Quick Diagnosis in an Emergency
Imagine it’s late at night and you’re experiencing chest pain or stabbing stomach pains. Or you’re pregnant and have acute cramping. You would probably take yourself to the Emergency Department. In the past, this could mean a series of tests that keeps you at the hospital for hours or even days. Now, with portable ultrasounds, many of these simple questions can be answered at the bedside.
The Emergency Department (ED) at London Health Sciences Centre has a few portable ultrasound machines, but they range from six to 12 years old and are well past their warranties. The ED continues to use the older machines, which are prone to malfunctions when they are available. This is not sustainable.
Our EDs need a dedicated point-of-care ultrasound (POCUS) program to help care for more than 150,000 patients in need of emergency care each year.
Tab 1
Point-of-Care Ultrasounds
From teens, to the elderly, to the most vulnerable people in our region; portable ultrasounds have the potential to help every single patient in need of emergency medicine. They can quickly be used to produce images of a patient’s organs (with no radiation) to diagnose, triage and – in ultrasound-guided procedures – treat a patient.
Patients like:
• A 17-year-old male patient whose heart was failing after he was found in a snowbank with hypothermia. The ED team used the ultrasound with the TEE probe (pictured) to help actively resuscitate him over several hours. He walked out of the ICU just a few days later.
• An 86-year-old female patient was in terrible pain after breaking her hip. She had dementia and didn’t know which medications she was taking. The ED physician was able to avoid any potential complications from painkillers by using the ultrasound machine to help guide the placement of a nerve block to ease her pain. This method also works for patients who may struggle with opioid dependencies by providing drug-free pain relief.
• A 72-year-old male has collapsed and arrives to the ED in critical condition. A bedside ultrasound reveals a previously unknown abdominal aortic aneurysm. This is a life-threatening condition if not recognized and immediately treated. With this diagnosis made within minutes of his arrival, his care is quickly expedited to the operating room where he undergoes a successful repair.
Other Ultrasound Applications
RESPIRATORY CONCERNS: Lung ultrasound is a fast and effective alternative to x-ray, particularly with COVID-19 patients. They come with a special probe that reveals images even during resuscitation, identifying any life-threatening blockages that can be treated on the spot to save a life.
SAVING THE VEIN: Sometimes just finding a vein to insert an intravenous (IV) line can be challenging for the care provider and distressing for the patient, especially if they can’t enter through the arm (periphery) and must use a central line through a larger tube in the neck, upper chest or groin. The ultrasound provides a quick and painless way of guiding this procedure.
DIAGNOSING PAINFUL CONDITIONS TO PROVIDE QUICK RELIEF: Urologic issues like testicular torsion (when the blood supply cord to the testicle becomes twisted, causing sudden pain and swelling) benefit from quick diagnosis with the ultrasound. Gallstones are another painful reason for visiting the ED. The ultrasound helps the care team see the gallbladder and bile ducts to identify any blockages.
PREGNANCY COMPLICATIONS: An expecting mother who is worried about her baby’s health finds immediate relief when she can see the fetal heart beat on an ultrasound, which helps lower her blood pressure and reduce her health risks.
Tab 2
Research and Education
POCUS Fellowships: Ultrasound Fellowship Program Director Dr. Frank Myslik oversees one-year POCUS fellowships to train the next generation of physician specialists in ultrasound technology. Each fellow performs over 800 scans and publishes a research project aimed at advancing ultrasound medicine.
Staff Training: LHSC is training 200 nurses on ultrasound-guided IV insertion as a pilot project. Ultrasounds save time and improve the patient experience, and the training is empowering the nursing staff.
Community Outreach: Ultrasound training is currently limited to London hospitals due to resource limitations. Donor support will help the team offer ultrasound training to community hospitals and clinicians eager to offer POCUS care, which has the potential to further reduce the strain on London’s EDs.
"There’s a lot of opportunity to grow the POCUS program both within the walls of our hospitals, as well as through outreach to community sites. We’re not there yet, but we will be able to get there with the help of donors."
-Dr. Christie MacDonald, Interim Chair/Chief, Emergency Medicine
Your donation to Emergency Medicine will ensure LHSC care teams can quickly and accurately diagnose, triage and treat patients when they need it most.