Abbreviations ED: Emergency department; ABC: Airway, breathing and circulation; CT scan: Computed tomography scan; CXR: Chest X-ray; PTC: Primary trauma care; ATLS: Advanced trauma life support; BPM: Beats per minute; EMS: Emergency medical services. Competing interests The authors declare that they have no competing interests. Authors’ contributions

GM, SA conducted and coordinated the case. Inhibitors,research,lifescience,medical GM, BB, RV, CH and AB conceived the case report, and participated in its design. BB, AB and RV and CH drafted the manuscript and sequence alignment of the report. BB, RV and CH reviewed the literature. All authors read and Inhibitors,research,lifescience,medical approved the final manuscript. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/this website 1471-227X/14/7/prepub

Acknowledgments The authors are grateful to R.K Rauniyar, MD, Department of Radiology and diagnostics for providing the plain film of the thorax and the abdominal CT scan reports.
Ultrasound is a form of medical imaging that is portable, non-invasive and Inhibitors,research,lifescience,medical does not expose the patient to ionizing radiation. Healthcare providers that use ultrasound are able to obtain immediate anatomical, diagnostic and functional information on their patients. In recent years, ultrasound machines Inhibitors,research,lifescience,medical have decreased in size and cost while producing images of enhanced quality. These advances have made ultrasound more accessible to prehospital care providers. There is evidence that prehospital ultrasound may be beneficial in diagnosis and management of critically ill patients [1,2] and may be useful in as many as one sixth of medical and trauma EMS missions [3]. EMS providers can be trained to interpret ultrasound

scans with a high degree of accuracy in Inhibitors,research,lifescience,medical a relatively short period of time [4-6]. For example, prehospital focused abdominal sonography for trauma (FAST) exams have the potential to provide valuable information in abdominal trauma with specificity of 97.5 – 99% and sensitivity of 93 – 100% Thiamine-diphosphate kinase [2,7] leading to more appropriate transport destination decisions. However, the use of prehospital ultrasound may result in a time delay to hospital by 0–6 min [8]. There is currently insufficient evidence that prehospital ultrasound improves morbidity or mortality in critically ill or injured patients [8,9]. An extensive literature review describes the potential ultrasound indications for prehospital EMS providers [10]. The review concluded that many potential applications exist for prehospital ultrasound but more prospective, outcome-based studies were needed to determine if ultrasound should be implemented more widely.