Is a Portable Ultrasound the future for EMS

hometownmedic5

Forum Asst. Chief
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Perhaps he is demonstrating his professional credibility by posting his name and resume. You "astronomically stupid" comment is "astronomically wrong". Or are you just jealous?

Read it again. Posting your whole, unrelated resume is annoying. It’s posting your full name, branch, unit assignments etc on the internet that’s astronomically stupid, unless you haven’t yet heard of identity theft, in which case, we need to talk.
 

MackTheKnife

BSN, RN-BC, EMT-P, TCRN, CEN
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With the caveat that I'm not currently a field medic, I'd have to say, in concurrence with other comments posted, can't really see the efficacy of prehospital US. It takes a lot of repetition, even in a hospital, viewing sonograms to be able to accurately interpret them. And what would be the advantage? What treatment modality would be enhanced by it? Any EBP to demonstrate enhanced survivability?
 

CCCSD

Forum Deputy Chief
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OP is a female...
 

silver

Forum Asst. Chief
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The butterfly isn't very appropriate for USGPIVs as the probe is so large that you can't really use standoff technique and are essentially forced to use fully sterile technique, which adds more time and cost.
I've put in a few IVs (like 3) with a butterfly. It is awkward to hold but I didn't really have a problem with it. Other than the fact that another individual had to hold the iphone up in a place that I could see it.



Multiple people have commented on FAST but likely a FATE exam would be more useful in terms of benefiting a patient.
 

Peak

ED/Prehospital Registered Nurse
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I've put in a few IVs (like 3) with a butterfly. It is awkward to hold but I didn't really have a problem with it. Other than the fact that another individual had to hold the iphone up in a place that I could see it.


The minimum standoff is 13mm, and realistically given the curve at the edge is more like 15mm. You should then have a bit of space between the probe and your needle so realistically you're looking at 2cm from insertion to the short axis plane. Depending on the angle of approach you will easily lose 2cm of catheter if not more.

Compared to the 2-3mm of standoff on the linear probe on our logic e and it's hard to say that the butterfly can reasonably used for USGPIVs. I've used it many times for PIVs and A lines, I just think you have to use a sterile probe cover and sterile gel.
 

Akulahawk

EMT-P/ED RN
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At this point, I don't see much advantage in field POCUS, at least for doing things like determining destination or the like. I do, however, see that doing USGPIV in the field with an appropriate probe could have some benefit for your patients that present a PIV challenge... if they're willing to be reasonably still during the procedure. I'm extremely good at doing PIV without US and have been known to be able to obtain PIV access in some patients where USGPIV attempts (by others) have failed. I've recently (within the past year) have started doing USGPIV and have become reasonably proficient at it. If things go smoothly, it only adds a couple minutes to the PIV process, though if things get more challenging, it can easily take 20 minutes or more to obtain PIV access.

In my ED we also have the availability of a vein finder and I've done a few starts with that, and it is an interesting piece... though I use it more as a screening tool as to where to concentrate my efforts. One irritating thing is that shallow flat veins look basically the same as shallow plump ones... Occasionally on more "fluffy" patients, I have been known to use US to take a look at something that I think is a vein.

On the flip side of things, POCUS, with appropriately trained practitioners, could have some field benefit under some circumstances. Of course if you're getting educated and trained well enough to be able to use POCUS for various screenings, you probably should also have a commensurate increase in procedures authorized (with appropriate training) to deal with what you find. Of course by then, you probably would be able to easily live-stream what you see to medical control even from relatively remote locations and get guidance as to what to do.
 
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