eus教學(11)。急診超音波在急救時之應用
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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
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Critical concepts during resuscitation
• Early initiation of resuscitation maneuvers
• Quick identification and treatment of underlying causes
• Reduction of the duration of no-flow intervals
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ACEP 2008 EUS guidelines
Ann Emerg Med. 2009;53:550-570
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Outcome versus cardiac activity
AJEM 2005;23:459–462
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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
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Heart evaluation
Resuscitation (2008) 76, 198—206
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Lung evaluation
Resuscitation (2008) 76, 198—206
9Resuscitation (2008) 76, 198—206
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69M, Shock with dyspneaPulmonary embolism
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EUS in 5th circle
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Focused echocardiographic evaluation in resuscitation management (FEER)
CCM2007;35[Suppl.]:S150–S161
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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
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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
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Cardiac tamponade(heart scans/ IVC)
Pericardial effusionRight chamber diastolic collapse
IVC engorgement without respiratory variation
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Massive pulmonary embolism
(Apical or subxiphoid/ IVC/FVs)Right chamber dilatation
Paradoxical interventricular movementEngorgement IVC without respiratory
variationPossible DVT
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Tension pneumothorax(Bilateral mid-clavicular/ 2-3rd ICS)
No lung slidingNo B line (Comet-tail artifact)注意 : Bat sign & Pleural line
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Endotracheal confirmation(Neck/Lung/Bilateral diaphragm)
Lung slidingDiaphragm movementEsophageal intubation
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正常影像介紹
Heart LungAortaIVC
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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
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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