Point-of-Care Cardiac Ultrasound

Focused Cardiac Ultrasound from Sun YaiCheng

Image-Based Resuscitation of the Hypotensive Patient with Cardiac Ultrasound: An Evidence-Based Review

J Trauma Acute Care Surg. 2016;80:511-518.

Focused Cardiac Ultrasound (FoCUS) 只需簡單的 echo 機, 在 bedsides 即可操作。任何臨床醫師, EP, PA, R, 甚至醫學生都可學習上手，為所有急重症照護者必備的臨床技能。

• 檢查重點：①心臟收縮功能 ②RV, LV 大小 ③有無 pericardial effusion

• M mode：① 檢查 cardiac wall 的收縮 ②測量 vena cava 的大小

• 臨床應用：①鑑別診斷休克的原因 ②決定是否需要灌水

• Hypovolemia：① empty heart: kissing LV wall ② flat IVC: : IVC collapses >50% during the respiratory cycle

• Pulmonary embolism: RV enlargement. paradoxic septal movement. D-sign: LV collapse

• Cardiac tamponade: pericardial effusion + right heart collapse

• Lung Ultrasound: 看 A line 和 B line (一橫一縱)

• Interstitial lung edema: lung rockets, B+ lines

• Pneumothorax: stratosphere sign (B line 可排除此診斷)

【延伸閱讀】

• RUSH Exam: Rapid Ultrasound in SHock. Emerg Med Clin N Am 28 (2010) 29–56
• BLUE Protocol: Diagnosis of Acute Respiratory Failure. Chest 2008;134;117-125
• FALLS Protocol: Fluid administration limited by lung sonography. Expert Rev
  Respir Med 2012; 6: 155-62.
• C.A.U.S.E.: Cardiac arrest ultrasound exam. Resuscitation (2008) 76, 198—206