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Application of Point-of-care Ultrasonography in Trauma Treatment

Point-of-care ultrasonography (POCUS) has been widely used in trauma treatment. Focused Assessment with Sonography for Trauma (FAST) is a point-of-care examination that allows doctors to quickly evaluate trauma patients and provide support for decision-making. In addition, POCUS has become an important auxiliary tool in trauma surgery, including the establishment of ultrasound-assisted vascular channels and local nerve blocks in anaesthesia, as well as the portability, economy and versatility of ultrasound equipment. Therefore, it becomes a valuable tool for auxiliary examination of trauma treatment in resource-limited environments. POCUS gives hope by playing a clinical diagnostic role in limited-resource environments and pre-hospital settings, and it can provide relevant evidence-based medical evidence for the clinic.

POCUS Examination By Stork Wireless Handheld Ultrasound Scanner

POCUS examination by Stork wireless handheld ultrasound scanner

According to statistics in 2013, there are about 973 million people suffering trauma worldwide each year, and 4.8 million deaths due to trauma. For developing countries with scarce medical resources, the social and economic burden caused by trauma is even greater. Point-of-care ultrasonography (POCUS) examination is a method that uses ultrasound equipment to examine patients at the bedside to provide information to support clinical decision-making. Since the 1990s in the United States, as ultrasound equipment has become smaller and more portable, and the image quality has become higher, the application range is greatly expanded. POCUS machine has great advantages in the treatment of pure and penetrating trauma, especially for trauma patients with hemodynamic instability. These advantages include immediate identification of life-threatening injuries, such as pneumothorax, hemothorax, or pericardial tamponade, as well as assisting with other imaging tests such as plain X-rays or CT scans. In addition, POCUS does not have ionizing radiation so that it allows repeated dynamic assessment of patients.

POCUS Follow-Up By Stork Wireless Handheld Ultrasound Scanner

POCUS Follow-Up By Stork Wireless Handheld Ultrasound Scanner

POCUS follow-up by Stork wireless handheld ultrasound scanner

1. Point-of-care ultrasound machines

The three most commonly used trauma ultrasound probes are curved array probes, linear array probes, and phased array probes. The frequency of the curved array probe is 2~5MHz, and it has strong tissue penetration and is suitable for abdominal cavity imaging. The linear array probe has a higher frequency (7~12MHz) and it can provide better surface structure resolution, display lung apex, blood vessels, nerves, musculoskeletal and other tissues. The phased array probe (1~4MHz) has the smallest volume and can display the heart and thoracic tissue through the auxiliary window. In the case of limited resources, some ultrasound machines do not equip with all three types of probes. However, for trauma assessment, one or two types of probes can basically meet the demand since there are partial overlaps of the inspection windows of these three types of probes. Stork ultrasound can provide you with the following probes.

Wireless Handheld Ultrasound Scanner Of Stork - Convex Probe

Wireless handheld ultrasound scanner of Stork - convex probe

Wireless Handheld Ultrasound Scanner Of Stork - Linear Probe

Wireless handheld ultrasound scanner of Stork - linear probe

Wireless Handheld Ultrasound Of Stork - Phased Array Probe

Wireless handheld ultrasound of Stork - phased array probe

2. Applications of point-of-care ultrasonography in trauma

2.1 Focussed assessment sonography for trauma

Focussed Assessment Sonography for Trauma (FAST) is a typical POCUS designed to help doctors quickly answer the three core questions in the treatment of patients with blunt or penetrating trauma. Is there a pericardial effusion? Is there free abdominal fluid? Is there a hemothorax? To answer the three questions, the first step is to obtain an ultrasound image at the corresponding part. The most commonly used probe is the curved array probe (2~5MHz).

POCUS -- Few Pleural Effusion

POCUS - few pleural effusion

2.2 Chest wall ultrasound

Although the section of the septum and thoracic cavity is very useful for detecting pleural effusion during the FAST examination, it is difficult to find pneumothorax. Therefore, a separate ultrasound evaluation of the chest wall is required to detect pneumothorax. High-frequency linear probes (7-12MHz) are most commonly used for chest wall ultrasound.

2.3 Enhanced ultrasound

Although two-dimensional ultrasound is very important for the detection of free fluid in the abdomen during trauma, the sensitivity for the identification of intraperitoneal parenchymal organ injury is poor. Contrast-enhanced ultrasound (CEUS) is performed on trauma patients by filling microvesicles and phospholipid shells with intravenous injection of low doses (1.2 to 2.4mL) of emotional gas and then scanning parenchymal organs such as the liver, kidneys, lumbar glands, and organs. After injecting the contrast agent, normal parenchymal organs will show uniformly hyperechoic, while traumatic lesions have relatively hypoechoic due to the reduction of vessel distribution. There is extravasation of microbubbles in the active bleeding. In addition, more and more studies have shown that CEUS has high application value in adults and children with blunt trauma.

2.4 Musculoskeletal ultrasound

The application of ultrasound in the musculoskeletal system began in 1954. Musculoskeletal ultrasound can be used for the non-invasive assessment of soft tissue disease when other imaging tests such as plain X-ray, CT, and MRI are not appropriate or available. Musculoskeletal injuries are more common in patients with single or multiple injuries. High-frequency probes, portable ultrasound machines, and wireless ultrasound transducers facilitate the point-of-care assessment of multiple injury sites, allowing visualization of dynamic operations and complementing physical examinations. The musculoskeletal POCUS can be used to diagnose shoulder dislocation, and POCUS is also a useful tool for assessing tendon injuries, and it also plays a role in assessing fractures.

Knee Joint Ultrasound Guidance By Stork Ultrasound Probe

Knee joint ultrasound guidance

2.5 Ultrasound-guided local anaesthesia

Delayed administration of analgesics, insufficient doses and insufficient analgesia often occurs in the emergency department. Elderly patients may be more susceptible to this phenomenon than younger patients. The major challenges of analgesia for trauma patients include two aspects. The first is to minimize the time of surgery and invasive operations. The second is the potential adverse effects of systemic analgesia, including respiratory depression, hemodynamic deterioration, excessive sedation and delirium. Ultrasound-guided nerve block anesthesia allows direct observation of self-labeled nerves and surrounding structures. The high-frequency probes can best observe the peripheral nerves.

Anesthesia Puncture-Guided By Stork Ultrasound Probe

Anesthesia puncture-guided

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