The focused trauma ultrasound examination. Can, and should, accident and emergency physicians in the UK acquire this skill?

Abstract

The use of ultrasonography for the investigation of urgent diagnostic problems has been used widely for almost 40 years. During the past decade ultrasonography, by non-emergency department physicians, has achieved a primary role in Europe and Asia in the investigation of emergent conditions such as abdominal and thoracic trauma.1–6 In the United States the use of this bedside modality by emergency physicians (EPs) has expanded rapidly in recent years with more than 100 emergency departments providing an ultrasound service delivered by EPs.7 A fellowship programme in emergency ultrasonography and model curriculum for EP training in ultrasound have been produced.8 This is fully supported by the American College of Emergency Physicians (ACEP) and the Society for Academic Emergency Medicine (SAEM) who produced their position statements on the subject in 1991.9,10 The crux, of the EPs use of ultrasound in trauma, is that by placement of the ultrasound probe over six anatomical areas (see fig 1) it is possible to answer highly focused questions yielding useful diagnostic information as quickly as possible. It is expected that the investigation should take 5–10 minutes to complete and be carried out, during trauma resuscitation, at the patient's bedside. Figure 1 Probe placement in the focused trauma ultrasound examination. In traumatised patients there are three primary applications for its use in the emergency department: Is there intra-abdominal free fluid? Is there a pericardial effusion? Is there evidence of a haemothorax? It is clear that these are potentially life threatening problems and that timeliness is important. It has been shown that bedsideultrasonography has helped to increase the efficiency and safety of patient management by reducing the time taken to identify these conditions.11–16 Can, and should, accident and emergency (A&E) department physicians in the UK follow the American moves …