role of ultrasound in abdominal emergencies

Abstract

Ultrasound has long been recognized as a powerful tool for use in the diagnosis & evaluation of many clinical entities. Over the past decade, as higher quality, less expensive scanners were developed; ultrasound has proliferated throughout various specialties .Ultrasound is no longer limited to radiology, but is being utilized by at least eight different specialties. One specialty which has contributed new research regarding ultrasound multiple clinical applications is emergency medicine. The attraction of immediate bedside Sonographic examinations in the evaluation of specific emergent complaints makes it an ideal tool for the emergency specialist. Emergency ultrasound is probably the most significant addition to emergency medicine practice since the introduction of RSI .Our physicians are now able to use a basic ultrasound unit, in a rapid and simple manner to dramatically alter there management of patients, in whom they are trying to rule - in or rule out the presence of one of five life-threatening conditions which are: Pulse less electrical activity Pericardial tamponade Intraabdominal hemorrhage Abdominal Aortic Aneurysm (AAA) Ectopic pregnancy These are universally recognized as the key indications for ultrasound to be performed by the emergency physicians. Not only are these conditions in which management decisions must some times be made in minutes (making a consultation by a radiologist is impossible),but the ultrasound images which they generate are easily interpretable. Introduced in 2001, this technique has already had a significant impact on our practice. Occasionally it has allowed us to make very rapid diagnosis of potentially life-threatening conditions. Very often it has allowed us to rule out those conditions. In both cases our disposition of patients has been accelerated while the quality of our care has improved. Bedside ultrasound evaluation including examination, interpretation and equipment should be immediately available 24 hours a day for emergency patients. Emergency physicians providing emergency ultrasound services should posses appropriate training and hands-on experience to perform and interpret limited bedside ultrasound imaging. The use of ultrasound imaging by emergency physicians is appropriate in clinical situation that include but are not limited to: Thoraco-abdominal trauma Ectopic pregnancy Abdominal Aortic Aneurysm(AAA) Pericardial effusion Determining cardiac activity Biliary disease Renal disease Procedures that would benefit from assistance of ultrasound Each hospital medical staff should review and approve criteria for granting ultrasound privileges based on background and training for the use of ultrasound technology insure that these criteria are in accordance with recommended training and education standard developed by each physician respective specialty. Training in performing and interpreting ultrasound imaging studies should be included in emergency medicine residency curricula. -Continuous research in the area of ultrasound should be encouraged. -Emergency physicians should be appropriately reimbursed for providing emergency ultrasound procedures in the emergency department.