Search Results for : Emergency Medicine

Handheld Ultrasound Education.

Embrace Handheld Ultrasound Training to Expand Patient Engagement

Handheld ultrasound may present the opportunity to help physicians further engage their patients, which is why some are evaluating adding it to their practices. After all, having another diagnostic tool is appealing to providers looking to improve patient care. However, bringing in this new technology requires training to get the most out of it. 

Many technologies have been presented as solutions, but few offer the accessibility, results and efficiency of hand-held ultrasound. For example, a study in Clinical Cardiology demonstrated "that the pocket-sized [portable transthoracic echocardiography (pTTE)] provides accurate detection of cardiac structural and functional abnormalities beyond the [electrocardiogram]." It also found that "the use of pTTE as an initial screening tool prior to [standard TTE] is cost-effective." And yet, the benefits don't stop there.

An Exceptional Patient Experience
The majority of patients most likely appreciate fewer tests, more convenience and reduced complications in their billing and financial experiences. Reducing unnecessary tests is important, and point of care ultrasound may be a practical step toward achieving that goal. According to Heart, "[Hand-held cardiac ultrasound] performed at the point of care by [family doctors] with remote expert support interpretation using a web-based system is feasible, rapid and useful for detecting significant echocardiographic abnormalities and reducing the number of unnecessary echocardiographic studies."

Increased Physician Engagement
Put simply, becoming a more confident user of handheld ultrasound gives physicians another way to engage their patients. According to the Journal of Ultrasound in Medicine, "By implementing pocket-size ultrasound examinations that took less than 11 minutes to the usual care, we corrected, verified or added important diagnoses in more than 1 of 3 emergency medical admissions. Point-of-care examinations with a pocket-size imaging device increased medical residents' diagnostic accuracy and capability."

Empowerment Through Ultrasound Training
Giving physicians access to the benefits of these new approaches to ultrasound and the physical examination requires training that is adaptable and that empowers physicians to optimize their results and maintain their skills over time.

On-Demand Training
The benefits of portable ultrasound training shouldn't be limited just to residents. Physicians who are advanced in their careers need flexible training methods to maintain and refresh their ultrasound skills over time.
Comprehensive, on-demand options facilitate continuous education and are accessible to physicians ranging from novice users who are just learning the technology to experienced practitioners who want to keep their skills sharp. These options include the following:
  • Focused courses.
  • Online videos and tutorials.
  • Point-of-care technology courses.
  • Point-of-care preceptorship courses.
  • Third-party training options.
  • Coaches.
  • Webcasts and webinars.
Learning Online
Online training now offers flexibility and continuous education that wasn't possible in the past. GE's POCUS FocusClass by 123 Sonography may help doctors gain confidence in performing basic ultrasound studies and interpretation. Physicians have access to modular options that can be tailored to training budgets, schedules and learning styles. These include common applications involving the following:
  • Heart.
  • Lung.
  • Obstetrics.
  • Kidney.
  • Vascular (abdominal aorta and deep vein thrombosis).
  • Biliary tract.
This type of training is designed specifically for primary care physicians and their busy schedules so that proficiency can be developed with maximum efficiency.

Today's ultrasound training options offer a wide range of benefits, including providing opportunities for physician champion projects, patient interaction initiatives and overall engagement goals. Clinical leaders invested in keeping their teams up to date in a fast-changing clinical technology landscape should keep ultrasound training on their shortlist of priorities.
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Improving Patient Care.

Handheld Ultrasound for Gallstones Improves Physician Effectiveness

Patients visiting their physician with right upper quadrant (RUQ) pain may have vague symptoms that are difficult to diagnose. A condition that physicians commonly check for is gallstones, but it is difficult to reliably diagnose with a physical exam and review of medical history alone.

Bedside ultrasound is an option for providers who are interested in expanding their ability to diagnose patients who are clinically suspected of having acute calculous cholecystitis.

Why Handheld Ultrasound for Gallstones
According to a piece in the Atlas of Handheld Ultrasound, "Bedside [ultrasound (US)] of the biliary system has been shown to decrease the costs as well as emergency department length of stay in patients with cholelithiasis. Bedside US can detect gallstones, a thickened gallbladder wall, pericholecystic fluid, and a sonographic Murphy sign to assist in diagnosis of acute cholecystitis. Also, point-of- care US for gallbladder disease is a skill that can be learned by physicians at all levels of training."

Pocket-sized mobile ultrasound devices (PUDs) have also been found to be a helpful addition to the physical exam. According to a study published in PLOS One, " After a simple and short training course, a PUD examination can be used in addition to a physical examination to improve the answer to ten common clinical questions concerning in- and outpatients, and can reduce the need for further testing.”

How Handheld Ultrasound Stacks Up
Handheld ultrasound offers clinicians portability and easy point-of-care imaging that ultimately transforms the traditional physical exam and expands its capabilities into areas that were previously only available through slow and expensive testing. According to the Journal of Ultrasound in Medicine, "Point-of-care examinations with a pocket-size imaging device increased medical residents' diagnostic accuracy and capability."

Additionally, a study in the Internal and Emergency Medicine journal noted, “PSUD is a reliable tool for the diagnosis of cholelithiasis when used by expert operators potentially reducing the need for further diagnostic tests. It can even be successfully used by non-expert operators in outpatients setting after a short-focused training.”

As diagnostic demands on physicians increase, handheld ultrasound options could be a primary consideration for physician leaders who want to best serve their patients, improve outcomes and increase the effectiveness of individual practitioners.
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Handheld Ultrasound Trends.

Prehospital Ultrasound in Emergency Medicine: Think Outside the 4 Walls

In cardiac care, mere minutes matter. That's why some medical specialists today may be turning to prehospital ultrasound to accelerate treatment, ensuring patients receive life-saving therapies faster.

In the hands of paramedics and other emergency services providers, handheld ultrasound devices, such as GE's Vscan Extend™, may obtain cardiac images sufficient enough for interpretation even before patients arrive in the emergency department. With proper training, prehospital clinicians can not only use ultrasound to identify a problem, but also to help triage patients.

Benefits of Prehospital Use
Point-of-care ultrasound (PoCUS) has already been shown to potentially help diagnose a plethora of life-threatening conditions, such as hemoperitoneum, pericardial effusion, cardiac tamponade, pneumothorax and abdominal aortic aneurysm. Prehospital ultrasound can also identify situations where resuscitative efforts could be beneficial and should be continued. Putting those diagnostic capabilities to use en route to a hospital may save more lives.

For example, according to investigators in a World Journal of Emergency Medicine study, PoCUS education for paramedics can be helpful to patients: "Our pilot study suggests that with minimal training, paramedics can use [ultrasound] to obtain cardiac images that are adequate for interpretation and diagnose cardiac standstill."

An American Journal of Emergency Medicine editorial also discussed the importance of using prehospital ultrasound in situations with critical patients.

"Streamlined [focused assessment with sonography for trauma] may increase triage accuracy of blunt torso trauma patients in mass casualty incidents with limited medical resources," the authors noted. "We recommend the use of [streamlined focused assessment with sonography for trauma] to decrease patient triage to treatment time in any unfortunate future disasters."

In many instances, prehospital clinicians are the first to interact with critically ill patients. Consequently, having PoCUS available to provide real-time internal images may provide significant benefits to both cardiac life support and advance trauma support. Not only may it assist with any prehospital decision-making, but it may also help inform how physicians proceed once patients arrive in the emergency department.

Real-World Implementation
Prehospital ultrasound offers a real-world option in helping to provide immediate care to patients in acute situations. Using GE Vscan Extend™, a helicopter paramedic unit in New Zealand screened airlifted patients for potential cardiac problems prior to landing at Dunedin Hospital, which is located in an area where road travel can be precarious.

In these and other frenetic conditions, PoCUS is helpful because paramedics may clearly see heart function. With ultrasound, New Zealand's paramedics assessed cardiac activity and checked for internal bleeding, thoracic injuries and pulmonary embolisms. They also used handheld ultrasound to side-step unnecessary procedures. For example, PoCUS use determined a suspected pneumothorax in one patient did not exist, so paramedics opted not to decompress the chest.

Prehospital ultrasound may also be used to triage patients who should be taken immediately to the operating room. Doing so saves valuable time otherwise spent running further diagnostic tests in the emergency department.

PoCUS Training
Handheld ultrasound can be a valuable tool for nearly any healthcare provider who receives proper training. Paramedics and other prehospital clinicians may achieve the same level of skill as physician sonographers if they undergo comparable instruction.

This level of accuracy may alter and positively impact the care a patient receives upon arriving at the hospital by giving physicians insight into a patient's condition.

While research into the use of prehospital ultrasound is in the early phases, study results and real-world implementation have already shown it may play a vital role in time-sensitive, critical conditions. All in all, proper use may decrease both mortality and morbidity, improving overall patient outcomes.
 

The device has been verified for limited use outside of professional healthcare facilities including during transport. Use is restricted to environmental properties described in the user manual , please contact your GE Healthcare sales representative for detailed information

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Handheld Ultrasound Education.

How Handheld Cardiac Ultrasound Aids in Diagnosis

Handheld cardiac ultrasound does not aim to replace routine comprehensive echocardiography, but its use may decrease the frequency of comprehensive scans. As a result, it might not only make clinicians' lives easier, but it may also lead to better patient experiences and outcomes.

Making a Cardiology Diagnosis
There are many applications for handheld ultrasound in making a cardiology diagnosis. For example, it may be used specifically to assess cardiac chamber size and function and valvular regurgitation. An article in Clinical Cardiology reported that "the pocket-sized [portable transthoracic echo (pTTE)] provides accurate detection of cardiac structural and functional abnormalities beyond the [electrocardiogram (ECG)]. In addition, the use of pTTE as an initial screening tool prior to [standard TTE] is cost-effective, suggesting that the pocket-sized pTTE is poised to alter the current diagnostic strategy in clinical practice."

Non-cardiologists may use handheld ultrasound as a tool for aortic stenosis and mitral regurgitation. This means that the ultrasound may be an adjunct to clinical examination in patients where a murmur is heard. Wiener Klinische Wochenschrift reports, "Pocket-size ultrasound imaging devices without continuous and pulse wave Doppler modalities can, even in the hands of a non-cardiologist with limited cardiac ultrasound instructions with high sensitivity and specificity, be a useful tool for detecting more than mild aortic stenosis and more than mild mitral regurgitation."

Handheld ultrasound may also be used to assess the volume status of the patient, via the inferior vena cava (IVC) diameter, as an indicator of progression of heart failure. As discussed in the American Journal of Cardiology, this use of ultrasound "is associated with an increased risk of heart failure admission and may provide clinically useful information at the point of care to guide heart failure management."

Augmenting Workflow
Handheld ultrasound may be used by primary care physicians to detect cardiovascular disease, and this may decrease the number of unnecessary formal echocardiograms. One study, published in Heart, used remote expert support to help interpret the handheld ultrasound images and found it to be "rapid and useful for detecting significant echocardiographic abnormalities and reducing the number of unnecessary echocardiographic studies."

Having repeat formal transthoracic echocardiograms (TTEs) to detect problems such as impaired ventricular function, pericardial effusion and IVC collapse is common. Using handheld, focused ultrasound scans of the heart may reduce the need for so many follow-up TTEs in a short space of time. A paper in the Journal of the American Society of Echocardiography concluded that "[t]he judicious use of expert focused cardiac ultrasound in place of repeat inpatient TTE has the potential to deliver quality cardiac imaging at reduced cost."

In some patients who are acutely unwell, moving them into a good position in their bed for a formal echocardiogram could be challenging. Handheld ultrasound may have an advantage as it can be used on patients in a semi-recumbent position. An article in Acta Anaesthesiologica Scandinavia concluded that "[t]he apparatus is well-suited for performing a [focus-assessed transthoracic echocardiography] examination in a one-day surgery setting and could very well also be applicable in almost any situation involving patients with acute illness."

Streamlining Care
What's more, handheld ultrasound may be used by cardiologists on their ward rounds. Being able to do a bedside ultrasound may reduce the number of formal echo studies that need to be done. As described in the American Journal of Medicine, "For hospitalized patients, [t]his finding could shift the burden of performing and interpreting the echocardiogram to the examining physician and reduce the number and cost associated with formal echocardiography studies."

In emergency departments, handheld ultrasound may reduce the time to diagnosis in patients presenting with shortness of breath. Herz reported, "One-third of patients had significant findings on the scans to possibly aid diagnosis and prevent misdiagnosis. This has the potential to reduce time to diagnosis in the [emergency department]."

Handheld ultrasound may be used by a broad range of healthcare professionals in different specialties to help streamline patient care, improve diagnosis and direct therapy — and it might be a beneficial adjunct to formal echocardiography.
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Handheld Ultrasound Education. Improving Patient Care.

Handheld Point-of-Care Ultrasound: Why Having it is Important

When it comes to the best quality patient care, the physical exam is a fundamental factor. Providers glean a great deal of information this way, but using handheld ultrasound to visualize non-visible parts of the body might be a powerful clinical complement.

In many cases, having handheld ultrasound available might also be the key to accelerated patient care and accurate diagnoses. And, when time is of the essence, point-of-care ultrasound (PoCUS) may be the tool that speeds up your diagnostic capabilities.

Ultimately, using PoCUS, such as GE's Vscan Extend™, increases not only your confidence with your diagnosis, but your patient's comfort with the care you provide.

Inspiring Confidence
When a patient presents with a suspected problem, such as right upper quadrant or flank pain, making a timely diagnosis may be critical. Alongside a physical exam, PoCUS lets you focus immediately on the problem area and see what's invisible to the naked eye, giving you greater confidence in identifying the cause of the symptoms.

In fact, point-of-care ultrasound could increase how detailed your exam can be, adding valuable information to the patient's electronic health record. In a short amount of time, PoCUS may capture multiple clear images to give you a more robust picture. According to the concluding findings of a 2016 report from The World Book of Family Medicine, "because of a significant number of advantages, ultrasonography should be a diagnosis tool" used with a stethoscope in medical offices.

If needed, this level of detail lets you refer your patients for the right test or diagnostic treatment, reducing the likelihood they will go through unnecessary doctor visits or unneeded additional imaging.

Saving Time
PoCUS images may also help you save time whether you're an emergency department (ED) physician or a general practitioner.

In the ED, having access to a handheld ultrasound device may determine if and how you triage your patients. For example, if an individual has symptoms of cardiac distress, PoCUS may reveal information at the bedside in real time.

A PoCUS exam may also pave the way for rapid diagnosis during a regular doctor's visit. During an appointment, you may make an immediate decision whether your patient needs to see a specialist or be hospitalized. Not having to wait for another provider's analysis may fast-track needed therapy and reduce any stress patients might have about their symptoms.

Shortening Diagnosis Time
As you use PoCUS more often and fine-tune your skills, you're likely to become more confident in your findings. Over time, it's possible that you'll be able to render your bedside diagnoses and offer guidance more quickly.

A 2011 European Journal of Echocardiography study tested the diagnostic efficiency of PoCUS and high-end echocardiography and concluded that "pocket-sized echocardiographic examinations of approximately four-minute length, performed at the bedside by experts, offers reliable assessment of cardiac structures, the pleural space and the large abdominal vessels."

Improving Relationships
As a hand-held device, PoCUS gives you the opportunity to have more face time with your patients. In many cases, they watch as you conduct the exams and can ask questions. Getting real-time information from ultrasound images may increase the patient's confidence in your diagnosis and the treatment you'll prescribe. For example, PoCUS at the bedside may provide a pregnant woman with the immediate visual confirmation that her unborn baby is healthy.

Additionally, according to a 2018 Annals of Internal Medicine study, PoCUS may also offer high ultrasound imaging quality, and the authors concluded that they "believe that use of ultrasound by hospitalists will continue to modernize the bedside evaluation and streamline the diagnostic process." Bedside testing may lead to decreased lengths of stay, a reduction in resource utilization and lower costs.

PoCUS vs. Other Modalities
In many instances, PoCUS may provide better ultrasound image quality than the other modalities you employ with your patients. For example, according to the conclusions of a 2013 Clinical Cardiology study, "the pocket-sized (portable transthoracic echocardiography) provides accurate detection of cardiac structural and functional abnormalities beyond the ECG." These findings may boost your confidence that you'll catch a problem earlier.

In addition, research has also shown PoCUS is a strong alternative to chest X-ray when diagnosing pericardial (PE) and pleural effusions (PLE). A 2015 Scandanavian Cardiovascular Journal article that observed nurses using ultrasound concluded that "Cardiac nurses were able to obtain reliable measurements and quantification of both PE and PLE bedside by focused ultrasound."

Overall, in today's healthcare environment, PoCUS may play a significant role in providing additional clues during physical exams to make a diagnosis. By employing PoCUS, you may be able to gather these images much faster than you possibly could with other options. And, as you become more proficient with the hand-held technology, you may become more confident with your real-time diagnosis, potentially improving patient care.

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Improving Patient Care. Handheld Ultrasound Trends. Technology and Innovation.

Massive Storm, Small Technology

On September 9, Jeff Hersh, a doctor, watched the northbound lanes of Interstate 75 in Florida fill with carloads of people fleeing the path of Hurricane Irma.

Jeff was on the other side of the highway, driving south and intentionally heading into the oncoming storm.

Irma struck northern Caribbean islands as well as the U.S. mainland and is blamed for dozens of deaths as well as power outages to millions of homes and businesses.

Jeff is among the 36 members of the Boston Strong MA1 Disaster Medical Assist Team (DMAT), which was activated as part of the United States Health and Human Service’s National Disaster Medical System (NDMS) response to Hurricane Irma.

In its 30-year history, NDMS has participated in more than 300 deployments to disasters domestically. It’s is made up of civilian, disaster-response trained people who become intermittent federal employees, serving as boots on the ground when and where they’re needed.

Read the full article

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