Abstract
Introduction
Point-of-care ultrasound (POCUS) advancements, such as the Butterfly IQ™, have made ultrasound (US) accessible in austere settings. Ultrasound gel provides a conductive medium between the probe and skin to obtain POCUS images.
Objective
Space and weight are limited during travel, making single-use items, such as POCUS gel, impractical. Eliminating this need could improve wilderness responders’ efficiency. This study investigates whether POCUS gel alternatives can be derived from multiuse materials in austere environments to provide diagnostic imaging.
Methods
Sixteen commonly carried day-pack liquids were collected: shampoo, body wash, lotion, sunscreen, hazelnut spread, jelly, honey, vegetable oil, vaginal lubricant, hand sanitizer, aloe vera, peanut butter, fiber supplement, toothpaste, petroleum jelly, and water. Point-of-care ultrasound images were taken of the Morison pouch on a human model. Ultrasound-trained emergency physicians were asked whether the POCUS image taken with a gel alternative is the same as or better or worse than the control taken with standard gel and if the image with test gel is sufficient to identify acute pathologies. Tests of binomial proportions and identifications of image agreement were performed, respectively, using SAS Enterprise Guide 8.3.
Results
Twenty-six survey responses were collected. Vegetable oil (88.5%), aloe vera (80.8%), lubricant (73.1%), and shampoo (69.2%) were rated as the same or better quality as the control images. Physicians who rated the control image as sufficient to diagnose acute pathologies also rated vegetable oil (100%), shampoo (100%), aloe vera (91.7%), lubricant (91.7%), water (91.7%), and fiber supplement (87.5%) as sufficient.
Conclusions
Gel alternatives, including vegetable oil, aloe vera, vaginal lubricant, and shampoo, were rated equal or better quality US mediums when compared to traditional gel and were sufficient for diagnosing acute pathologies. This study provided evidence that standard US gel is not a requirement for obtaining POCUS images in austere environments.
Keywords: ultrasound, gel, POCUS, austere, butterfly, FAST
Winner of the Outstanding Research Poster award at the 2023 Wilderness Medical Society Summer Conference.