eus教學(11)。急診超音波在急救時之應用
TRANSCRIPT
![Page 1: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/1.jpg)
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
![Page 2: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/2.jpg)
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
![Page 3: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/3.jpg)
3
ACEP 2008 EUS guidelines
Ann Emerg Med. 2009;53:550-570
![Page 4: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/4.jpg)
4
![Page 5: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/5.jpg)
5
Outcome versus cardiac activity
AJEM 2005;23:459–462
![Page 6: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/6.jpg)
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
![Page 7: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/7.jpg)
7
Heart evaluation
Resuscitation (2008) 76, 198—206
![Page 8: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/8.jpg)
8
Lung evaluation
Resuscitation (2008) 76, 198—206
![Page 9: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/9.jpg)
9Resuscitation (2008) 76, 198—206
![Page 10: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/10.jpg)
10
69M, Shock with dyspneaPulmonary embolism
![Page 11: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/11.jpg)
11
EUS in 5th circle
![Page 12: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/12.jpg)
12
Focused echocardiographic evaluation in resuscitation management (FEER)
CCM2007;35[Suppl.]:S150–S161
![Page 13: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/13.jpg)
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
![Page 14: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/14.jpg)
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
![Page 15: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/15.jpg)
15
Cardiac tamponade(heart scans/ IVC)
Pericardial effusionRight chamber diastolic collapse
IVC engorgement without respiratory variation
![Page 16: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/16.jpg)
16
Massive pulmonary embolism
(Apical or subxiphoid/ IVC/FVs)Right chamber dilatation
Paradoxical interventricular movementEngorgement IVC without respiratory
variationPossible DVT
![Page 17: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/17.jpg)
17
Tension pneumothorax(Bilateral mid-clavicular/ 2-3rd ICS)
No lung slidingNo B line (Comet-tail artifact)注意 : Bat sign & Pleural line
![Page 18: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/18.jpg)
18
Endotracheal confirmation(Neck/Lung/Bilateral diaphragm)
Lung slidingDiaphragm movementEsophageal intubation
![Page 19: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/19.jpg)
19
正常影像介紹
Heart LungAortaIVC
![Page 20: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/20.jpg)
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
![Page 21: EUS教學(11)。急診超音波在急救時之應用](https://reader033.vdocuments.pub/reader033/viewer/2022061519/557205ce497959fc0b8b7c32/html5/thumbnails/21.jpg)
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