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      Prehospital point-of-care ultrasound: A transformative technology

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          Abstract

          Point-of-care ultrasound at the bedside has evolved into an essential component of emergency patient care. Current evidence supports its use across a wide spectrum of medical and traumatic diseases in a variety of settings. The prehospital use of ultrasound has evolved from a niche technology to impending widespread adoption across emergency medical services systems internationally. Recent technological advances and a growing evidence base support this trend. However, concerns regarding feasibility, education, and quality assurance must be addressed proactively. This topical review describes the history of prehospital ultrasound, initial training needs, ongoing skill maintenance, quality assurance and improvement requirements, available devices, and indications for prehospital ultrasound.

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          Most cited references47

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          Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access.

          We assess the success rate of emergency physicians in placing peripheral intravenous catheters in difficult-access patients who were unsuccessfully cannulated by emergency nurses. A technique using real-time ultrasonographic guidance by 2 physicians was compared with traditional approaches using palpation and landmark guidance. This was a prospective, systematically allocated study of all patients requiring intravenous access who presented to 2 university hospitals between October 2003 and March 2004. Inclusion criterion was the inability of any available nurse to obtain intravenous access after at least 3 attempts on a subgroup of patients who had a history of difficult intravenous access because of obesity, history of intravenous drug abuse, or chronic medical problems. Exclusion criterion was the need for central venous access. Patients presenting on odd days were allocated to the ultrasonographic-guided group, and those presenting on even days were allocated to the traditional-approach group. Endpoints were successful cannulation, number of sticks, time, and patient satisfaction. Sixty patients were enrolled, 39 on odd days and 21 on even days. Success rate was greater for the ultrasonographic group (97%) versus control (33%), difference in proportions of 64% (95% confidence interval [CI] 39% to 71%). The ultrasonographic group required less overall time (13 minutes versus 30 minutes, for a difference of 17 [95% CI 0.8 to 25.6]), less time to successful cannulation from first percutaneous puncture (4 minutes versus 15 minutes, for a difference of 11 [95% CI 8.2 to 19.4]), and fewer percutaneous punctures (1.7 versus 3.7, for a difference of 2.0 [95% CI 1.27 to 2.82]) and had greater patient satisfaction (8.7 versus 5.7, for a difference of 3.0 [95% CI 1.82 to 4.29]) than the traditional landmark approach. Ultrasonographic-guided peripheral intravenous access is more successful than traditional "blind" techniques, requires less time, decreases the number of percutaneous punctures, and improves patient satisfaction in the subgroup of patients who have difficult intravenous access.
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            Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database

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              The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature.

              To review the scientific literature pertaining to the use of hand-carried and hand-held ultrasound devices in low- and middle-income countries (LMIC), with a focus on clinical applications, geographical areas of use, the impact on patient management and technical features of the devices used.
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                Author and article information

                Journal
                SAGE Open Med
                SAGE Open Med
                SMO
                spsmo
                SAGE Open Medicine
                SAGE Publications (Sage UK: London, England )
                2050-3121
                26 July 2020
                2020
                : 8
                : 2050312120932706
                Affiliations
                [1-2050312120932706]Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
                Author notes
                [*]Torben K Becker, Department of Emergency Medicine, College of Medicine, University of Florida, P.O. Box 100186, Gainesville, FL 32610-0186, USA. Email: tbeckermd@ 123456gmail.com
                Article
                10.1177_2050312120932706
                10.1177/2050312120932706
                7383635
                32782792
                cb806309-ad25-4cfa-8574-1e4a59464f65
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 31 December 2019
                : 22 April 2020
                Categories
                Review Paper
                Custom metadata
                January-December 2020
                ts1

                critical care,emergency medicine,point-of-care ultrasound,emergency medical services,prehospital medicine

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