Emergency Ultrasound and Error Reduction

Posted in: Emergency Medicine, Patient Satisfaction|June 6, 2014

SONOSIM SUMMARY: This article touches on several of the procedural applications of bedside ultrasound, and how bedside ultrasound improves patient care through error reduction. Ultrasound-guided central venous catheter placement is noted to be among the highest rated patient safety practices, as it allows the physician to precisely locate vessels and surrounding structures, and confirm that the needle and guide-wire are in the lumen of the vein. Ultrasound is also useful for performing thoracenteses, as the physician may actually visualize the pleural effusion and surrounding anatomical structures, thus reducing the frequency of iatrogenic pneumothoraces. Soft-tissue ultrasound is discussed for assessing cellulitis versus abscess, as ultrasound has been shown to change clinical management in about half of those cases. Lastly, ultrasound allows emergency physicians and anesthesiologists to directly target nerve sheaths for extremity nerve blocks. Even given all of the established benefits of ultrasound, 66% of community EDs still do not have access to ultrasonography for ED physician use (at the time of this publication); this statistic is quickly changing, as more and more residency program directors choose to integrate ultrasound education into their curricula.

Blackstock U, Stone MB. Emergency Ultrasonography and Error Reduction
Ann Emerg Med. 2009 Jul;54(1): 53-55

“You are working an overnight shift in the critical care area of your emergency department (ED). Paramedics bring in an elderly patient from a nursing home with fever, shortness of breath, and a presumptive diagnosis of sepsis. She has a history of multiple medical problems and was recently admitted to your hospital for pneumonia. As you examine the patient, you observe that she is febrile, tachypneic, hypoxemic, tachycardic, and hypotensive. There are diffuse rhonchi on examination and decreased breath sounds at the right base. A stat portable chest radiograph shows a moderate right pleural effusion and consolidation of the left lower lobe. The patient remains hypotensive despite boluses of crystalloid. You decide to place central venous access and an arterial catheter to assess her central venous pressure and mean arterial pressures. You consider thoracentesis to improve her respiratory status. Should you reach for the ultrasonography machine?”

To read the complete article, visit The Annals of Emergency Medicine website by clicking here.

SonoSim Keywords: Ultrasound, Emergency Ultrasound, Patient Safety

Emergency Ultrasound and Error Reduction

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