12 - Introduction to Bedside Ultrasound

Summary

Nothing has generated as much change in emergency medicine in the past 15 years as the introduction of bedside ultrasound. Why? Because physicians who have embraced this new tool realize how important it is to their everyday practice and how lost they would be without it. “Bedside ultrasound” means ultrasound examinations performed and interpreted by the treating physician at the time of the patient encounter. Clinical questions can be answered immediately, accelerating both decision making and treatment. In acute situations where time to diagnosis directly affects treatment and outcome, such as with penetrating cardiac trauma, pericardial tamponade, intraperitoneal hemorrhage due to trauma or ectopic pregnancy, or leaking abdominal aortic aneurysm, ultrasound can be a critical adjunct.

Ultrasound also benefits many procedures commonly performed in the ED. The use of ultrasound for procedures was underemphasized until recently, but it appears that it may now be a major driving force behind the desire of practicing emergency physicians (EPs) to learn ultrasound. No longer does inaccurate clinical judgment have to be relied on to guide the decision to perform time-consuming, expensive, and potentially hazardous procedures. Central lines go in on the first attempt with a reduced risk of puncturing an artery or having an unsuccessful procedure, suspected abscesses are not needled or drained without knowing whether there is a fluid collection present, paracentesis is nearly 100% successful with little risk of puncturing tethered bowel, and pericardiocentesis is only done when there is pericardial fluid to drain, with the needle placed exactly where it is wanted (1),(2).