[精品]外伤超音波简介.ppt

外傷超音波簡介 陳昭文 醫師 急診部 外傷科 高雄醫學大學附設中和紀念醫院 及時而正確的診斷對嚴重外傷之病患是絕對重要的… 我們常用的工具: Physical Examination DPL FAST Abdominal CT Scenario XY 19歲男性因車禍受腹部鈍傷送入急診, 血壓為80/40 mmHg, 心搏115, 左上腹壓痛; 輸液2000ml給予後血壓未見起色, 你接下來要安排的檢查是? Scenario XX 31歲女性於衝突受上腹部刀傷送入急診, 血壓為130/60 mmHg, 心搏95, 上腹稍微壓痛; 初級檢傷後, 除上腹部五公分傷口外無其他外傷; 血壓仍然穩定, 你接下來要安排的檢查是? 常用診斷工具 DPL Sonographic survey (FAST) CT DPL Diagnostic Peritoneal Lavage 腹膜腔內灌洗術 可近性高, 易於床邊施行 侵襲性檢查 易有偽陽性 DPA ”A” Closed method 判讀方法 Open and closed techniques Catheter inserted into the abdomen, aspirate Positive if gross blood, bile, food, stool If aspirate negative, lavage with 1 liter NS positive Lavage fluid 100,000 RBC/mm3, 500 WBC/mm3, Bacteria on Gram stain Abdominal CT Computed tomography, CAT scan 需影像部門配合, 檢查速度不一 重裝備, 可近性低 亂槍射鳥, 一網打盡, 敏感度高 CAT scan FAST Focused Abdominal Sonography for Trauma 輕裝備, 易於使用 檢查時間短 解析度不佳 受操作者個人經驗影響 FAST 主要搜尋腹腔內積液 對生命徵象不穩之病患, 先排除腹內出血與心包填塞之可能 Basic 4 views 劍突下 Cardiac (subxyphoid) view 右上腹 RUQ view (Morrison’s pouch) 左上腹 LUQ view (splenorenal space) 骨盆腔 Suprapubic view (Cul-de-Sac) Typical 4 views RUQ view Longitudinal scan Transverse scan Intercostal scan Hypochondral scan Morison pouch May observe pleural space 10% is identified with infusing 400ml saline 97% is noted with infusing 1L saline LUQ view Longitudinal scan Transverse scan Intercostal scan Hypochondral scan Spleen may be obscured during deep inspiration May observe pleural space simultaneously Subxyphoid view Pericardiac sac Echogenesity of blood Pericardial effusion? Heart movement? Decompressive measure Echo guided pericardiocentesis Equipment 16-gauge short-bevel large-bore needle 30- or 50-mL syringe Echo- guided Local anesthesia Sterile supplies and povidone-iodine solution Suprapubic view Longitudinal scan Transverse scan Best viewed under full bladder Physiologic fluid EFAST Extended FAST scan Detect thoracic lesion Focus on occult pneumothorax (OPTX) Gliding pleura signs Lung Sliding Lung point Hemotho