Ultrasound diagnosis of fractures in mass casualty incidents

The role of point-of-care ultrasound in mass casualty incidents (MCIs) is still evolving. Occasionally, hospitals can be destroyed by disasters resulting in large number they are used for diagnosing fractures^[10,11]. It will be easy to perform POCUS on long bones using the linear probe because it gets in direct contact over the long bone (Figure 1A). The patient is asked to point at the maximum point of pain. The finger of the examiner is gently passed over the area to define the suspected area of fracture. This may not be possible in children, geriatrics and unconscious patients. It is always advised to compare the injured region with the normal side especially in children. Starting with the normal side in children will assure them and avoid the pitfall of misdiagnosing ossification centers and epiphysis as fractures^[11]. One of the major technical difficulties encountered when detecting fractures of small bones is the irregularity of the bone surface. Accordingly, air may be present between the probe and the bone. Air gives very highly echogenic reflections (white) and can cause a barrier when performing ultrasound. Adequate gel should be applied between the ultrasound probe and skin to reduce the artifacts caused by air (Figure 4). Some may even use water bath as an ultrasound transmitter to reduce the air artifact and pain while examining the patient^[11]. Ultrasound is not recommended to be done on open fractures. The diagnosis is already clinically made; this will delay the management, may cause infection, and will be very painful.