Some recollections of early work with bedside ultrasound in emergency medicine: the first 10 years.

The early history of ultrasound in emergency medicine has remained for the most part undocumented up to this time. This piece represents personal recollections of the evolution of point-of-care ultrasound from its origins in the late 1980s in the United States. A description of ultrasound equipment, resistance to widespread implementation, the evolution of training, and fellowship programs with subsequent publications and committee developments are examined in detail. Special attention to the advancement of trauma ultrasound is also examined from the viewpoint of an early adopter. The purpose of this manuscript is to recognize the persistence and dedication of some of the early founders of emergency ultrasound, thus gaining a deeper appreciation for the scope of practice and meaningful use that emergency physicians are now using on a daily basis.

Seat belt use by police: should they click it?

BACKGROUND: Motor vehicle crashes are a leading cause of mortality in the United States, although seat belts significantly reduce the risk of death. Police officers do not always wear a seat belt. A retrospective study was conducted on all crashes that involved marked police vehicles in the United States and included a death in any of the involved vehicles. METHODS: For the years 1997 through 2001, crash data were collected and analyzed from the Fatality Analysis Reporting System that included an isolated or multiple vehicle crash with a marked police vehicle and a resulting death in any of the involved vehicles. Motorcycle, aircraft, and undercover police crashes were excluded from this study. Only the occupants of the police vehicle involved in the crash were included in the study. In addition, crashes involving police vehicles where the status of seat belt use by the occupants of the police vehicle was unknown were also excluded. RESULTS: When the crashes occurred, 59.9% of the officers were responding to nonemergency calls, 79.8% of the occupants were wearing their seat belts, and 79.5% survived. Of the 104 occupants that were not belted, 42 (40.4%) died in the crash, compared with 64 (15.5%) of the 412 belted occupants (risk ratio, 2.6; odds ratio, 3.7). CONCLUSION: The risk of death was 2.6 times higher for unbelted occupants of police vehicles than for belted occupants in our study population. In addition, seat belt use was not statistically related to emergency versus nonemergency calls.

Sensitivity in detecting free intraperitoneal fluid with the pelvic views of the FAST exam.

The multiple-view focused assessment with sonography for trauma (FAST) exam is an integral tool in the assessment of blunt abdominal trauma. A prospective observational study was performed to compute the average minimum volume of detectable intraperitoneal fluid with the pelvic views of the FAST exam. All adult patients from October 1999 to May 2001, who presented to the ED with blunt abdominal trauma and underwent a clinically indicated diagnostic peritoneal lavage (DPL), were candidates for admission to the pelvic ultrasound study. In the supine position, patients were administered lavage fluid in 100 cc increments until the examiner detected the fluid on ultrasound. An independent reviewer also examined the hard-copy ultrasound images for fluid detection. Patients were excluded if they had (1) a positive DPL for hemoperitoneum (defined as 10 cc of gross blood or >100,000 red blood cells/mL), (2) a positive initial ultrasound for free fluid, or (3) lacked sufficient hard-copy ultrasound images. The mean minimal volume of fluid needed for pelvic ultrasound detection by the examiner and reviewer was 157 and 129 cc (n = 7), respectively. The median quantity of fluid for ultrasound detection by both the examiner and reviewer was 100 cc. The pelvic views of the FAST exam identified a significantly smaller quantity of intraperitoneal fluid than previous studies of the right upper quadrant single-view exam.