EUS教學_990624

Challenging cases & Journal Reading

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
US is superior to radiography for
diagnosing sternal fracture

Sternal fracture: 24/36 patients

Sensitivity and specificity
Plain radiographs: 70.8%; 75.0%
US: both 100%

J Clin Ultrasound 2010; 38:135–137

 Comparison of Web-versus Classroom-Based Basic
Ultrasonographic and EFAST Training in 2 European Hospitals

Ann Emerg Med. 2010. In press

Bedside ultrasonographic measurement of caval
index greater than or equal to 50% is strongly
associated with a low central venous pressure

Ann Emerg Med. 2010;55:290-295

 Bedside ultrasonographic measurement of caval
index greater than or equal to 50% is strongly
associated with a low central venous pressure

Caval index: (IVCe – IVCi )/IVCe Ann Emerg Med. 2010;55:290-295

Bedside Ultrasonography to Identify
Hip Effusions in Pediatric Patients

Ann Emerg Med. 2010;55:284-289

US for CVC_CLEAR database
Central Line Emergency Access Registry Database

AJEM 2010; 28, 561–567

 US for CVC_CLEAR database
Central Line Emergency Access Registry Database

1. did not observe improved success with the use of

ultrasound for CVC cannulation on the first attempt
2. observe a reduced number of total punctures per attempt

AJEM 2010; 28, 561–567

An initial description of a sonographic sign that
verifies intrathoracic chest tube placement

AJEM 2010; 28, 626–630

 Disappearance/Intrathoracic,
Continuation/ Extrathoracic (DICE) sign

Sensitivity 100%; Specificity 100% AJEM 2010; 28, 626–630

 Ultrasound-guided femoral nerve
blocks are feasible to perform in the ED

N=13; Median age: 82 AJEM 2010 28, 76–81

Significant and sustained decreases in
pain scores were achieved

AJEM 2010 28, 76–81

 Needle tip visualization during ultrasound-guided
vascular access: short-axis vs long-axis approach

9/39, 23%

AJEM 2010;28: 343–347

 Needle tip visualization during ultrasound-guided
vascular access: short-axis vs long-axis approach

24/39, 62%

AJEM 2010;28: 343–347

 Kinetic Echography in the
Evaluation of Retinal Detachment

Video clip: right eye

Video clip: left eye
ACAD EMERG MED • June 2010
 Emergency Ultrasound
Identification of Pneumoperitoneum

ACAD EMERG MED • 2010

Soft Tissue Ultrasound and the
Comet Tail Artifact

ACAD EMERG MED • 2010

Needle Aspiration of Spontaneous
Pneumothorax

Video Clip S1. Absent pleural sliding

Video Clip S2. Aspiration PTX
Video Clip S3. Repeat ultrasound examination
demonstrated partial resolution of the
pneumothorax, with ‘‘lung point’’ sign
Video Clip S4. Confirmation of return of normal
pleuralsliding anteriorly
Diagnosis of Lemierre’s Syndrome
by Bedside Sonography

ACAD EMERG MED • 2010

Challenging Cases
68F_abdominal pain with leukocytosis
79F, c/o whole abdominal pain
 70M, RLQ pain
SKH_ER
32M, RLQ pain
55F, LLQ pain
18M, severe epigastralgia
45F, right 3rd finder swollen
SKH_ER
67F, persistent fever
SKH_ER
 Cases of this month
• 1. Emphysematous cystitis
• 2. Diverticulitis rupture & pneumoperitoneum
• 3. Appendicitis rupture
• 4. Terminal ileum diverticulitis
• 5. Epiploic appendagitis
• 6. PPU with pneumoperitoneum
• 7. Finger abscess
• 8. Psoas muscle abscess