eus教學(11)。急診超音波在急救時之應用

1

Emergency Ultrasound EUS教學(11)

急診超音波在急救時之應用新光醫院急診醫學科

陳國智醫師中華民國醫用超音波學會指導醫師

2

Critical concepts during resuscitation

• Early initiation of resuscitation maneuvers

• Quick identification and treatment of underlying causes

• Reduction of the duration of no-flow intervals

3

ACEP 2008 EUS guidelines

Ann Emerg Med. 2009;53:550-570

4

5

Outcome versus cardiac activity

AJEM 2005;23:459–462

6

C.A.U.S.E.Cardiac arrest ultra-sound

exam

A better approach to managing patients in

primarynon-arrhythmogenic

cardiac arrestResuscitation (2008) 76, 198—206

7

Heart evaluation

Resuscitation (2008) 76, 198—206

8

Lung evaluation

Resuscitation (2008) 76, 198—206

9Resuscitation (2008) 76, 198—206

10

69M, Shock with dyspneaPulmonary embolism

11

EUS in 5th circle

12

Focused echocardiographic evaluation in resuscitation management (FEER)

CCM2007;35[Suppl.]:S150–S161

13

Usefulness of emergency ultrasound

in nontraumatic cardiac arrest• Pulseless arrest

– Hypovolemia– Cardiac tamponade– Massive pulmonary embolism– Tension pneumothorax

• Diagnosis of cardiac standstill• Verification of endotracheal tube position

– Lung sliding – Diaphragm movement– Esophageal tube

AJEM 2010, in press

14

Severe hypovolemia(Heart scans/ IVC/ Aorta)

沒有心博時Small chambers 、 Collapsed IVC

有心博時Hyperdynamic heart 、 IVC collapse index >50%

Possible AAA

15

Cardiac tamponade(heart scans/ IVC)

Pericardial effusionRight chamber diastolic collapse

IVC engorgement without respiratory variation

16

Massive pulmonary embolism

(Apical or subxiphoid/ IVC/FVs)Right chamber dilatation

Paradoxical interventricular movementEngorgement IVC without respiratory

variationPossible DVT

17

Tension pneumothorax(Bilateral mid-clavicular/ 2-3rd ICS)

No lung slidingNo B line (Comet-tail artifact)注意 : Bat sign & Pleural line

18

Endotracheal confirmation(Neck/Lung/Bilateral diaphragm)

Lung slidingDiaphragm movementEsophageal intubation

19

正常影像介紹

Heart LungAortaIVC

20

臨床個案• OHCA with STEMI• OHCA with HPVG & Left hemothorax• INCA: AD rupture with cardiac tamponade• Heart failure• Pulmonary embolism• Traumatic PTX and AIS• Nontraumatic hemopneumothorax• Hypovolemic shock• Pneumonia with profound hypovolemia• Hemoperitoneum• AAA rutpure

21

Take Home Message

• EUS在急救時的重點在找可治療的原因

• 勿因掃描中斷急救

• 重點部位 : 心、肺、再來才是 Aorta & IVC