Emergency ultrasound
Encyclopedia
Emergency ultrasound is the specialized application of point of care ultrasound
Medical ultrasonography
Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...

 (POCUS) by emergency physician
Emergency physician
An emergency physician is a physician who works at an emergency department to care for acutely ill patients. The emergency physician is a specialist in advanced cardiac life support , trauma care such as fractures and soft tissue injuries, and management of other life-threatening situations.In...

s in an emergency department
Emergency department
An emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...

.

Emergency department ultrasound versus radiology ultrasound

Many emergency physicians now view screening ultrasound as a tool, and not a procedure or study. It is primarily used to quickly and correctly ascertain a limited set of internal injuries, specifically those injuries where conventional methods of determining them, such as trauma to the torso or heart, would either take too long, require too much time to prepare, or introduce greater risk to the patient.

While conventional ultrasound can be a lengthy process, and is usually conducted with non-mobile units and advanced image filtering and manipulation built into the unit, emergency ultrasound is as simple and quick to operate as possible, and narrowly focused on a small set of criteria.

Indications

The use of point of care emergency ultrasound may be considered in patients who present with:
  • Trauma
  • Hypotension
  • Cardiac Arrest
  • Chest Pain
  • Dyspnea
  • Abdominal/Pelvic Pain
  • Early Pregnancy
  • Evaluation for DVT
  • Abscess and Cellulitis
  • Musculoskeletal Complaints
  • Testicular Pain
  • Procedural Guidance

Core applications

  • Trauma - The FAST exam
    Focused assessment with sonography for trauma
    Focused Assessment with Sonography for Trauma is a rapid bedside ultrasound examination performed by surgeons and emergency physicians as a screening test for blood around the heart or abdominal organs after trauma.The four areas that are examined for free fluid are the perihepatic space...

     for trauma - evaluation for hemoperitoneum
    Hemoperitoneum
    Hemoperitoneum is the presence of blood in the peritoneal cavity. The blood accumulates in the space between the inner lining of the abdominal wall and the internal abdominal organs. Hemoperitoneum is generally classified as a surgical emergency; in most cases, urgent laparotomy is needed to...

     or pericardial effusion
    Pericardial effusion
    Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. Because of the limited amount of space in the pericardial cavity, fluid accumulation will lead to an increased intrapericardial pressure and this can negatively affect heart function...

  • Intrauterine pregnancy - evaluation for miscarriage, normal and ectopic pregnancy
    Ectopic pregnancy
    An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...

  • Aorta. Evaluation of the abdominal aorta for aneurysm
    Abdominal aortic aneurysm
    Abdominal aortic aneurysm is a localized dilatation of the abdominal aorta exceeding the normal diameter by more than 50 percent, and is the most common form of aortic aneurysm...

    , dissection
    Aortic dissection
    Aortic dissection occurs when a tear in the inner wall of the aorta causes blood to flow between the layers of the wall of the aorta and force the layers apart. The dissection typically extends anterograde, but can extend retrograde from the site of the intimal tear. Aortic dissection is a medical...

    , rupture.
  • Cardiac. Evaluation for pericardial effusion
    Pericardial effusion
    Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. Because of the limited amount of space in the pericardial cavity, fluid accumulation will lead to an increased intrapericardial pressure and this can negatively affect heart function...

    , tamponade
    Tamponade
    Tamponade is the closure or blockage as if by a tampon especially to stop bleeding.Tamponade is a useful method of stopping a hemorrhage...

    , systolic and diastolic function, valvular abnormalities, cardiac activity in cardiac arrest
  • Biliary- Evaluation for gallstones, cholecystitis
    Cholecystitis
    -Signs and symptoms:Cholecystitis usually presents as a pain in the right upper quadrant. This is known as biliary colic. This is initially intermittent, but later usually presents as a constant, severe pain. During the initial stages, the pain may be felt in an area totally separate from the site...

    , or choledocholithiasis
  • Urinary Tract- Evaluation for hydronephrosis
    Hydronephrosis
    Hydronephrosis is distension and dilation of the renal pelvis calyces, usually caused by obstruction of the free flow of urine from the kidney, leading to progressive atrophy of the kidney...

     ,
  • DVT- Evaluation for upper and lower extremity deep venous thrombosis
  • Soft-tissue/musculoskeletal- evaluation for cellulitis
    Cellulitis
    Cellulitis is a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters,...

    , abscess
    Abscess
    An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...

    , tendon injury, inflammation, fracture
  • Thoracic- Evaluation for pneumothorax
    Pneumothorax
    Pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...

    , acute interstitial syndrome, pneumonia
    Pneumonia
    Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...

    , and pleural effusion
    Pleural effusion
    Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...

  • Ocular- Evaluation for retinal detachment
    Retinal detachment
    Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness. It is a medical emergency.The retina is a...

    , globe rupture, lens dislocation, vitreous hemorrhage
    Vitreous Hemorrhage
    Vitreous Hemorrhage is the extravasation of blood into the areas in and around the vitreous humor of the eye. The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye...

    , and orbital cellulitis
    Orbital cellulitis
    Orbital cellulitisis an infection of eye tissues posterior to the orbital septum. It most commonly refers to an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood...

  • Procedural Guidance- thoracentesis
    Thoracentesis
    Thoracentesis , also known as thoracocentesis or pleural tap, is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. A cannula, or hollow needle, is carefully introduced into the thorax, generally after administration of local anesthesia...

    , paracentesis
    Paracentesis
    Paracentesis is a medical procedure involving needle drainage of fluid from a body cavity, most commonly the peritoneal cavity in the abdomen.A related procedure is thoracocentesis, which is needle drainage of the chest cavity...

    , central venous cannulation, peripheral IV placement, pericardiocentesis
    Pericardiocentesis
    In medicine, pericardiocentesis is a procedure where fluid is aspirated from the pericardium .-Position:The patient undergoing pericardiocentesis is positioned supine with the head of the bed raised to a 30- to 60-degree angle.This places the heart in proximity to the chest wall for easier...

    , arthrocentesis
    Arthrocentesis
    Arthrocentesis is the clinical procedure of using a syringe to collect synovial fluid from a joint capsule. It is also known as joint aspiration. Arthrocentesis is used in the diagnosis of gout, arthritis, and synovial infections....

    , nerve blocks


Other Applications:
  • Testicular Pain- Evaluation for testicular torsion
    Testicular torsion
    Testicular torsion is when the spermatic cord to a testicle twists, cutting off the blood supply. The most common symptom is acute testicular pain and the most common underlying cause is a congenital malformation known as a "bell-clapper deformity". The diagnosis is often made clinically but if it...

    , orchitis
    Orchitis
    Orchitis or orchiditis is a condition of the testes involving inflammation. It can also involve swelling and frequent infection.-Symptoms:Symptoms of orchitis are similar to those of testicular torsion...

    , epididymitis
    Epididymitis
    Epididymitis is a medical condition in which there is inflammation of the epididymis . This condition comprises gradual onset of testicular pain that can vary from mild to severe, and the scrotum may become red, warm and swollen...

    , hernia
    Hernia
    A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes into the mediastinum through the esophageal opening in the diaphragm....

  • Pelvic Pain- Evaluation for ovarian torsion
    Ovarian torsion
    Ovarian torsion refers to the rotation of the ovary to such a degree as to occlude the ovarian artery and/or vein.-Epidemiology:Ovarian torsion accounts for about 3% of gynecologic emergencies. In 70 percent, it is diagnosed in women between 20 and 39 years. The risk is greater during pregnancy...

    , ovarian cyst
    Ovarian cyst
    An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. An ovarian cyst can be as small as a pea, or larger than an orange....

    , and ovarian cyst rupture
  • IVC- Evaluation of volume status and estimation of fluid responsiveness
  • The RUSH exam for Shock or Hypotension

See also

  • pre-hospital ultrasound
    Pre-hospital ultrasound
    Prehospital ultrasound is the specialized application of ultrasound by emergency responders, such as paramedics, to guide immediate care and first aid procedures...

  • Duplex ultrasonography
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