Use of Lung Ultrasound in Prehospital Care to Aid in Diagnosis and Management for Patients With Dyspnea: A Case Series

Summary: Lung Ultrasound (LUS) is a widely utilized point-of-care ultrasound (POCUS) application in emergency and critical care settings for assessing dyspneic patients. It aids clinicians in differentiating among various potential diagnoses, including congestive heart failure, chronic obstructive pulmonary disease, pneumothorax, pleural effusion, and pneumonia, thereby guiding appropriate treatments and interventions. In the prehospital setting, clinical decision-making can be especially challenging due to limited diagnostic resources when distinguishing these common causes of acute dyspnea. POCUS is a tool that has been used in Helicopter Emergency Medical Services (EMS) for over a decade, but has only recently found its way into ground ambulance services. Advances in technology have made ultrasound machines more portable, durable, and affordable, improving both the accessibility and feasibility of using this valuable diagnostic tool in prehospital care. While POCUS has increasingly been integrated into prehospital training protocols for various applications, LUS has not been widely adopted in this context despite its recognized utility in the management of dyspneic patients and its relative ease of training. New Orleans EMS in Louisiana, USA, has begun incorporating LUS education into their POCUS training for providers. Paramedics and advanced EMTs are now employing basic LUS to evaluate dyspneic patients in the field, using ultrasound findings to inform treatment decisions. This case series presents several patient cases from this initiative, demonstrating how LUS contributed to identifying the etiology of dyspnea and highlighting typical pathologic findings observed during LUS examinations. We will further explore how these findings lead to a change in management that would not have been available without the use of POCUS in the prehospital setting.