{"id":150846,"date":"2016-05-31T09:17:01","date_gmt":"2016-05-31T16:17:01","guid":{"rendered":"https:\/\/clarius.com\/blog\/dean-meenach-sur-lechographie-pre-hospitaliere\/"},"modified":"2026-08-06T08:14:32","modified_gmt":"2026-08-06T15:14:32","slug":"dean-meenach-sur-lechographie-pre-hospitaliere","status":"publish","type":"post","link":"https:\/\/clarius.com\/fr\/blog\/dean-meenach-sur-lechographie-pre-hospitaliere\/","title":{"rendered":"Dean Meenach sur l’\u00e9chographie pr\u00e9-hospitali\u00e8re"},"content":{"rendered":"

\"BC<\/p>\n

L’une des utilisations les plus prometteuses de Clarius est l’\u00e9chographie pr\u00e9hospitali\u00e8re, c’est-\u00e0-dire l’\u00e9chographie dans les services m\u00e9dicaux d’urgence (EMS), avant que le patient n’atteigne le service des urgences. Dans ces situations, le diagnostic pr\u00e9coce des pathologies peut faire une diff\u00e9rence significative dans l’\u00e9volution de l’\u00e9tat des patients. Sans fil, ultra-portable et facile \u00e0 utiliser<\/a>, Clarius conviendra parfaitement \u00e0 ce type d’applications. <\/p>\n

Dean Meenach, directeur de la formation EMS au Mineral Area College, a \u00e9crit un excellent article sur EMS1.com d\u00e9crivant 9 utilisations potentielles de l’\u00e9chographie pr\u00e9hospitali\u00e8re.<\/p>\n

En voici un extrait :<\/p>\n

\n
    \n
      \n
    1. Causes de la dyspn\u00e9e<\/li>\n<\/ol>\n<\/ol>\n

      L’\u00e9chographie de terrain augmente la pr\u00e9cision du diagnostic de l’\u0153d\u00e8me pulmonaire par rapport \u00e0 la maladie pulmonaire obstructive chronique comme cause de la dyspn\u00e9e aigu\u00eb [1,18,]. Elle est efficace chez les patients pr\u00e9sentant une instabilit\u00e9 h\u00e9modynamique inexpliqu\u00e9e pour aider \u00e0 diff\u00e9rencier les causes cardiaques et non cardiaques de l’\u00e9tat de choc [18,19]. Dans certains cas limit\u00e9s, le potentiel de l’\u00e9chographie de terrain pour d\u00e9tecter des embolies pulmonaires massives chez les patients a \u00e9t\u00e9 d\u00e9montr\u00e9 [15,20]. <\/p>\n

       <\/p>\n

        \n
          \n
        1. Reconna\u00eetre les urgences obst\u00e9tricales<\/li>\n<\/ol>\n<\/ol>\n

          Bien qu’une formation avanc\u00e9e soit n\u00e9cessaire, certains prestataires pr\u00e9hospitaliers ont montr\u00e9 que la grossesse ectopique, le placenta praevia et le d\u00e9collement du placenta peuvent \u00eatre identifi\u00e9s avec une fiabilit\u00e9 d’environ 95 % [4,21,22].Bien qu’une formation avanc\u00e9e soit n\u00e9cessaire, certains prestataires pr\u00e9hospitaliers ont montr\u00e9 que la grossesse ectopique, le placenta praevia et le d\u00e9collement du placenta peuvent \u00eatre identifi\u00e9s avec une fiabilit\u00e9 d’environ 95 % [4,21,22].<\/p>\n

           <\/p>\n

            \n
              \n
            1. \u00c9valuation cardiaque et r\u00e9animation<\/li>\n<\/ol>\n<\/ol>\n

              Des protocoles de r\u00e9animation pr\u00e9hospitali\u00e8re sp\u00e9cialis\u00e9s utilisant l’\u00e9chographie ont montr\u00e9 que chez les patients subissant une RCP, l’\u00e9chographie aidait les prestataires pr\u00e9hospitaliers \u00e0 d\u00e9terminer le mouvement de la paroi cardiaque lorsque le diagnostic initial de l’ECG \u00e9tait identifi\u00e9 comme une asystolie [23]. Cela a \u00e9t\u00e9 associ\u00e9 \u00e0 une augmentation du taux de survie jusqu’\u00e0 l’admission \u00e0 l’h\u00f4pital [24]. <\/p>\n

              En plus des mouvements cardiaques, l’\u00e9chographie a permis de diff\u00e9rencier la v\u00e9ritable PEA – dissociation \u00e9lectrom\u00e9canique – de la pseudo-PEA – activit\u00e9 \u00e9lectrique coordonn\u00e9e sans pouls palpable [23,24]. La pseudo-PEA a \u00e9galement \u00e9t\u00e9 associ\u00e9e \u00e0 une survie accrue jusqu’\u00e0 l’admission \u00e0 l’h\u00f4pital par rapport \u00e0 la vraie PEA [23,24]. <\/p>\n

              Chez les patients en \u00e9tat de p\u00e9ri-r\u00e9animation, l’\u00e9chographie a am\u00e9lior\u00e9 la pr\u00e9cision des diagnostics potentiels de tamponnade, d’hypovol\u00e9mie profonde, d’insuffisance myocardique (dysfonctionnement ventriculaire gauche et\/ou droit s\u00e9v\u00e8re) ou de thromboembolie (pulmonaire ou cardiaque) [25,26]. Les syst\u00e8mes de SAMU dont les protocoles pr\u00e9hospitaliers utilisent l’asystolie ou l’AEP comme crit\u00e8res d’arr\u00eat de la r\u00e9animation sur le terrain peuvent b\u00e9n\u00e9ficier de l’ajout de l’\u00e9chographie \u00e0 ces protocoles [23,25,26]. <\/p>\n

               <\/p>\n

                \n
                  \n
                1. Confirmation et surveillance de la mise en place des voies a\u00e9riennes<\/li>\n<\/ol>\n<\/ol>\n

                  Une autre application diagnostique de l’\u00e9chographie de terrain consiste \u00e0 confirmer la mise en place d’un tube endotrach\u00e9al gr\u00e2ce \u00e0 une d\u00e9tection \u00e0 haute r\u00e9solution [27]. Bien que la capnographie par ondes soit consid\u00e9r\u00e9e comme l’\u00e9talon-or pour la v\u00e9rification de l’ETT, cette m\u00e9thode pr\u00e9sente certaines limites dans des situations sp\u00e9cifiques telles que l’arr\u00eat cardiaque, le faible d\u00e9bit cardiaque, l’embolie pulmonaire aigu\u00eb et l’hypothermie [28]. <\/p>\n

                  L’\u00e9chographie offre aux professionnels pr\u00e9hospitaliers une m\u00e9thode alternative de confirmation de l’ETT pour reconna\u00eetre le d\u00e9placement de la sonde ou diff\u00e9rencier l’intubation trach\u00e9ale principale de l’intubation du tronc principal droit [27,28,29,30,31]. Par exemple, l’\u00e9tude d’Adi et al (2013) a montr\u00e9 un r\u00e9sultat impressionnant de 98,1 % de pr\u00e9cision lors de la v\u00e9rification initiale [30]. <\/p>\n

                   <\/p>\n

                    \n
                      \n
                    1. Confirmation de la mise en place de la sonde gastrique<\/li>\n<\/ol>\n<\/ol>\n

                      La mise en place d’une sonde gastrique – nasogastrique ou orogastrique – reste une intervention recommand\u00e9e en soins intensifs pour tous les patients intub\u00e9s, car elle diminue le risque d’aspiration et am\u00e9liore le volume courant. Certains syst\u00e8mes de SAMU qui posent des sondes gastriques signalent que la pose est facilement confirm\u00e9e par l’\u00e9chographie sur le terrain [32]. <\/p>\n

                       <\/p>\n

                        \n
                          \n
                        1. D\u00e9termination des fractures<\/li>\n<\/ol>\n<\/ol>\n

                          De nombreux types de fractures suspectes des os longs sont pris en charge dans le cadre pr\u00e9hospitalier. De plus en plus de preuves sugg\u00e8rent que l’utilisation de l’\u00e9chographie sur le terrain permet d’identifier avec succ\u00e8s plusieurs types de fractures des os longs [33,49,50]. <\/p>\n

                           <\/p>\n

                            \n
                              \n
                            1. Placement pr\u00e9hospitalier d’une thoracostomie \u00e0 l’aiguille<\/li>\n<\/ol>\n<\/ol>\n

                              L’utilisation de l’\u00e9chographie pr\u00e9hospitali\u00e8re chez les patients traumatis\u00e9s pr\u00e9sentant une suspicion de pneumothorax peut \u00eatre efficace pour \u00e9viter les thoracostomies inutiles \u00e0 l’aiguille sur le terrain [34,35]. Une \u00e9tude a montr\u00e9 que lorsque l’\u00e9chographie thoracique \u00e9tait utilis\u00e9e pour d\u00e9tecter un pneumothorax, seuls 26 % des patients n’avaient en fait pas de pneumothorax [34,35,36,37]. L’utilisation de l’\u00e9chographie sur le terrain pourrait contribuer \u00e0 r\u00e9duire le nombre de thoracostomies \u00e0 l’aiguille potentiellement inutiles et d’autres proc\u00e9dures invasives en cours d’acheminement vers l’h\u00f4pital [38]. <\/p>\n

                               <\/p>\n

                                \n
                                  \n
                                1. Acc\u00e8s intraveineux p\u00e9riph\u00e9rique<\/li>\n<\/ol>\n<\/ol>\n

                                  L’\u00e9tablissement d’un acc\u00e8s vasculaire est l’une des proc\u00e9dures les plus courantes pratiqu\u00e9es en milieu pr\u00e9hospitalier et constitue parfois une priorit\u00e9 absolue pour les patients gravement malades et instables. L’\u00e9tat du patient pr\u00e9sente souvent des difficult\u00e9s pour \u00e9tablir un acc\u00e8s intraveineux. Les conditions associ\u00e9es \u00e0 un acc\u00e8s vasculaire difficile comprennent le tr\u00e8s jeune \u00e2ge, l’ob\u00e9sit\u00e9, les maladies chroniques, l’abus de m\u00e9dicaments par voie intraveineuse et l’hypovol\u00e9mie, pour n’en citer que quelques-unes [39,40,41]. <\/p>\n

                                  Les patients dont l’acc\u00e8s IV est difficile sont souvent soumis \u00e0 des tentatives r\u00e9p\u00e9t\u00e9es car, dans certains cas, le temps n\u00e9cessaire \u00e0 la mise en place de l’IV peut affecter la r\u00e9animation optimale du patient gravement malade. L’acc\u00e8s IV guid\u00e9 par ultrasons a permis d’augmenter le taux de r\u00e9ussite et de r\u00e9duire les complications [42,43,44,45,46,47,48]. <\/p>\n

                                   <\/p>\n

                                    \n
                                      \n
                                    1. Diagnostic de l’AVC<\/li>\n<\/ol>\n<\/ol>\n

                                      La litt\u00e9rature sp\u00e9cialis\u00e9e montre que l’am\u00e9lioration de l’issue des patients victimes d’un AVC passe par un diagnostic et un traitement pr\u00e9coces et rapides, ainsi que par le transport vers un centre agr\u00e9\u00e9 pour les AVC. Le diagnostic pr\u00e9coce \u00e0 l’aide de protocoles de t\u00e9l\u00e9AVC avec \u00e9chographie transcr\u00e2nienne sur le terrain pour le diagnostic de l’AVC a permis de r\u00e9duire les d\u00e9lais entre le diagnostic et la th\u00e9rapie fibrinolytique et d’\u00e9tendre l’utilisation de proc\u00e9dures radiologiques interventionnelles sp\u00e9ciales [51,52,53]. <\/p><\/blockquote>\n

                                      Lisez l’article complet sur http:\/\/www.ems1.com\/ems-products\/technology\/articles\/72040048-Prehospital-Ultrasound-Emerging-technology-for-EMS\/<\/p>\n","protected":false},"excerpt":{"rendered":"

                                      L’une des utilisations les plus prometteuses de Clarius est l’\u00e9chographie pr\u00e9hospitali\u00e8re, c’est-\u00e0-dire l’\u00e9chographie dans les services m\u00e9dicaux d’urgence (EMS), avant que le patient n’atteigne le service des urgences. Dans ces situations, le diagnostic pr\u00e9coce des pathologies peut faire une diff\u00e9rence significative dans l’\u00e9volution de l’\u00e9tat des patients. Sans fil, ultra-portable et facile \u00e0 utiliser, Clarius…<\/p>\n","protected":false},"author":3,"featured_media":30088,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","inline_featured_image":false,"footnotes":""},"categories":[990],"tags":[],"specialities":[55],"class_list":["post-150846","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-perspectives","specialities-ems"],"acf":[],"yoast_head":"\nDean Meenach sur l'\u00e9chographie pr\u00e9-hospitali\u00e8re | Clarius | Blog Post<\/title>\n<meta name=\"description\" content=\"L'une des utilisations les plus prometteuses de Clarius est l'\u00e9chographie pr\u00e9hospitali\u00e8re, c'est-\u00e0-dire l'\u00e9chographie dans les services m\u00e9dicaux d'urgence\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/clarius.com\/fr\/blog\/dean-meenach-sur-lechographie-pre-hospitaliere\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dean Meenach sur l'\u00e9chographie pr\u00e9-hospitali\u00e8re\" \/>\n<meta property=\"og:description\" content=\"L'une des utilisations les plus prometteuses de Clarius est l'\u00e9chographie pr\u00e9hospitali\u00e8re, c'est-\u00e0-dire l'\u00e9chographie dans les services m\u00e9dicaux d'urgence\" \/>\n<meta property=\"og:url\" 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