وصف
Ultrasound is a non-invasive diagnostic tool that uses high-frequency sound waves to create images of the inside of the body. It can be performed at the bedside, which allows for rapid diagnosis and treatment. Ultrasound is particularly useful in ER because it does not expose the patient to ionizing radiation, unlike X-ray and CT scans. It is also useful in evaluating pregnancy-related emergencies such as ectopic pregnancy and miscarriage.
ملخص
- Emergency ultrasound, or point-of-care ultrasound (POCUS), serves to rule out diagnoses, assess prognosis, and understand patient outcomes, particularly valuable in emergency and critical care settings. The talk emphasizes POCUS applications in the emergency department, including experiences and uses during the COVID-19 pandemic.
- Key parameters of POCUS include bedside availability, machine mobility, and ease of sterilization for moving between patients. Focus Cardiac Ultrasound (2D ECHO) and lung ultrasound were crucial during COVID-19.
- During COVID-19 surges in 2020-2022, POCUS helped address the need for differential diagnoses and guide treatment strategies. It aided in determining what next steps were needed after administering basic treatments like medicines, fluids, and antivirals.
- While X-rays and CT scans are alternative imaging methods, POCUS provides a valuable bedside diagnostic tool. However, physical examination and auscultation remain essential components of patient assessment and should be correlated with ultrasound findings.
- Comparing the COVID-19 pandemic to prior pandemics, portable and safer ultrasound machines became readily available and accessible, along with data sharing, teleguidance, and AI support which allowed remote expert consultation.
- During patient triage, POCUS aids in determining the appropriate level of care based on clinical features and lung sonography findings.
- POCUS algorithms in the ICU focus on Airway, Breathing, and Circulation. This includes confirming endotracheal tube position, assessing for pleural abnormalities and lung sliding, evaluating cardiac contractility and IVC status, and differentiating cardiogenic pulmonary edema from ARDS.
- In airway management, ultrasound confirms endotracheal tube position via the comet sign or double-track sign. For breathing assessment, lung ultrasound identifies pleural changes through A-lines and B-lines and assess for Lung sliding as well as other abnormalities like sub pleural consolidations.
- Lung sliding signifies normal lung function, while its absence suggests pneumothorax, as confirmed by Stratosphere sign in M-mode. Focal B-lines could indicate pneumonia while diffuse B-lines can indicate cardiogenic pulmonary edema, necessitating careful differentiation.
- Atelectasis displays a lung pulse sign, whereas pleural effusion presents as a hypoechoic fluid collection with a collapsed lung. Circulation assessment includes global cardiac function evaluation using views like parasternal long axis and apical four-chamber.
- Right heart failure, often seen in COPD or pulmonary embolism, exhibits right ventricular hypokinesis and paradoxical septal movement. For Deep Vein Thrombosis (DVT) assessment, the leg veins like femoral are checked for thrombi and compressibility which informs diagnostic and treatment decisions.
- The letter "E" in the ABCDE approach stands for effective ventilator management, where ultrasound guides ventilator settings. The letter "F" represents fluid status, assessed via IVC collapsibility measurements in relation to respiration.
نموذج شهادة
حول المتحدثين
الدكتورة شيفالي شارما
Head & Assistant DirectorDepartment of Emergency Medicine & Trauma CenterTender Palm Superspeciality Hospital
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