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

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Ann Emerg Med. 2009;53:550-570
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Outcome versus cardiac activity

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AJEM 2005;23:459–462
 C.A.U.S.E.
Cardiac arrest ultra-sound exam

A better approach to managing

patients in primary
non-arrhythmogenic cardiac arrest

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Resuscitation (2008) 76, 198—206
Heart evaluation

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Resuscitation (2008) 76, 198—206
Lung evaluation

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Resuscitation (2008) 76, 198—206
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Resuscitation (2008) 76, 198—206
69M, Shock with dyspnea
Pulmonary embolism

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EUS in 5 circle
th

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Focused echocardiographic evaluation in
resuscitation management (FEER)

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CCM2007;35[Suppl.]:S150–S161
 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

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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 effusion
Right 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 movement
Engorgement IVC without respiratory variation
Possible DVT

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

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

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Endotracheal confirmation
(Neck/Lung/Bilateral diaphragm)

Lung sliding
Diaphragm movement
Esophageal intubation

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正常影像介紹
Heart
Lung
Aorta
IVC

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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

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