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Point-of-care ultrasound (POCUS) is a critical clinical tool that facilitates the early diagnosis of many life-threatening injuries. As with any test, clinicians need to fully appreciate indications and limitations of the diagnostic tool and integrate where advantageous to their practice. POCUS also is a valuable tool to enhance the speed, accuracy, and safety of several procedures that are frequently required in the trauma patient. The authors provide a synopsis of the state-of-the-art use of ultrasound for trauma patients.
— Ann M. Dietrich, MD, Editor
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Introduction
Injury is a leading cause of death in the United States. In 2013, injured patients constituted 31 million emergency department (ED) visits and resulted in more than $406 billion in medical care and lost productivity. More people ages 1–44 died from injuries than from noncommunicable diseases and infectious diseases combined.1 Given these staggering statistics, clinicians should have the proper skill sets to rapidly identify and treat injuries.
Ultrasonography is an ideal tool for the care of injured patients. It is rapid, noninvasive, portable, versatile, low cost, and easy to use. Discovered in the 1820s by Swiss physicist Jean-Daniel Colladon, it was first used as a diagnostic tool during World War II.2 Since that time, ultrasound has gained tremendous popularity within the acute care specialties. German and Japanese physicians began using routine POCUS for trauma patients in the 1970s,3 and emergency physicians in the United States followed in the 1980s.4-5 POCUS is now also utilized in developing countries to direct patient care, as there is a scarcity of computer tomography (CT) scanners in many places.6
This issue of Trauma Reports will focus on the fundamental concepts of POCUS for the care of adult injured patients. This article begins with an overview of the important concepts in ultrasound physics, which serve as the foundation for better understanding of ultrasound techniques and image interpretations. Each subsequent section contains information on the indications, interpretations, and limitations of the specific ultrasound modality.
Ultrasound Physics
The source of the ultrasound wave is the piezoelectric crystal housed within the probe transducer. This crystal has the ability to transform an electrical current into mechanical pressure (ultrasound) waves and vice versa. Once the ultrasound wave is generated and travels through the medium, the...