medicine echocardiography急诊医学超声心动图课件

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1、CardiacUltrasoundinEmergencyMedicineAnthonyJ.WeekesMD,RDMSSarahA.StahmerMDFortheSAEMUSInterestGroupPrimaryIndicationsThoraco-abdominaltraumaPulselessElectricalActivityUnexplainedhypotensionSuspicionofpericardialeffusion/tamponadeSecondaryIndicationsAcuteCardiacI

2、schemiaPericardiocentesisExternalpacercaptureTransvenouspacerplacementMainClinicalQuestionsWhatistheoverallcardiacwallmotion?Isthereapericardialeffusion?CardiacprobeselectionSmallroundfootprintforscanbetweenribs2.5MHz:aboveaveragesizedpatient3.5MHz:averagesizedp

3、atient5.0MHz:belowaveragesizedpatientorchildMaincardiacviewsParasternalSubcostalApicalWallMotionNormalHyperkineticAkineticDyskinetic:mayfailtocontract,bulgesoutwardatsystoleHypokineticOrientationSubcostalorsubxiphoidviewBestallaroundimagingwindowGoodforidentific

4、ationof:CircumferentialpericardialeffusionOverallwallmotionEasytoobtain–liveristheacousticwindowSubcostalViewMostpracticalintraumasettingAwayfromairwayandneck/chestproceduresSubcostalViewLiverasacousticwindowAlternativetoapical4chamberviewSubcostalViewSubcostal

5、ViewSubcostalViewAngleproberighttoseeIVCResponseofIVCtosniffindicatescentralvenouspressureNocollapseTamponadeCHFPEPneumothoraxParasternalViewsNextbestimagingwindowGoodforimagingLVComparingchambersizesLocalizedeffusionsDifferentiatingpericardialfrompleuraleffusio

6、nsParasternalLongAxisNearsternum3rdor4thleftintercostalspaceMarkerpointedtopatient’srightshoulder(orlefthipifscreenisnotreversedforcardiacimaging)RotateenoughtoelongatecardiacchambersParasternalLongAxisParasternalLongAxisViewParasternalShortAxisObtainedby90°cloc

7、kwiserotationoftheprobetowardstheleftshoulder(orrighthip)SweepthebeamfromthebaseofthehearttotheapexfordifferentcrosssectionalviewsParasternalShortAxisViewParasternalShortAxisApicalViewDifficultviewtoobtainAllowscomparisonofventricularchambersizeGoodwindowtoasses

8、sseptal/wallmotionabnormalitiesApicalViewsPatientinleftlateraldecubituspositionProbeplacedatPMIProbemarkerat6o’clock(orrightshoulder)4chamberviewApical4chamberviewMar