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Abstract
Ultrasonography is a noninvasive, reliable, repeatable, and inexpensive technology that has dramatically changed the practice of medicine. The clinical use of portable ultrasound devices has grown tremendously over the last 10 years in the fields of intensive care, emergency medicine, and anesthesiology. In this review we present the various ways that handheld portable ultrasound devices can be used in austere environments. The purpose of this review is to consider the wide-ranging applications for providers going into the austere environment, which include pulmonary, ocular, vascular, and trauma evaluations, the postdisaster setting, and the role of ultrasonography in tropical diseases. This review is not meant to be a comprehensive how-to guide for each study type, but an overview of some of the more common wilderness applications. This review also focuses on the limitation of each study type. The goal is to help wilderness medicine providers feel more comfortable incorporating ultrasonography as part of their tool kit when heading into austere environments.
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Affiliation(s)
| | - N Stuart Harris
- 2 Division of Wilderness Medicine, Massachusetts General Hospital, Boston, Massachusetts.,3 Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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Roy S, Schielke RK, Haffey D, Coombs H. Chemical Heat Packs as an Intervention to Prolong Ultrasound Battery Runtime. Wilderness Environ Med 2019; 30:186-190. [PMID: 31056373 DOI: 10.1016/j.wem.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 01/01/2019] [Accepted: 02/13/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Point-of-care ultrasonography is a burgeoning field of practice and study. Although point-of-care ultrasonography has started to penetrate the field of wilderness medicine, its use in cold environments is often limited by poor battery performance. In the current study, we investigated the effect of chemical foot warmers on battery runtime of handheld ultrasound machines in cold weather. METHODS This prospective study used a balanced, crossover randomization design to compare handheld ultrasound machines exposed to cold weather with and without the application of chemical foot warmers. Time to power off, ambient temperature, air humidity, and wind speed were recorded for each trial and compared in a mixed-effects model analysis of variance. RESULTS Ultrasound machines showed significantly decreased functional battery life with decreasing temperature (P<0.01) and increasing wind speed (P=0.01). Addition of the chemical foot warmer resulted in a statistically significant increase in handheld ultrasound machine runtime compared with controls (P<0.001). Overall machine runtime was increased by approximately 21.8 min (95% CI 16.2-27.3). CONCLUSIONS The application of chemical foot warmers to handheld ultrasound machines exposed to cold environments prolongs usable battery life and, consequently, may allow for extended scanning time in austere and remote environments.
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Affiliation(s)
- Steven Roy
- McGill University, Faculty of Medicine, Montreal, Québec, Canada.
| | - Ryck K Schielke
- University of Saskatchewan, College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Daniel Haffey
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Heather Coombs
- McGill University, Faculty of Medicine, Montreal, Québec, Canada
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Pourmand A, Pyle M, Yamane D, Sumon K, Frasure SE. The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients. World J Emerg Med 2019; 10:232-238. [PMID: 31534598 DOI: 10.5847/wjem.j.1920-8642.2019.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Volume resuscitation has only been demonstrated to be effective in approximately fifty percent of patients. The remaining patients do not respond to volume resuscitation and may even develop adverse outcomes (such as acute pulmonary edema necessitating endotracheal intubation). We believe that point-of-care ultrasound is an excellent modality by which to adequately predict which patients may benefit from volume resuscitation. DATA RESOURCES We performed a search using PubMed, Scopus, and MEDLINE. The following search terms were used: fluid responsiveness, ultrasound, non-invasive, hemodynamic, fluid challenge, and passive leg raise. Preference was given to clinical trials and review articles that were most relevant to the topic of assessing a patient's cardiovascular ability to respond to intravenous fluid administration using ultrasound. RESULTS Point-of-care ultrasound can be easily employed to measure the diameter and collapsibility of various large vessels including the inferior vena cava, common carotid artery, subclavian vein, internal jugular vein, and femoral vein. Such parameters are closely related to dynamic measures of fluid responsiveness and can be used by providers to help guide fluid resuscitation in critically ill patients. CONCLUSION Ultrasound in combination with passive leg raise is a non-invasive, cost- and time-effective modality that can be employed to assess volume status and response to fluid resuscitation. Traditionally sonographic studies have focused on the evaluation of large veins such as the inferior vena cava, and internal jugular vein. A number of recently published studies also demonstrate the usefulness of evaluating large arteries to predict volume status.
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Affiliation(s)
- Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Matthew Pyle
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - David Yamane
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kazi Sumon
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sarah E Frasure
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Lipman GS, Hackett P. In Response to Ibuprofen vs Acetaminophen in AMS Prevention by Kanaan et al. Wilderness Environ Med 2017; 28:383-385. [DOI: 10.1016/j.wem.2017.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 07/15/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022]
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Gharahbaghian L, Anderson KL, Lobo V, Huang RW, Poffenberger CM, Nguyen PD. Point-of-Care Ultrasound in Austere Environments. Emerg Med Clin North Am 2017; 35:409-441. [DOI: 10.1016/j.emc.2016.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Ladd E, Shea KM, Bagley P, Rundell S, Auerbach PS, Pirrotta EA, Wang E, Lipman GS. Hydration Status as a Predictor of High-altitude Mountaineering Performance. Cureus 2016; 8:e918. [PMID: 28083462 PMCID: PMC5218879 DOI: 10.7759/cureus.918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Hydration status is a controversial determinant of athletic performance. This relationship has not been examined with mountaineering performance. Methods: This was a prospective observational study of mountaineers who attempted to climb Denali in Alaska. Participants’ urine specific gravity (SG), and ultrasound measurements of the inferior vena cava size and collapsibility index (IVC-CI) were measured at rest prior to ascent. Upon descent, climbers reported maximum elevation gained for determination of summit success. Results: One hundred twenty-one participants enrolled in the study. Data were collected on 111 participants (92% response rate); of those, 105 (87%) had complete hydration data. Fifty-seven percent of study participants were found to be dehydrated by IVC-CI on ultrasound, and 55% by urine SG. No significant association was found with summit success and quantitative measurements of hydration: IVC-CI (50.4% +/- 15.6 vs. 52.9% +/- 15.4, p = 0.91), IVC size (0.96 cm +/- 0.3 vs. 0.99 cm +/- 0.3, p = 0.81), and average SG (1.02 +/- 0.008 vs. 1.02 +/- 0.008, p = 0.87). Categorical measurements of urine SG found 24% more successful summiters were hydrated at 14 Camp, but this was not found to be statistically significant (p = 0.56). Summit success was associated with greater water-carrying capacity on univariate analysis only: 2.3 L, 95% confidence interval (2.1 – 2.5) vs. 2.1 L, 95% confidence interval (2 – 2.2); p < 0.01. Conclusions: Intravascular dehydration was found in approximately half of technical high-altitude mountaineers. Hydration status was not significantly associated with summit success, but increased water-carrying capacity may be an easy and inexpensive educational intervention to improve performance.
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Affiliation(s)
- Eric Ladd
- Department of Emergency Medicine, Stanford University School of Medicine
| | - Katherine M Shea
- Department of Emergency Medicine, Stanford University School of Medicine
| | - Patrick Bagley
- University of New England College of Osteopathic Medicine, University of New England
| | - Sean Rundell
- Department of Rehabilitation Medicine, University of Washington
| | - Paul S Auerbach
- Department of Emergency Medicine, Stanford University School of Medicine
| | | | - Ewen Wang
- Department of Emergency Medicine, Stanford University School of Medicine
| | - Grant S Lipman
- Department of Emergency Medicine, Stanford University School of Medicine
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Kanaan NC, Lipman GS, Constance BB, Holck PS, Preuss JF, Williams SR. Reply. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:456-457. [PMID: 26795047 DOI: 10.7863/ultra.15.10050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Nicholas C Kanaan
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
| | - Grant S Lipman
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
| | - Benjamin B Constance
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
| | - Peter S Holck
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
| | - James F Preuss
- University of Utah, Salt Lake City, Utah USA (N.C.K.)Stanford University School of Medicine, Palo Alto, California USA (G.S.L., S.R.W.)Tacoma General Hospital, Tacoma, Washington USA (B.B.C.)University of Hawaii, Honolulu, Hawaii USA (P.S.H.)Royal Perth Hospital, Perth, Western Australia, Australia (J.F.P.)
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