Emergency Ultrasound (EUS)教學(10)

急診超音波在緊急處置的應用
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
 2006 ACEP US-guided procedures
Extended indication
• To evaluate for and/or • To evaluate for and
drain with US localize with US
– Soft tissue abscess – Soft tissue FB
– Peritonsillar abscess – Pacemaker placement
– Pericardial effusion and capture
– Pleural effusion – Fracture reduction
– Peritoneal fluid – Endotracheal tube
– Joint effusion placement
– Cerebrospinal fluid
 2006 ACEP US-guided procedures
Primary indication
• Vascular access
– Central vein
– Peripheral vein
– Arterial structure
2009 ACEP急診超音波核心應用

1. Resuscitative
2. Diagnostic
3. Symptom/Sign-based
4. Procedure guidance
5. Therapeutic and
monitoring
 Procedural ultrasound techniques
• Probe:
– High frequency (7-12 MHz), linear probe
• Approach:
– Short axis
– Long axis
• Techniques
– Static
– Real-time
 Procedures
• Vascular access-central and peripheral
• Pericardiocentesis
• Paracentesis
• Thoracentesis
• Foreign body detection & removal
• Bladder aspiration
• Arthrocentesis
• Abscess identification and drainage
• Endotracheal tube confirmation
• Shoulder reduction confirmation
• Lumbar puncture landmark identification
Anterior superficial structures of the neck
IJV placement

SV placement
Mechanical complications for CVC
Position of IJV and CA
US image of IJV & CA
IVJ and CA
Real-time US guidance
LIVJ thrombus
 Cannulation of the
subclavian/axillary vein
Femoral vein
US of EJV & IJV
Upper extremity veins
Axillary venogram and US images
Axillary vein approach
Axillary vein (short axis)
Axillary vein (long axis)
Cannulation of peripheral vein
Basilic and cephalic vein
Basilic and cephalic vein
Basilic and cephalic vein
Radial a. cannulation
RA transverse view
RA longitudinal view
Clinical scenario
Prescan
Preparation
Poke
Path
Transverse and longitudinal
orientation
Sterile Technique
Short & long axis approach
Effect of head turning
Good and bad positioned equipment
Arthrocentesis
Sagittal and transverse approach
US-assisted LP
Lumbar puncture
US-guided lumbar puncture
US landmarks for LP
Paracentesis
Pericardiocentesis
Suprapubic bladder aspiration
Thoracentesis
ETT placement
IO needle placement
IO needle placement