! Peter.C • talk • contribs 21:06, 26 September 2012 (UTC)[reply]

Welcome to Wikipedia!

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Hello, I am a member of Wikiproject Medicine and I just want to personally welcome you to Wikipedia. I saw that you were interested in expanding the emergency untrasound article. If you are interested I would be very happy to help guide you through the process of editing medical articles for the first time. If you are, just reply here. Peter.C • talk • contribs 21:06, 26 September 2012 (UTC)[reply]

Emergency Ultrasound

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Hello,

I first want to compliment you on your work on emergency ultrasound, however, due to some problems I reverted it. Honest to god, it was a great contribution in many ways to the article, but, it had many problems as it did not follow the Medical Manual of Style, so much so, that it read as unencyclopedic and more like a research article. Typically I would just rewrite it myself but I have been extremely busy as of yet. I want to highly encourage you to read the manual of style and make corrections and resubmit the article. I truly do not wish I had to do this and I would be more than welcome to answer any questions you have. Peter.C • talk • contribs 18:30, 3 October 2012 (UTC)[reply]

Thanks. And Whoops. Sorry I apparently went about this the wrong way. I was working with another emergency physician and we put together the content over the last two months. I will look at the Medical Manual of Style and try to get it back up. If you do not feel strongly about the original content, I will edit both together so it "flows" - Not sure what questions I'll have as I haven't looked at the manual yet. Dmresop (talk) 09:53, 4 October 2012 (UTC)[reply]


Me again!

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Try this on for size... I'd really like to keep the more detailed content...I can always divide it out later into more detailed pages... but I am working on simplifying it and using more internal links, fewer definitions. I hate to ask to do this, but I'd like to know if I'm on the wrong track. Can you skim this and tell me if it's okay? I still have to complete the editing, but I really want to know if I'm on the right track...Or if I still need to make major changes, what they are? Still too much info? I can scale it down a lot by removing most of the info...whatever we need to do to improve the page to make it more accurate. There's a bit of a time crunch as there is a national emergency ultrasound meeting next week and I'd really like to get it up by this weekend so I can get feedback from colleagues at the meeting. Thanks!Dmresop (talk) 15:07, 5 October 2012 (UTC)[reply] 

 RE-EDIT:

Emergency ultrasound is the application of ultrasound at the point of care to make immediate patient-care decisions. It is performed by the health care professional caring for the patient. This point-of-care use of ultrasound is often to evaluate an emergent medical condition, in settings such as an emergency department, critical care unit, ambulance, or combat zone. [1][2]

Emergency and point-of-care ultrasound is focused on a limited set of Emergency ultrasound is used to quickly diagnose a limited set of injuries or pathologic conditions,[3] specifically those where conventional diagnostic methods would either take too long or would introduce greater risk to the patient (either by transporting the patient away from the most closely monitored setting, or exposing them to ionizing radiation and/or intravenous contrast agents).[4]


Point of care ultrasound has been used in a wide variety of specialties and has increased in use in the last decade as ultrasound machines have become more compact and portable.[5] It is now used for a variety of exams in various clinical settings at the patient's bedside. In the emergency setting, it is used to guide resuscitation and monitor critically ill patients, provide procedural guidance for improved patient safety and confirm clinical diagnosis.

Scope

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Emergency ultrasound can help direct resuscitation, monitor therapy, guide procedures or indicate diagnosis.

RESUSCITATION of the critically ill

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Point of care ultrasound is sometimes the only option in the evaluation of patients who are too ill for transport to other imaging modalities (ie computed tomography, or CT scan) or whose illness is so acute that medical decisions in their care need to be made in seconds to minutes. It is also increasingly used to guide and triage care in resource-limited situations, in rural or medically-underserved areas. [6]

In patients who present with a traumatic injury, The Focused assessment with sonography for trauma or FAST exam is used to assess hypotensive patients for occult bleeding. Traditionally used by emergency physicians and surgeons treating trauma patients, it has also been used by paramedics [7] in combat zones, [2]and for non-traumatic problems such as ruptured ectopic pregnancy. Similarly, emergency ultrasound can also evaluate the lungs for hemothorax, or bleeding in the chest, and pneumothorax, a puncture resulting in air trapped in the chest and lung collapse.

For patients presenting with hypotension of unknown cause, ultrasound has been utilized to determine the cause of shock.[8][9] Evaluation of the heart and inferior vena cava (IVC) can help the clinician at the bedside choose important treatments and monitor the response to the interventions. [10] [11]

A patient who has hypotension and a bedside ultrasound showing hyperdynamic left heart with a flat, collapsible IVC indicates low blood volume. If the patient has a fever, the clinician may deduce sepsis, or severe infection is causing the problem. If that same patient has back pain instead of a fever, the clinician may see an abdominal aortic aneurysm that is leaking or ruptured. Conversely, weak heart activity and a very full, non-collapsible IVC would indicate a cardiac cause for low blood pressure.

For patients presenting with acute shortness of breath, ultrasound assessment of the lung, heart, and IVC can evaluate for potentially life threatening diseases including pneumothorax, significant pleural effusions, congestive heart failure, pulmonary edema, pericardial effusion, and some large pulmonary emboli. [10] [12]

With its increased availability, ultrasound is now frequently used more in code situations, in which patients have lost most or all signs of life. [13] Practitioners may use the ultrasound to see if the heart is moving, beating in organized fashion or if it has a pericardial effusion or fluid around it. Pericardiocentesis, a procedure in which a needle is used to drain the effusion, can utilize ultrasound guidance of a needle to decrease the risk of hitting lungs, heart or other vital organs [14]

MONITORING THERAPY

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Emergency ultrasound can not only diagnose, but also monitor a patient’s response to therapeutic interventions. Ultrasound can be utilized to assess a patient’s intravascular volume status and response to intravenous fluid therapy by measuring the size and respiratory change in the diameter of the IVC.[10] Ultrasound of the lungs may demonstrate resolution of pulmonary edema from congestive heart failure. [15]

PROCEDURAL GUIDANCE

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Using ultrasound to guide needles during procedures may improve success and decrease complications in procedures performed by multiple specialties, including central[16] and venous access,[17][18] thoracentesis[19], paracentesis, pericardiocentesis[20], arthrocentesis, regional anesthesia, incision and drainage of abscesses[21][22], localization and removal of foreign bodies, lumbar puncture, biopsies, and other procedures. [16]

DIAGNOSTIC

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to be continued...

REFERENCES

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  1. ^ ACEP Policy Statement: Emergency Ultrasound Guidelines. Ann Emerg Med. 2009;53:550-570.
  2. ^ a b Beck-Razi N, Fischer D, Michaelson M et al. The utility of focused assessment with sonography for trauma as a triage tool in multiple-casualty incidents during the second Lebanon war. J Ultrasound Med 2007;26:1149–1156.
  3. ^ Atlas of Emergency Medicine. Kevin J. Knoop, Lawrence B. Stack, Alan B. Storrow. McGraw-Hill Professional, 2002.ISBN 0071352945, ISBN 978-0-07-135294-9.
  4. ^ Emergency Ultrasound: Principles and Practice. Romolo Joseph Gaspari, J. Christian Fox, Paul R. Sierzenski. Mosby, 2005. ISBN 0-323-03750-X, 9780323037501.
  5. ^ Levin DC, Rao VM, Parker L, Frangos AJ. Noncardiac point-of-care ultrasound by nonradiologist physicians: How widespread is it?. JACR 2011; 8(11):772-775.
  6. ^ Dean AJ, Ku BS, Zeserson EM. The utility of handheld ultrasound in an austere medical setting in Guatemala after a natural disaster. Am J Disaster Med. 2007;2(5):249–256.
  7. ^ Walcher F, Weinlich M, Conrad G, Schweigkofler U, Breitkreutz R, Kirshning T. Marzi I. Prehospital ultrasound imaging improves management of abdominal trauma. Br J Surg 2006;93(2): 238-42.
  8. ^ Rose JS et al. The UHP Ultrasound Protocol: A Novel Ultrasound Approach to the Empiric Evaluation of the Undifferentiated Hypotensive Patient. AJEM; 19(4):299-301.
  9. ^ Jones AE et al. Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Critical Care Med. 2004;32(8):1703-1708.
  10. ^ a b c Labovitz AJ et al. Focused Cardiac Ultrasound in the Emergent Setting: A Consensus Statement of the American College of Emergency Physicians. JASE 2010; 23(12):1225-1230.
  11. ^ Hernandez C et al. C.A.U.S.E.:Cardiac arrest ultrasound exam—a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. Resuscitation 2008; 76:198-206.
  12. ^ Litchenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure. The BLUE Protocol. Chest 2008; 134(1):117-125.
  13. ^ Blaivas M, Fox J. Outcome in cardiac arrest patients found to have cardiac standstill on bedside emergency department echocardiogram. Acad Emerg Med. 2001;8:616-621.
  14. ^ Salem K, Mulji A, Lonn E. Echocardiographically guided pericardiocentesis -- the gold standard for the management of pericardial effusion and cardiac tamponade. Can J Cardiol 1999;15:1251-1255.
  15. ^ Noble VE et al. Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis: time course for resolution. CHEST. 2009; 135(6) 1433-1439.
  16. ^ a b Moore CL, Copel JA. Point-of-Care Ultrasonography. NEJM 2011; 462(8):749-757.
  17. ^ Constantino TG et al. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med. 2005; 46:456-61.
  18. ^ Blaivas M, Lyons M. The Effect of Ultrasound Guidance on the Perceived Difficulty of Emergency Nurse-Obtained Peripheral IV Access. Journal of Emergency Medicine 31(4):407-410.
  19. ^ Tayal VS, Nicks BA, Norton HJ. Emergency ultrasound evaluation of symptomatic nontraumatic pleural effusions. American Journal of Emergency Medicine. 2006. 24, 782-786.
  20. ^ Nazeer SR, Dewbre H, Miller AH. Ultrasound-assisted paracentesis performed by emergency physicians vs the traditional technique: a prospective, randomized study. Amer J Emerg Med. 2005; 23:363-367.
  21. ^ Squire BT, Fox JC, Anderson C. ABSCESS: Applied Bedside Sonography for Convenient Evaluation of Superficial Soft Tissue Infections. Acad Emerg Med 2005; 12(7): 601-606.
  22. ^ Vivek S. Tayal, MD, Nael Hasan, MD, H. James Norton, PhD, Christian A. Tomaszewski, MD The Effect of Soft-tissue Ultrasound on the Management of Cellulitis in the Emergency Department. Acad Emerg Med 2006; 13(4):384-388.

THAT'S IT FOR NOW.Dmresop (talk) 15:07, 5 October 2012 (UTC)[reply]

Sorry for the delayed reply. It needs a bit more fixing to comply with MOs, but from the small bit I read it seems good. One thing I would point out is that medical articles should read more like a general information page than a review article. I will try to fix these issues though. Peter.C • talk • contribs 04:52, 8 October 2012 (UTC)[reply]
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