Emergency Ultrasound. Emergency Room. EMERGENCY ULTRASOUND reimagined
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1 in Emergency and Critical Care WORKSHOP Emergency Room The POINT-OF-CARE THINKING and the EMERGENCY ULTRASOUND reimagined Luca Neri, MD & Enrico Storti, MD SSUEm 118 Milano Intenisve Care Unit AO Niguarda Ca Granda Hospital WINFOCUS Board February 2, 2007 Barcelona, Spain Emergency Emergency Room Emergency Room Emergency Room 1
2 Emergency Room Point- a new paradigm Emergency Care a new tool for improving Emergency & Critical Care is not a location It s a concept! Emergency Care POINT-of of-care EMERGENCY ULTRASOUND from the Emergency Room concept to the Emergency Point- concept 2
3 What Emergency stands usually for?! a basic, focused, limited, qualitative, goal direct US exam, performed by appropriately trained, non radiologist clinical staff, using compact portable devices in emergency care or screening settings (ex. FAST exam) WINFOCUS was actually born around a set of questions? Which are the characterizing features of the emergency ultrasound throughout the world? Scenarios, clinical indications, competences, equipments, protocols, organizational settings, credentialing processes, quality assurance plans What Emergency stands usually for?! a basic, focused, limited, qualitative, goal direct US exam, performed by appropriately trained, non radiologist clinical staff, using compact portable devices in emergency care or screening settings (ex FAST exam) Nevertheless, the diffusion of these techniques among non imaging specialist staff opens controversies about its diagnostic accuracy and an ongoing Survey? Feb 2004 Up to date Bibliographic review (papers, textbooks) About 150 experts, academics, authors from more than 30 countries About 400 investigators/interested people from nearly 30 countries About 70 organizations (scientific societies, emergency medical services, hospitals ) About a dozen of main manufacturers and a hundred of distributors/ representatives WINFOCUS was actually born around a set of questions? the appropriate clinical scenario - Which patient and which setting? the potential provider - Which sonographer? the competence level required - Which training? the adequate equipment performance - Which technology? the real impact on patient assessment, management, outcome and health care - What for? and an ongoing Survey? Very soon, we identified as users and scenarios: A large, worldwide scattered, critical care community ranging from Emergency Physicians to Emergency Surgeons, Intensivists, Anaesthesiologists, Cardiologists, Radiologists, General pratictioners, Flight-Nurses / Obstetrics, and Paramedics A large variety of workplaces EMS Ambulances & Helicopters, hospital ED, OR, ICU, remote mountain areas, urban chaotic centers, football stadiums, battlefields, disaster settings, austere underdeveloped regions, high-tech space flights 3
4 not only FAST at the point-of? Basic & Advanced Limited & Extended Goal-directed & Comprehensive Qualitative & Semi-/ Quantitative General & Specialized Consensus & Evidence -based Curriculum & Competence -based Portable (Mobile, HH, HC) & Stationary Sono-scope & High-tech machine Prehospital Emergency Medical Services On-scene :: Accident area (road), Bed-side (home) not only ABDOMINAL US at the point-of? Thoracic, Pleuro/Pulmonar (ex EFAST) Cardiac, Vascular (ex HHE) Extremities, Bones (ex FASTER) Pelvic, Uro-genital, O&G Procedural, Others Basic to Advanced US applications are increasingly performed by the clinical staff of the emergency departments over a set of selected focuses across the whole body of the patient not only HOSPITAL US at the point-of? IN-HOSPITAL APPLICATIONS Prehospital Emergency Medical Services On On-scene scene : : Accident area (road), Bed-side (home) On-board :: Ambulances, Helicopters, Airplanes OUT-OF-HOSPITAL APPLICATIONS 4
5 Disasters, Mass casualties Triage area, First Aid Station, Field Hospital 5
6 Humanitarian Medical Operations Remote Disaster Relief Underdeveloped Areas Primary Health Care Peace-keeping & Military Deployment Battlefield, Air Medical Evacuation, Surface Ship, Submarine, Field Hospital 6
7 Other Civilian Remote/Austere Locations Rural Area, Mountain, Island, Desert, Polar region, Sport Medicine, Cruise ship, Air and Space-flight 7
8 ACCIDENT & EMERGENCY DEPARTMENT TRAUMA BAY / SHOCK ROOM Telemedicine (Remote Remote Guidance / Diagnosis) Teleultrasound: : Modem/Internet, Radio, Satellite 8
9 OPERATIVE ROOM (Intra-operative US) PRE- / PERI- OPERATIVE AREA DAY SURGERY CENTER, PAIN CENTER ICU, CCU, STROKE UNIT HIGH DEPENDENCY & OBSERVATION UNIT 9
10 Which common key-points for such a virtual US community? Emergency & Critical Care of-care Transversal Critical MEDICAL, SURGICAL, IMAGING DPTs Which common key-points for such a virtual US community? Emergency & Critical Care of-care Transversal World Interactive Network Focused On Critical UltraSound Critical Which common key-points for such a virtual community? EMERGENCY & CRITICAL CARE MEDICINE of-care Thinking Transversal Thinking Critical US performed in [remote, austere, disaster, scarce-resource settings] on Critical Patients [acutely and subacutely ill or injured subjects ] Critical thinking 10
11 Critical Multi-setting, Multi-goals, Patient state-centred centred, Problem-based, based, Time-dependant, Multi-focused, Transversal, Prioritizing ABCDE and Head-to-Toe Neri L, Storti E, Lichtenstein D, Towards an Curriculum in Critical Care Medicine, Crit Care Med 2007, in press. Critical US Level 1 ORGANICALLY focused/limited Free fluid detection Gallbladder calculi detection CLINICALLY comprehensive Shock assessment Thoraco/abdominal pain assessment Neri L, Storti E, Lichtenstein D, Towards an Curriculum in Critical Care Medicine, Crit Care Med 2007, in press. Dr Luca Neri Neri L, Storti E, Lichtenstein D, Towards an Curriculum in Critical Care Medicine, Crit Care Med 2007, in press. 11
12 Neri L, Storti E, Lichtenstein D, Towards an Curriculum in Critical Care Medicine, Crit Care Med, 2007, in press. Neri L, Storti E, Lichtenstein D, Toward a ultrasound curriculum in Critical Care Medicine, Crit Care Med 2007; 35[Suppl]:S290 S304. 1st International Certified Course on in Critical Care Medicine June 2006 >> December 2009 Neri L, Storti E, Lichtenstein D, Toward a ultrasound curriculum in Critical Care Medicine, Crit Care Med 2007; 35[Suppl]:S290 S
![35[Suppl]:S290 S304.](/docs-images/51/13348438/images/page_12.jpg "1st International Certified Course on in Critical Care Medicine June 2006 >> December 2009 12")
13 Any Vision to share? Improving Emergency and Critical Care Medicine by incorporating -Care into Clinical Practice Neri L, Storti E, Lichtenstein D, Towards an Curriculum in Critical Care Medicine, Crit Care Med, 2007, in press. Any mission? Bringing qualified Point- to the acutely ill or injured patient in all out-of-hospital and in-hospital settings Neri L, Storti E, Lichtenstein D, Towards an Curriculum in Critical Care Medicine, Crit Care Med, 2007, in press. Any objective? by developing and fostering, on a global and multidisciplinary basis: Continuing Medical Education, Clinical Research, Technology Development, International Teamwork Neri L, Storti E, Lichtenstein D, Towards an Curriculum in Critical Care Medicine, Crit Care Med, 2007, in press. 13
14 NEW YORK CITY (NY, USA) JUNE The Future Challange Bringing qualified Point- Emergency to the critically injured or ill patient EVERY WHERE through all our modern highly sophisticated Emergency Depts, as well as, all the rural and poor Health Systems of most of the rest of the world 14
15 The Future Challange Point- ultrasound World Interactive Network Focused On Critical UltraSound 15
16 World Interactive Network Focused On Critical UltraSound Thank you! Let s s work together for a better world with point-of ultrasound! Luca Neri, MD 16
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