eus_head and neck
TRANSCRIPT
進階急診超音波於頭頸部掃描之應用
彰化基督教醫院 急診醫學部超音波推廣組 教學CR蔡揚名
2
頭頸部掃描之目標
新生兒腦部超音波
頸動脈超音波
穿顱超音波
眼眶超音波
呼吸道超音波
耳鼻喉科之超音波掃描應用
3
Neonatal Brain Ultrasound
首要目標-辨認出血
其他目標-水腦及先天性異常
4
5
6
Fontanelle compression test
7
8
9
True sagittal midline
10
Angled parasagittal
11
12
13
Anterior horns of lateral
ventricles
14
3rd ventricle
15
Classification of PVH-IVH based on
radiological findings (Papile, 1983)
Grade Site of hemorrhage
I Subependymal region and/or germinal matrix
II Subependymal hemorrhage with extension into
lateral ventricles without ventricular
enlargement
III Subependymal hemorrhage with extension into
lateral ventricles with ventricular enlargement
IV Intraparenchymal hemorrhage
16
Intracranial lesions in the
preterm infant
Hemorrhagic
IVH: Intraventricular hemorrhage
PVH: Periventricular hemorrhage (PVH)
(Post-hemorrhagic hydrocephlus)
Ischemic
PVL: Periventricular leucomalacia
Ventricular enlargement (cortical atrophy)
Porencephalic cysts
(Arterial infarct)
17
PVH-IVH
Predominantly affects the periventricular white matter (motor tracts)
Associated with long-term disability in prematurely-born infants
Cerebral palsy
Developmental delay
Seizures
Blindness
Deafness
Decreased incidence, but more survivors
18
Grade I:
bilateral germinal matrix haemorrhage
19
Grade II
20
Grade III IVH
21
Grade IV IVH
22
23
Carotid Ultrasound
急診Carotid Ultrasound唯一目標
-中風病患排除頸動脈剝離
-只掃兩側CCA部分
24
CCA
BLUB
ICAECA
25
26
Carotid Doppler
27
Carotid Dissection
28
有時會不小心看到……
29
CVP placement
30
31
32
33
34
Transcranial ultrasound
35
Transcranial Doppler
36
37
偵測Midline Shift為主要用途
38
Midline Shift Variation
AJNR Am J Neuroradiol 20:1567–1571,
September 1999
39
40
Acute Epidural Hematoma
Intensive Care Med. 2010 Jun;36(6):1091-2
41
Ocular Ultrasound
42
43
44
How to scan?
45
IICP?
46
IICP?
急診超音波如何判斷IICP
1. 使用high frequency, high resolution的linear
probe (7.5-10MHz)
2. 測量眼球後方3mm處的Optic Nerve Sheath
Diameter(ONSD)
3. ONSD 大於5mm和IICP有相關性
4. Sensitivity 100%, Sepcificity 63%
Annals of Emergency Medicine Volume 49, No. 4, April, 2007
47
48
Scandinavian Journal of Trauma, Resuscitation and Emergency
Medicine 2009, 17:34
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
Parotid abscess / parotitis
64
Maxillary Sinusitis
65
66
67
68
Epiglottitis
69
Take Home Message
新生兒腦部超音波:偵測出血
頸動脈超音波:只看兩側CCA有無Flap,輔助中央靜脈導管置放
穿顱超音波:追蹤CVA或ICH之中線偏移
眼眶超音波:IICP,視網膜剝離,眼內感染、出血、異物
呼吸道超音波:確認氣管位置
耳鼻喉超音波:偵測唾液腺和頸部之感染、膿瘍之形成
70
Special thanks to~~
新光急診陳國智醫師熱心指導
71
臉書讓一群對有志於急診超音 波的同好們結合—
急重症超音波特攻隊請期待我們的論文和教材
72
Thanks for your attention !!