Learning and Logistics of Emergency Ultrasound
from the beginning, basic steps can be acquired one after the other. To begin with, training can be limited to a single application, for instance lung sliding in the search for pneumothorax. Once accustomed, the intensivist knows that the device can be used every time this precise question is raised. Once fully familiarized, the intensivist will go on to another application, and so on for an indeterminate period. To give a rough esti- mate, personalized training including one 30-min session every week will cover the 12 basic appli- cations in 18 months [1]. The time required to master a single application can be extremely short.
The training of the intensivist in emergency ultrasound assumes a global reflection. This train- ing can be acquired by reading books devoted to emergency ultrasound. Classic training among colleagues in the same ICU is probably the best, but not many will be trained per year. Seminars may accelerate this process. In fact, integrating ultrasound use into university medical studies would be the most efficient way to prepare future intensivists.
The Pilot’s License
Untamed ultrasound is expanding more and more.
This means that the intensivist comes up to an ultrasound device, switches it on, carries out the examination and uses conclusions for immediate management. These conclusions may be compared with other diagnostic tools (time permitting) or with a follow-up ultrasound examination per- formed by authorized personnel. This practice is difficult to control and can give eminently variable results depending on the operator’s experience and conscientiousness. Usually performed in the anonymity of nighttime on-call duty, this practice has undoubtedly saved many critical situations throughout the world.
The introduction of emergency general ultra- sound in an intensive care unit should not be improvised. Usually, the current logistics combines a radiologist and a complete, cumbersome ultra- sound device in the radiology department. The ultrasound device is provided with wheels, but using these wheels is quite another matter. This set-up is effective when the radiologist is skilled in emergency ultrasound signs, and is physically pre- sent day and night, and when the patient can be transported without harm to the radiology depart- ment.
In an indeterminate number of institutions, even in high-income countries, the radiologist is little accustomed to emergency ultrasound, is reluctant to let the equipment leave the radiology department, or is absent outside of normal work- ing hours. In this precise configuration, a more active role for the intensivist can be envisaged.
A suitable ultrasound unit, suitable training and suitable checking of standards could then be com- bined.
The Ultrasound Unit
Chapter 2 described the ultrasound unit. The acquisition of a device in the ICU assumes a finan- cial investment. Occasionally the radiology depart- ment gets rid of obsolete units and leaves them to whoever wants them: these »old« machines can save lives. Their acquisition is a temporary but sometimes extremely interesting solution.
Training
Intensivists can be trained in emergency ultra-
sound. The training must progressively become
part of their day-to-day practice. Ultrasound mas-
tery has certainly a beginning but no end. This
author continues to learn every day. However,
CHAPTER 29Controlled access to this type of ultrasound use will be hard to apply, since deontology rules should be adapted. The deontology code indicates that no one should go beyond one’s abilities, but in cases of extreme emergency, all possible means must be put to service. We strongly believe that becoming an intensivist implies a very particular motivation. The same forces that pushed toward this discipline with admittedly few rewards will likewise motivate to combine self-control and conscientiousness. It is hoped that the appropriation of this life-saving method will give the user a feeling of humility, and not the opposite. The wise reader will beware of the danger of tarnishing the method [2, 3]. Let us wager that the number of situations saved with ultrasound will exceed the number of cases where the ultra- sound device should not have been switched on.
Meanwhile, the future organization of a univer- sity certificate will allow the intensivist to practice this discipline with the approval of the medical community, but it is as yet unknown exactly what official place ultrasound holds in extreme emer- gency situations.
References
1. Lichtenstein D, Mezière G (1998) Apprentissage de l’échographie générale d’urgence par le réanimateur.
Réan Urg 7 [Suppl]1:108
2. Filly RA (1988) Ultrasound: the stethoscope of the future, alas. Radiology 167:400
3. Weiss PH, Zuber M, Jenzer HR, Ritz R (1990) Echo- cardiography in emergency medicine: tool or toy?
Schweiz Rundschau Med Praxis 47:1469–1472 References 185
