Medicine Echocardiography急诊医学超声心动图课件.pptVIP

Cardiac Ultrasound in Emergency Medicine  Anthony J. Weekes MD, RDMS Sarah A. Stahmer MD For the SAEM US Interest Group Primary Indications Thoraco-abdominal trauma Pulseless Electrical Activity Unexplained hypotension Suspicion of pericardial effusion/tamponade Secondary Indications Acute Cardiac Ischemia Pericardiocentesis External pacer capture Transvenous pacer placement Main Clinical Questions What is the overall cardiac wall motion? Is there a pericardial effusion? Cardiac probe selection Small round footprint for scan between ribs 2.5 MHz: above average sized patient 3.5 MHz: average sized patient 5.0 MHz: below average sized patient or child Main cardiac views Parasternal Subcostal Apical Wall Motion Normal Hyperkinetic Akinetic Dyskinetic: may fail to contract, bulges outward at systole Hypokinetic Orientation Subcostal or subxiphoid view Best all around imaging window Good for identification of: Circumferential pericardial effusion Overall wall motion Easy to obtain – liver is the acoustic window\ Subcostal View Most practical in trauma setting Away from airway and neck/chest procedures Subcostal View Liver as acoustic window Alternative to apical 4 chamber view Subcostal View Subcostal View Subcostal View Angle probe right to see IVC Response of IVC to sniff indicates central venous pressure No collapse Tamponade CHF PE Pneumothorax Parasternal Views Next best imaging window Good for imaging LV Comparing chamber sizes Localized effusions Differentiating pericardial from pleural effusions Parasternal Long Axis Near sternum 3rd or 4th left intercostal space Marker pointed to patient’s right shoulder (or left hip if screen is not reversed for cardiac imaging) Rotate enough to elongate cardiac chambers Parasternal Long Axis Parasternal Long Axis View Parasternal Short Axis Obtained by 90° clockwise rotation of the probe towards the left shoulder (or right hip) Sweep the beam from the base of the heart to the apex for different cross sectional views