The utility of handheld ultrasound in an austere medical setting in Guatemala after a natural disaster
DOI:
https://doi.org/10.5055/ajdm.2007.0033Keywords:
hand carried, ultrasonography, disasters, emergencyAbstract
Objective: To identify equipment needs, utility, clinical applications, and acuity of diagnoses made by hand-carried ultrasound (HCU) after a natural disaster.
Methods: An HCU with four probes (curved array, linear array, phased array, and endocavitary) was taken to the site of a natural disaster in Guatemala as part of the relief effort after mudslides killed approximately 1,000 people. Ultrasound (US) scans were classified by transducer type, anatomic region, presenting complaint, and therapeutic urgency of treatment.
Results: Ninety-nine patients received 137 US: 58 pelvic, 34 right upper quadrant, 23 renal, six other abdominal, five orthopedic, four cardiac, three pleura and lung, three soft tissue, and one focused assessment by sonography in trauma. Acuity of presenting illness: 23 percent 24 hours, 15 percent 1-14 days, 44 percent 14 days. Eighteen percent were performed in prenatal clinic. Results of US ruled in 12 percent with an emergent problem and excluded disease in 42 percent. In 14 percent, US diagnosed a problem needing f/u in 2 weeks, and 32 percent with a problem needing long-term observation. Transducer utilization was general purpose curved array 88 percent, linear array 10 percent, endocavitary 8 percent, and phased array 4 percent.
Conclusions: HCU has a range of applications in an austere medical setting after a natural disaster. Most can be dealt with using a single transducer.
References
Kronzon I: The hand-carried ultrasound revolution. Echocardiography. 2003; 20: 453-454.
Greenbaum LD, Benson CB, Nelson LH, et al.: Proceedings of the compact ultrasound conference sponsored by the American Institute of ultrasound in medicine. J Ultrasound Med. 2004; 23: 1249-1254.
Duvall WL, Croft LB, Goldman ME: Can hand-carried ultrasound devices be extended for use by the noncardiology medical community? Echocardiography. 2003; 20: 471-476.
Croft LB, Duvalll WL, Goldman ME: A pilot study of the clinical impact of hand-carried cardiac ultrasound in the medical clinic. Echocardiography. 2006; 23: 439-446.
Kendall JL, Hoffenberg SR, Smith SR: History of emergency and critical care ultrasound: The evolution of a new imaging paradigm. Crit Care Med. 2007; 35[suppl]: S126-S130.
Ostensen H: Developing countries. Ultrasound Med Biol. 2000; 26(suppl 1): S159-S161.
Ali QM, Roth J, Abdel-Rahim IM, et al.: Cost saving with ultrasonography in a developing country district hospital. East Afr Med J. 1999; 76(5): 272-274.
Ma OJ, Norvell JG, Subramanian S: Ultrasound applications in mass casualties and extreme environments. Crit Care Med. 2007; 35(5 suppl): S275-S279.
Kobal SL, Lee SS,Willner R, et al.: Hand-carried cardiac ultrasound enhances healthcare delivery in developing countries. Am J Cardiol. 2004; 94(4): 539-541.
Lyon M, Blaivas M, Brannam L: Use of emergency ultrasound in a rural ED with limited radiology services. Am J Emerg Med. 2005; 23(2): 212-214.
Blaivas M, Kuhn W, Reynolds B, et al.: Change in differential diagnosis and patient management with the use of portable ultrasound in a remote setting. Wilderness Environ Med. 2005; 16(1): 38-41.
Mindel S: Role of imager in developing world. Lancet. 1997; 350(9075): 426-429.
Kobal SL, Czer LSC, Feldsher Z, et al.: Making an imposible mission possible. Chest. 2004; 25: 293-296.
Kirkpatrick JN, Davis A, Decara JM, et al.: Hand-carried cardiac ultrasound as a tool to screen for important cardiovascular disease in an underserved minority health care clinic. J Am Soc Echocardiogr. 2004; 17(5): 399-403.
Sarkisian AE, Khondkarian RA, Amirbekian NM, et al.: Sonographic screening of mass casualties for abdominal and renal injuries following the 1988 Armenian earthquake. J Trauma Injury Infect Crit Care. 1991; 31(2): 247-250.
Keven K, Ates K, Yamurlu B, et al.: Renal doppler ultrasonographic findings in earthquake victims with crush injury. J Ultrasound Med. 2001: 20(6): 675-679.
American College of Emergency Physicians: ACEP emergency ultrasound guidelines-2001. Ann Emerg Med. 2001: 38(4): 470-481.
Health in the Americas.Vol II. Guatemala Social Statistics, 1997. ISBN 92 75 11569 9. Pan American Health Organization Online Bookstore.Available at http://www.paho.org/english/hia_1998ed.htm. Accessed September 14, 2007.
Reproductive, maternal and child health in central America: Trends and challenges facing women and children, CDC/USAID. Available at http://www.usaid.gov/locations/latin_america_caribbean/ health/Chp8.pdf. Accessed September 14, 2007.
Jones AE, Tayal VS, Sullivan DM, et al.: Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med. 2004; 32(8): 1703-1708.
Jones AE, Craddock PA, Tayal VS, et al.: Diagnostic accuracy of left ventricular function for identifying sepsis among emergency department patients with nontraumatic symptomatic undifferentiated hypotension. Shock. 2005; 24(6): 513-517.
McKenney MG, Martin L, Lentz K, et al.: 1,000 consecutive ultrasounds for blunt abdominal trauma. J Trauma Injury Infect Crit Care. 1996; 40(4): 607-610; Discussion 611-612.
Mayo PH, Goltz HR, Tafreshi M, et al.: Safety of ultrasoundguided thoracentesis in patients receiving mechanical ventilation. Chest. 2004: 125(3): 1059-1062.
Lichtenstein DA, Lascols N, Meziere G, et al.: Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med. 2004; 30(2): 276-281.
Shih CH: Effect of emergency physician-performed pelvic sonography on length of stay in the emergency department. Annal Emerg Med. 1997; 29(3): 348-345.
Hanson GP: Essential X-ray services: The basic radiological system (BRS). Trop Geogr Med. 1988; 40(4): S76-S84.
The World Health Imaging System for Radiography—WHISRAD: Simply perfect. Available at http://www.rotarywhis-rad.org/ WHIS_RAD_brochure_2.doc. Accessed June 22, 2007.
Strode CA, Rubal BJ, Gerhardt RT, et al.: Satellite and mobile wireless transmission of focused assessment with sonography in trauma. Acad Emerg Med. 2003; 10(12): 1411-1414.
Huffer LL, Bauch TD, Furgerson JL, et al.: Feasibility of remote echocardiography with satellite transmission and real-time interpretation to support medical activities in the austere medical environment. J Am Soc Echocardiogr. 2004; 17(6): 670-674.
Downloads
Published
How to Cite
Issue
Section
License
Copyright 2007-2023, Weston Medical Publishing, LLC
All Rights Reserved
