Prehospital Use of Ultrasound in Undifferentiated Shortness of Breath

In the first phase of the study, a cohort of senior and supervisory paramedics will be recruited into the study. These paramedics would undergo didactic and hands-on training to learn how to operate the U/S machine, and obtain and interpret basic U/S images. The paramedics will then participate in video review sessions and spend time in the emergency department (ED) with the U/S team to get hands-on experience with patients. In the second phase of the study, paramedics will be staffing ambulances or fly cars in and around the greater New Haven region and will respond to dyspnea calls. At each call, the paramedic will initially evaluate the patient clinically conducting a standard history and physical exam. The paramedic will then use the portable U/S machine to look for the presence of either unilateral or bilateral B-lines indicating possible pneumonia (in the case of unilateral B-lines) or pulmonary edema (in the case of bilateral B-lines). The paramedic will then document the presence or absence of B-lines for each lung on the prehospital study sheet. The paramedic will then use the U/S to evaluate for the presence of pleural effusions, lung sliding and pericardial effusion.

Inclusion criteria

• Dyspnea and any of the following:

• Respiratory rate > 20
• Room air oxygen saturation < 92%
• Accessory muscle use, tripod position, nasal flaring
• Exam with evidence of rales/rhonchi or wheezing
• In acute respiratory distress on paramedic evaluation
• Any patient in acute respiratory distress with

Exclusion criteria

• Trauma
• Burns
• Pregnancy
• Kussmaul respirations from metabolic acidosis
• Cheyne-stokes from increased ICP (intracranial pressure), heart failure or CVA
• Drowning