3D Augmented Ultrasound for Identification of Abdominal/Pelvic Traumatic Hemorrhagic Shock

Duke University School of Medicine

Bleeding from injuries such as motor vehicle collisions is a leading cause of death worldwide, with one in 9 patients with internal injuries dying from shock despite medical care. Treatment requires doctors to rapidly identify and stop bleeding by performing surgery or blocking damaged blood vessels. A test called Computed Tomography (CT scan or CAT scan) accurately identifies life-threatening injuries requiring immediate medical attention – but has disadvantages that limit its use. CT scanners are large and require doctors to move injured patients out of the best environment for their care. During transportation and testing with CT, treatment of the patient is interrupted and delayed – putting the patient’s life at risk.

An alternative test called ultrasound is often used for severely injured patients and has some advantages over CT scan. Ultrasound machines are small and portable, allowing them to be used at the patient’s bedside, without interrupting the care provided by doctors and nurses. Unlike CT, which uses x-rays to produce detailed pictures of the body, ultrasound uses high frequency sound waves to form a picture, similar to the way that dolphins use sound to “see” their surroundings. These sound waves have no known risks, while x-rays from CT pose a small cancer risk. Ultrasound machines are much less expensive than CT scanners as well. Common ultrasound machines produce only two- dimensional (2D) pictures, unlike CT scanners which can produce 3D pictures, and doctors using ultrasound machines need to be extremely skilled to understand what these pictures are showing. Sound waves also can’t see through some body parts, such as bones and organs containing air, such as the intestine. 2D ultrasound pictures can guide “big picture” decisions, such as the decision to perform exploratory surgery in a dying patient, but don’t give the more detailed information needed to treat injuries in a less invasive way, such as with small incisions or by blocking bleeding from the inside of a blood vessel, a treatment called “angiographic embolization.” 3D ultrasound machines exist – and are familiar to the public through uses such as looking for problems with pregnancies – but are expensive and large, and therefore rarely used in Emergency Departments. A medical test that combines the portability, speed, safety, and low cost of 2D ultrasound systems with the detailed and useful pictures from CT scanners could improve the medical care of severely injured patients, potentially saving lives.

We have recently invented a new inexpensive device to create 3D pictures comparable to CT scans from 2D ultrasound machines. With support from the GE/EMF POC Challenge Grant, we plan to study the way these 3D ultrasound pictures might help doctors treat severely injured patients. 3D ultrasound promises to speed the diagnosis and treatment of bleeding and reduce interruptions in other critical parts of medical resuscitation – potentially increasing the shock patient’s chance of survival.

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