Emergency department ultrasounds: saving time and lives

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In an emergency department, time is of the essence. A quicker diagnosis can mean the difference between life and death, which is why physicians at Toronto East General Hospital (TEGH) are often now reaching for an ultrasound machine faster than a stethoscope and are national leaders in practicing this new technique.

Abdominal pain is the most common patient complaint in an emergency department, yet the underlying cause can range from indigestion to an aneurysm. Narrowing down a diagnosis is often a matter of elimination and thanks to ultrasound, many life-threatening complications can be diagnosed faster than ever before.

“Having the ability to use ultrasound in the emergency department is significant because it changes the way we are able to care for our patients,” says Dr. Paul Hannam, Chief of Emergency Medicine, TEGH. “There is better information available at the bedside. No single test is perfect, but using ultrasound adds another dimension to the clinical picture. In some cases, this can be lifesaving.”

The Canadian Emergency Ultrasound Society (CEUS) is the national organization that oversees emergency ultrasound training in the country and is comprised of physicians who promote the safe and effective use of ultrasound. “The TEGH Emergency Department staff are among the leaders in emergency ultrasound in Canada,” says Dr. Peter Ross, President, CEUS. “All members of the department have taken a basic course in this subject. Much more importantly, they have nearly all gone on to be certified by the CEUS as Independent Practitioners. This is an extremely noteworthy achievement, as most emergency departments have no more than a few of its members certified to this level.”

The ultrasound machine, which is more compact than an average laptop, sits atop a metal trolley and can be easily manoeuvred throughout the busy halls of the unit. TEGH, which began using the technology in 2007, has two devices, which physicians use multiple times during their shift.

The scanners are used to rule out possibilities so that physicians can guide the timing of a definitive scan in radiology. “We use the scanners to make sure there isn’t an immediate danger to our patient,” says Dr. Hannam. “A CT scan provides greater detail, but it can take a few hours to perform the scan and get the results back. Emergency ultrasound allows us to say yes or no right away. We still rely on our colleagues in radiology, but we can make decisions in the emergency room with more confidence.”

Emergency ultrasound focuses on the detection of certain urgent, life threatening conditions. For example, one patient walked into emergency and was complaining of pain in his abdomen and fainted. The physician, who would have previously sent the patient for a CT scan, used the ultrasound and saw a large aneurysm which was slowly leaking. A leaking aneurysm can become fatal within three hours without treatment. The patient, who wasn’t showing classic symptoms of an aneurysm, was immediately transferred to the operating room for surgery and was able to go home a week later.

“Ultrasound is transforming the way emergency medicine is practiced in Canada,” says Dr. Ross. “What makes the Canadian experience unique is the rigorously high standard with which ultrasound education has been disseminated across the country.”

Currently, there are 27 emergency physicians who have voluntarily completed the CEUS courses and can now call themselves Independent Practitioners at TEGH. Dr. Francis Sem, Ultrasound Education Coordinator at TEGH, has been the driving force behind much of this success. “The docs have really embraced this and all of us are doing it,” reveals Dr. Hannam. “This is most beneficial to the community as it’s rare to see such high and consistent standards with a new, non-mandatory practice. Emergency physicians like it because it works.”