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Knowledge, attitude, and practices of paramedics regarding optic nerve sheath diameter ultrasonography

Published:February 29, 2016DOI:https://doi.org/10.1016/j.ajem.2016.02.063
      We read with great interest an article published in The American Journal of Emergency Medicine by Komut et al titled “Bedside sonographic measurement of optic nerve sheath diameter as a predictor of intracranial pressure in Emergency Department” [
      • Komut E.
      • Kozacı N.
      • Sönmez B.M.
      • Yılmaz F.
      • Komut S.
      • Yıldırım Z.N.
      • et al.
      Bedside sonographic measurement of optic nerve sheath diameter as a predictor of intracranial pressure in Emergency Department.
      ]. We congratulate the authors for great work on how important medical problem, which is the prediction of increased intracranial pressure (IIP). Research conducted by Komut et al confirms the results of research carried out by us. In our Emergency Department, ultrasonography is also used to evaluate optic nerve sheath (ONS). Confirmation of IIP is most often performed using computed tomography or magnetic resonance imaging. However, these methods require time and are associated with additional costs of assistive patient exposure to ionizing radiation. It is worth noticing that ultrasound is more and more widely used in emergency medicine, ranging from Focused Assessment with Sonography in Trauma examination [
      • Bhoi S.
      • Sinha T.P.
      • Ramchandani R.
      • Kurrey L.
      • Galwankar S.
      To determine the accuracy of focused assessment with sonography for trauma done by nonradiologists and its comparative analysis with radiologists in emergency department of a level 1 trauma center of India.
      ], or confirm the correct position of the endotracheal tube during intubation [
      • Truszewski Z.
      • Samarin S.
      • Czyzewski L.
      • Evrin T.
      • Szarpak L.
      Are paramedics able to confirm endotracheal tube placement using ultrasonography? Preliminary data.
      ]. The application of ultrasound examination of the ONS for confirmation of IIP offers several advantages. First of all it is portable, rapid, noninvasive, low cost, and widely available [
      • Doniger S.J.
      Bedside emergency cardiac ultrasound in children.
      ,
      • Atkinson P.
      • Boyle A.
      • Robinson S.
      • Campbell-Hewson G.
      Should ultrasound guidance be used for central venous catheterisation in the emergency department?.
      ]. Furthermore, it can be used both in the Emergency Department as well as in Emergency Medical Services.
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      References

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        • Kozacı N.
        • Sönmez B.M.
        • Yılmaz F.
        • Komut S.
        • Yıldırım Z.N.
        • et al.
        Bedside sonographic measurement of optic nerve sheath diameter as a predictor of intracranial pressure in Emergency Department.
        Am J Emerg Med. 2016; https://doi.org/10.1016/j.ajem.2016.02.012
        • Bhoi S.
        • Sinha T.P.
        • Ramchandani R.
        • Kurrey L.
        • Galwankar S.
        To determine the accuracy of focused assessment with sonography for trauma done by nonradiologists and its comparative analysis with radiologists in emergency department of a level 1 trauma center of India.
        J Emerg Trauma Shock. 2013; 6: 42-46https://doi.org/10.4103/0974-2700.106324
        • Truszewski Z.
        • Samarin S.
        • Czyzewski L.
        • Evrin T.
        • Szarpak L.
        Are paramedics able to confirm endotracheal tube placement using ultrasonography? Preliminary data.
        Am J Emerg Med. 2016; https://doi.org/10.1016/j.ajem.2016.02.034
        • Doniger S.J.
        Bedside emergency cardiac ultrasound in children.
        J Emerg Trauma Shock. 2010; 3: 282-291https://doi.org/10.4103/0974-2700.66535
        • Atkinson P.
        • Boyle A.
        • Robinson S.
        • Campbell-Hewson G.
        Should ultrasound guidance be used for central venous catheterisation in the emergency department?.
        Emerg Med J. 2005; 22: 158-164https://doi.org/10.1136/emj.2003.011288