#30: Portable Ultrasound and a Deep Dive into Diving Med
Jun 26, 2023
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Jennifer N. Wray, a contributor to the Wilderness & Environmental Medicine journal, joins Zachary P. Soucy, Nicholas J. Daniel, Nicholas E. Weinberg, and G. Michael Krauthamer, MDs specializing in wilderness and diving medicine. They delve into groundbreaking research on ultrasound gel alternatives, revealing how everyday liquids can enhance medical imaging in remote settings. The discussion shifts to the critical nuances of diving medicine, addressing challenges faced at high altitudes and during underwater emergencies. Listeners will discover innovative techniques and essential safety measures for outdoor medical practices.
Improvised liquids like soap and shampoo can substitute traditional ultrasound gel effectively in wilderness medical settings, enabling better diagnostic capabilities.
Diving at high altitudes presents unique challenges such as HAPE and IPE, necessitating specialized knowledge for safe practices and ascent rates.
Clear communication protocols and radio etiquette are essential in wilderness medicine to ensure accurate information exchange during emergencies.
Deep dives
Ultrasound Gel Alternatives
A study assessed the effectiveness of nine improvised liquids as substitutes for traditional ultrasound gel in wilderness settings. The tested alternatives included common items like soap, shampoo, olive oil, and even energy gels, aimed at determining their capabilities for ultrasound imaging. The study's results indicated that all the tested liquids, except for energy gel, performed comparably to standard ultrasound gel, presenting a viable option for medical practitioners in austere environments. This innovative approach emphasizes the value of creative problem-solving when resources are limited, particularly for those in wilderness and emergency medical situations.
Study Design and Execution
In this investigation, specific ultrasound windows were chosen to standardize conditions while using different gels during imaging. A total of 160 ultrasound clips were captured and reviewed, with sonographers not being blinded to the liquid used but the image reviewers were. The study aimed to replicate real-world scenarios in remote settings, where medical professionals may lack access to conventional ultrasound gel. Despite its limitations, including potential biases from sonographers, the findings highlight that practical solutions can be implemented in emergency medicine to enhance diagnostic capabilities.
Impact of Environment on Ultrasound Practices
The choice of liquid alternatives for ultrasound gel also depended on practical considerations, such as the availability of materials during outdoor expeditions. Some of the selected alternatives posed safety concerns regarding their effects on both the patients and the ultrasound equipment. Factors such as the viscosity and temperature of the liquids may influence their performance and effectiveness in an actual medical emergency. The study inspired further exploration into other improvisations that can meet clinical needs efficiently and safely while minimizing weight and space in a medical pack.
Diving Medicine Insights
Diving medicine was another significant topic, highlighting the unique challenges faced when diving at high altitudes. The discussion included risks such as high altitude pulmonary edema (HAPE) and immersion pulmonary edema (IPE), both of which exhibit similar clinical presentations but arise from different physiological mechanisms. The conversation emphasized the importance of precautions while diving at altitude, including understanding nitrogen's effects on the body and adhering to safe ascent rates to avoid decompression sickness. These insights stress the need for specialized training and knowledge in wilderness medicine, especially for divers engaging in extreme environments.
Effective Communication in Crisis Situations
The episode underscored the critical role of clear communication in wilderness medicine scenarios, particularly when utilizing radio equipment in emergency responses. Experts shared insights on proper radio etiquette and communication protocols to ensure effective information exchange during high-stress situations. They stressed the significance of speaking clearly and succinctly to prevent misunderstandings that could jeopardize patient safety. The emphasis on structured communication methods highlights the importance of preparation and training in ensuring that medical responders can manage emergencies efficiently.
#30: Portable Ultrasound and a Deep Dive into Diving Med
Jun 2023
Wilderness & Environmental Medicine journal online: www.wemjournal.org
Questions/comments/feedback and/or interest in participating? Send an email to: WMPodcast@wms.org
Part 1: Journal Club
Title: Comparison of Commonly Carried Liquids Against Commercial Ultrasound Gel for Use in the Backcountry Setting
Authors: Jennifer N. Wray, BA; Zachary P. Soucy, DO; Nicholas J. Daniel, DO; Nicholas E. Weinberg, MD; G. Michael Krauthamer, MD; Sarah C. Crockett, MD; Catherine C. Pollack, PhD; Johndavid M. Storn, MD
Link to article: https://www.wemjournal.org/article/S1080-6032(22)00220-4/fulltext
CME Available for WMS members at wms.org.
Part 2: A deep dive into diving medicine and high-altitude medicine and a primer on radio communications
Part 3: NEW THIS EPISODE! A summary of the episode is offered in English, Spanish, and French!
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