Objectives

1. Identify the role of ultrasound in trauma.

2. Understand the technique of neurovascular examination.

3. Identify normal neurovascular appearance and injury.

4. Understand ultrasound-guided regional anesthesia.

5. Understand ultrasound-guided vascular cannulation.

SUMMARY

Ultrasound examination plays an increasingly important role in trauma management and anesthesia. Sonographic examination of peripheral nerves and vasculature can not only assess injury, but also guide needles for vascular access and regional anesthesia. Ultrasound-guided cannulation of arteries and veins allows invasive hemodynamic monitoring and fluid resuscitation in the trauma patient. Regional anesthesia provides immediate analgesia of injured limbs and enables specific surgical intervention. This chapter focuses on neurovascular anatomy and its recognition by ultrasound. The examination and identification of individual sonoanatomy is the basis for all ultrasound-guided procedures.

INTRODUCTION

The recent development of portable high-frequency ultrasound units has made ultrasound examination an important component in the assessment of the trauma patient. Trauma management requires both resuscitation and careful systematic assessment of individual wounds, both evident and suspected. Injury, however, can often be difficult to evaluate, especially when injury is concealed, such as in the case of blunt abdominal trauma or neurovascular injury associated with limb fractures. Sonography can be applied first as a diagnostic tool in the individual patient, and second, as a guide in therapeutic procedures [1].

Focused sonographic examination of the chest and abdomen can identify internal organ injury and hemorrhage, while examination of injured limbs can identify underlying musculoskeletal injury.