0,34 CME

Penggunaan 2D Echo dalam Pengaturan Perawatan Kritis

Pembicara: Dokter Shefali Sharma

Head & Assistant DirectorDepartment of Emergency Medicine & Trauma CenterTender Palm Superspeciality Hospital

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Keterangan

2D echo, or two-dimensional echocardiography, is a valuable diagnostic tool used in critical care settings. It provides real-time images of the heart's structures and function, aiding in the assessment and management of critically ill patients. In critical care, 2D echo is used to evaluate cardiac function and detect abnormalities that may require immediate intervention.

It allows for the visualization of the heart's chambers, valves, and blood flow patterns, providing crucial information for decision-making. 2D echo helps in the assessment of myocardial contractility, which is vital in monitoring and managing critically ill patients. It is useful in evaluating and diagnosing conditions such as myocardial infarction, cardiomyopathies, and pericardial diseases. In critical care settings, 2D echo aids in the detection of complications like cardiac tamponade or acute valvular dysfunction. It helps assess the impact of acute respiratory distress syndrome (ARDS) or sepsis on cardiac function. It assists in identifying the cause of shock, such as cardiogenic, hypovolemic, obstructive, or distributive shock. 2D echo can detect right ventricular dysfunction, which is a common feature in acute respiratory failure or pulmonary embolism. It helps guide fluid resuscitation by evaluating left ventricular filling pressures and assessing volume status.

Ringkasan

  • The lecture discusses the use of 2D echocardiography (echo) in critical care settings like the ICU, highlighting its role in patient monitoring and management. The origins of echocardiography are traced back to Dr. Edler and Dr. Hertz, emphasizing its initial use in diagnosing mitral valve stenosis and regurgitation.
  • The evolution of ICU is discussed from traditional iron lung ventilators to modern, well-equipped units with advanced monitoring and therapeutic devices. Florence Nightingale and John Ipsson are mentioned as pioneers in nursing and intensive care, respectively.
  • Critical care ultrasonography (CCU) encompasses various elements, including point-of-care ultrasound, thoracic ultrasound, abdominal pelvic ultrasound, vascular ultrasound, and cardiac ultrasound (critical care echocardiography or CCE). The intensivist performs image acquisition and interpretation at the bedside, integrating findings into the management plan.
  • Echo is valuable in categorizing shock and respiratory failure, identifying coexisting diagnoses, and tracking the progression of critical illnesses. Studies demonstrate that echo can lead to immediate changes in patient management in up to 50% of cases, even when performed by non-cardiologists. Key questions to be addressed during a focus eco include assessing left and right ventricular function, detecting pericardial effusion, and evaluating filling pressures.
  • The rapid ultrasound for shock and hypotension (RUSH) exam is highlighted, with components including heart, inferior vena cava (IVC), Morrison's pouch, aorta, and pneumothorax. Sepsis represents a complex situation where early hemodynamic assessment and support is vital, emphasizing the use of echo in septic shock for volume status and inotrope management. Cardiac abnormalities commonly seen in severe sepsis or septic shock include left ventricular dilation, contractile impairment, diastolic dysfunction, and right ventricular dysfunction.
  • Echo is crucial in differentiating cardiac edema from primary lung disease and in assessing LV size and function in patients with suspected heart failure. Bedside echo can be used during cardiopulmonary resuscitation to diagnose pericardial tamponade, profound hypovolemia, thrombus, or absent cardiac contractility, which can inform decisions about terminating CPR.
  • Vascular sonography is valuable for central line and dialysis catheter placement, reducing complications, and assessing volume status. In patients requiring ECMO, echo plays a key role in pre-cannulation evaluation, proper positioning of cannulas, and assessment for weaning from ECMO. Competency in basic critical care echocardiography is essential for safe and effective application of the technique.

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