最新急诊超声对于休克患者的鉴别诊断(刘继海)课件PPT.ppt

《最新急诊超声对于休克患者的鉴别诊断(刘继海)课件PPT.ppt》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、急诊超声对于休克患者的鉴别诊断(刘继海)主要内容急诊超声和普通超声的区别？以不明原因休克患者RUSH检查为例进一步阐释急诊超声的重要性急诊超声的未来发展方向？急诊超声技术的开展带来的冲击“争地盘”或“抢饭碗”——该不该做？“资质问题”与“收费问题”——如何做？“难做吗”与“做得准吗”——培训与质量控制如何解决？可能的诊断LeftventricularfailureTensionpneumothoraxHemoperitoneumAnaphylaxisSeveredehydrationNeurogenicshockCardiactamponadeValvulardysfunctionPulmo

2、naryembolusOccultmedicationerrororoverdoseSepsisRupturedaneurysmAorticdissectionMyocardialischemia/infarctionThyrotoxicosisAdrenalfailureDysrhythmiaAutonomicdysfunctionOccultgastrointestinalbleedMesentericischemiaAbdominalinflammationRUSHExamThistechnologyisidealinthecareofthecriticalpatientinshock

3、,andthemostrecentACEPguidelinesfurtherdelineateanewcategoryof‘‘resuscitative’’ultrasound.Step1:Thepump（泵）Step2:Thetank（血容量）Step3:Thepipes（血管）Step1—EvaluationofthePump‘‘Effusionaroundthepump’’:evaluationofthepericardium‘‘Squeezeofthepump’’:determinationofgloballeftventricularfunction‘‘Strainofthepum

4、p’’:assessmentofrightventricularstrainEvaluationofthePumpNormalsubxiphoidNormalparasternallongNormalparasternalshortLateralwallNormalparasternalshortatlevelofaorticvalveNormalapical4LateralwallNormalapical2AnteriorwallPericardialeffusionCardiactamponade‘‘Squeezeofthepump’’determinationof‘‘howstron

5、gthepumpis?”avisualcalculationofthepercentagechangefromdiastoletosystoleMotionofanteriorleafletofthemitralvalvecanalsobeusedtoassesscontractility.NormalparasternallongNormalparasternalshortLateralwallAneasysystemofgradingTojudgethestrengthofcontractionsasgood,withthewallsoftheventriclecontractingwe

6、llduringsystole;Poor,withtheendocardialwallschanginglittleinpositionfromdiastoletosystole;Intermediate,withthewallsmovingwithapercentagechangeinbetweentheprevious2categories.BenefitsKnowingthestrengthofleftventricularcontractilitywillgivetheEPabetterideaofhowmuchfluid‘‘thepump’’orheartofthepatientc

7、anhandle,beforemanifestingsignsandsymptomsoffluidoverload.Incardiacarrest,theclinicianshouldspecificallyexamineforthepresenceorabsenceofcardiaccontractions.‘‘Strainofthepump’’Onbedsideechocardiography,theno