Page 133 - Journal of Special Operations Medicine - Winter 2016

An Ongoing Series

Ultrasound-Guided Triage

Christopher Dare, SOIDC; Katarzyna (Kasia) Hampton, MD

uring a Partner Nation Force (PNF) field training Figure 1 Pertinent ultrasound images for patients 1, 2, 3 and
Dexercise, you are called to a scene of a motor vehicle 5 as indicated respectively.
accident. Two all-terrain vehicles, carrying a total of five
US and PNF Servicemembers, crashed into each other.
As you triage the victims, you realize that all five poten-
tially need further medical care. The closest hospital is
90 minutes away, and your local ambulance service is
capable of transporting only two patients at a time.

• Patient 1: 35-Year-old man, heart rate (HR) 95 beats/
minutes (bpm), blood pressure (BP) 105/65mmHg,
respiratory rate (RR) 16/min, Spo 98% on room
2
air, temperature (T) 36.6ºC (97.8ºF); reporting deep
right flank pain; has a large right flank contusion and
tenderness
• Patient 2: 40-Year-old man, HR 98 bpm, BP
100/55mmHg, RR 19/min, Spo 98% on room air,
2
T 36.5ºC (97.7ºF); reporting generalized abdominal
pain; has multiple abdominal wall abrasions and dif- 1. What are their respective ultrasound findings?
fuse abdominal tenderness 2. How would your prioritize transfer before and after
• Patient 3: 21-Year-old man, HR 101 bpm, BP the ultrasound evaluations?
105/75mmHg, RR 12/min, Spo 100% on room air,
2
T 36.7ºC (98ºF); reporting pain in his abdomen and Join us at SOFsono.org for further case discussion.
left forearm; has diffuse abdominal tenderness and
left distal forearm swelling with intact neurovascular
examination CPO Dare is a Special Operations Independent Duty Corps-
• Patient 4: 32-Year-old man, HR 85 bpm, BP man (SOIDC) at 3D Marine Raider Battalion and is currently
100/60mmHg, RR 20/min, Spo 99% on room air, assigned as the Senior Enlisted Medical Advisor (SEMA) for
2
T 36.0ºC (96.8ºF), Glasgow Coma Scale score 15; Special Operations Command & Control Element–Sahel and
complains of a frontal headache centered around a Maghreb Regions.
4-cm forehead laceration.
• Patient 5: 25-Year-old man, HR 104 bpm, BP Dr Hampton is an emergency physician and a volunteer sub-
99/50mmHg, RR 25/min, Spo 97% on room air, ject matter expert ultrasound instructor for the military medi-
2
T 36.2ºC (97ºF); reporting right-sided pain in his ribs, cal community. She is currently practicing at the Landstuhl
Regional Medical Center, Germany (US Army Medical De-
it “hurts to breath.” He has notable shallow respira- partment). E-mail: katarzyna.hampton@gmail.com.
tions and a moderate-size chest wall contusion with-
out crepitus.
Disclosures
To get a more precise idea about the extent of your pa- The authors have nothing to disclose
tients’ injuries and to establish the priority of transfer,
you perform focused ultrasound studies on patients 1, Keywords: ultrasound; transfer; triage
2, 3, and 5 (Figure 1).

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