Prehospital Ultrasound Diagnosis of Traumatic Pericardial Effusion

A 41-year-old male was stabbed in the left chest. When paramedics arrived at the scene, the patient was unconscious. The airway was managed with a nasal trumpet, and the patient was quickly moved to the ambulance. The systolic blood pressure was 85 mm Hg. In the ambulance, one paramedic performed a bedside, prehospital ultrasound (PUS) using a SonoSite MicroMaxx (Sonosite Inc., Bothell, WA) with a P17 probe using a subcostal cardiac view. A large pericardial effusion with hyperechoic and anechoic fluid in the pericardial sac was identified (Figure 1, Video Clip S1, available as supporting information in the online version of this paper). Based on this ultrasound finding, the decision was made to immediately transport the patient to the closest Level 1 trauma center, with intravenous fluids administered enroute. The total emergency medical systems (EMS) scene time was 9 minutes and transport time was 6 minutes. The PUS took less than 1 minute to obtain and did not impact transport times. The emergency department was alerted that a patient with a hypotensive stab wound to the heart with a positive sonographic pericardial effusion was enroute. Still capture from the prehospital ultrasound showing a large mixed-density pericardial effusion with right ventricular collapse. This ultrasound was taken by paramedics enroute to the hospital. The patient was quickly assessed in the emergency department. The emergency physicians and trauma surgeons reviewed the PUS video. The patient was taken directly to the operating room based on the PUS video, and a median sternotomy was performed with evacuation of a large mixed-density clot and repair of a right ventricular stab wound using a single 3.0 Prolene suture with pledget. The patient had an uneventful postoperative course and was discharged from the hospital 4 days later with complete neurologic recovery. Prehospital ultrasound has been used in our EMS system on a limited basis for the past 12 months. This case demonstrates that EMS personnel can be adequately trained to utilize this technology to shorten time to determining certain diagnoses and facilitate proper destination decisions, which can improve overall patient care. This case is part of a larger PUS study that was approved by our institutional review board. Video Clip S1. Prehospital ultrasound showing a large mixed-density pericardial effusion with right ventricular collapse. This ultrasound was taken by paramedics enroute to the hospital. The video clip is an AVI file Please note: Wiley Periodicals Inc. is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.