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  • 990610 EUS教學 (3) 急診超音波在腹主動脈瘤之應用

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    juice119
    563 tayangan21 halaman
    Clinical indications All patients over 50 years of age with: classic presentation of ruptured AAA Any pain consistent with ruptured AAA Unexplained hypotension, dizziness, or syncope. - IVC - cylinder tangent effect A small aneurysm does not preclude rupture Large para-aortic nodes may be confused for AAA

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    990610_EUS教學(3)急診超音波在腹主動脈瘤之應用

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    Clinical indications All patients over 50 years of age with: classic presentation of ruptured AAA Any pain consistent with ruptured AAA Unexplained hypotension, dizziness, or syncope. - IVC - cylinder tangent effect A small aneurysm does not preclude rupture Large para-aortic nodes may be confused for AAA

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    563 tayangan21 halaman

    990610 EUS教學 (3) 急診超音波在腹主動脈瘤之應用

    Diunggah oleh

    juice119
    Clinical indications All patients over 50 years of age with: classic presentation of ruptured AAA Any pain consistent with ruptured AAA Unexplained hypotension, dizziness, or syncope. - IVC - cylinder tangent effect A small aneurysm does not preclude rupture Large para-aortic nodes may be confused for AAA

    Hak Cipta:

    Attribution Non-Commercial (BY-NC)
    Unduh sebagai PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 21

    Emergency Ultrasound (EUS)教學(3)

    急診超音波在腹主動脈瘤之應用
    新光醫院急診醫學科
    陳國智醫師
    中華民國醫用超音波學會指導醫師
    Scenario

    59 y/o man
    C/O: right flank pain, VAS: 8/10
    Past history: renal stone
    Your impression ?
    Next step ?
    Clinical indications
    • All patients over 50 years of age with:

    • Classic presentation of ruptured AAA


    • Any pain consistent with ruptured AAA
    • Unexplained hypotension, dizziness, or
    syncope
    • Cardiac arrest
    Triad of ruptured AAA
    • Abdominal, back, or flank pain
    • A palpable abdominal mass
    • Hypotension

    This "classic" presentation may be found


    in less than 25% of cases
    超音波檢查
    • 探頭:
    – 2.5-3.0MHz curvilinear
    • 掃描位置:
    – subxiphoid area
    – using the left lobe of the liver as an acoustic window
    • 技巧:
    – 施壓以移走腸氣
    • 掃描介面:
    – both the longitudinal and transverse planes
    Anatomy and Probe position
    Transverse View
    Transverse View
    Longitudinal View
    Coronal View
    傳統view看不見時的輔助介面
    Obstacles
    Bowel gas
    Obesity
    AAA
    Abdominal aortic dissection
    Pitfalls

    • Contraindication: delay operation


    • Overreliance on examination
    • Patient factors limiting imaging
    • Errors in imaging.
    – IVC
    – Cylinder tangent effect
    • A small aneurysm does not preclude rupture
    • Large para-aortic nodes may be confused for AAA
    The cylinder tangent effect
    Case
    • 74-year-old man
    • Complained sudden onset back pain
    • Pale appearance with cold sweating
    • Bedside ultrasound

    • Sent OR within one hour


    Bedside ultrasound
    Bedside ultrasound
    Bedside ultrasound
    Bedside ultrasound
    Take Home Message
    SKHER AAA protocol
    • Any patient: age >= 50 y/o
    – Syncope / hypotension/dizziness and/or
    – Abdominal / back / flank / groin pain

    • EUS – Abdominal aorta evaluation


    – Subxiphoid area, longitudinal & transverse
    – From just below diaphragm to bifurcation
    – Epigastrium, SMA, and 3cm above bifurcation
    – AAA: diameter more than 3cm (>=5cm, high risk)

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