Ultrasound in emergency and ambulatory medicine

ABSTRACT

Our primary reason for writing this book is to help physicians interested in ultrasonography get started. While the scope and importance of ultrasonography has grown tremendously over the past several decades, the strategy for introducing ultrasonography into nontraditional settings of emergency medicine and primary care deserves special attention. The photographs, artist’s drawings, and graphics are selected to illustrate basic concepts as well as to provide a framework for more advanced use of the technology. Our aim is to make ultrasonography as accessible and clinically relevant as possible. The term “goal-directed ultrasound” means using the images as an integral part of the diagnostic and therapeutic process. Finally, this book is designed to get nonradiologists excited about the possibilities ultrasound can offer. We started out looking for the obvious right upper quadrant and pelvic pathologic conditions. Then we added the aorta and blood in the abdomen as a result of trauma and then blood around the heart. Later we began to visualize the internal jugular vein before placing our central venous lines and we looked at the heart during medical codes to definitively document pulseless electrical activity (PEA). More recently, we began looking at the kidneys to identify hydronephrosis, leg veins to assess for deep venous thrombosis, the space above the diaphragm to look for pleural effusion, and the soft tissues to identify foreign bodies or abscess formation. All these subjects and more are discussed in this book. Just before this text went to print we discovered another use for ultrasonography that has never been discussed in the literature. We had a morbidly obese patient from whom we were unable to obtain spinal fluid even with by visualizing the echos caused by her spine. The applications are exciting and can have a significant impact on the quality of patient care