Importance of implementing point-of-care ultrasound at the prehospital level
Authors: Živanović Bogdan , Jovanović Kristina , Jakšić Stefan 
Published: June 2024

The use of ultrasonic waves dates back to the forties of the last century. Due to easy portability, ease of use, as well as diagnosing life-threatening conditions such as cardiac arrest, aortic dissection, myocardial infarction, cardiac tamponade, pericardial effusion, etc., ultrasound is recognized as a perfect diagnostic instrument at the prehospital level. Case report 1: The Emergency medical services (EMS) team received a first line emergency call for a 79-year-old female patient. After arriving at the scene, all measures of cardiopulmonary cerebral resuscitation (CPR) were started according to the protocol for shockable rhythms. During the rhythm check, the presence of cardiac activity was confirmed by ultrasound. Case report 2: A 59-year-old female patient called 194 due to a feeling of suffocation that has lasted all day and is intensifying. Ultrasound diagnostics in the form of urgent echocardiography were applied, where a decrease in systolic function was registered, which until then did not exist in the available medical documentation of the patient, who states in her anamnestic that she is not being treated for anything. In addition to the urgent echocardiography, the doctor on the field also performed an ultrasound of the lungs, where the pathological findings and the presence of B lines as part of the alveolar syndrome are registered. Alveolar syndrome and reduction of systolic function are sufficient pre-hospital diagnostic data that differentially indicated alveolar fluid overflow and consequent cardiac decompensation. Case report 3: A 71-year-old patient experiences cardiac arrest in the outpatient department of the Institute for Emergency Medical Assistance in Novi Sad, and all CPR measures are started. After 20 minutes of CPR closure, the doctor decides for an urgent echocardiography, as a result of which he observes the presence of cardiac activity in the patient. Urgent echocardiography registered a pathological finding in the form of akinesia of the lower wall of the heart, and a rupture of the papillary muscle was suspected, which was later confirmed at the emergency admission of the Institute for Cardiovascular Diseases of Vojvodina. Case report 4: A 48-year-old man calls 911 because of what he describes as stomach discomfort and sweating. Upon arrival of the team, patient states that his complaints have passed and refuses to see a doctor. The doctor still insists on the examination. The electrocardiographic findings at the time of examination are comparatively stationary compared to all previous ones. Using urgent echocardiography, the doctor finds a pathological finding in the form of hypokinesia to septo-apical akinesia, and the patient, accompanied by medical team, is referred to the Institute for Cardiovascular Diseases under the differential diagnosis of acute myocardial infarction. Conclusion: In addition to facilitating the doctor in the field in making a differential diagnosis of the patient, errors in therapeutic procedures can be significantly reduced, as shown by previous studies.