Application of portable ultrasound in severe emergency

Application of portable ultrasound in severe emergency

With the continuous development of society, ultrasound examination has become one of the indispensable examination means for medical diagnosis. In emergency treatment, portable ultrasound examination has a wide range, high accuracy, fast inspection speed, non-trauma and no contraindications. Repeated examination can quickly screen patients in any scenario, win precious rescue time for patients with severe fatal trauma, and make up for the shortage of X-rays. Mutual verification with X-ray examination; The biggest advantage is that emergency patients with unstable circulation or who should not be moved can be examined anytime and anywhere, and there is no scene limitation, which is the first examination method for critically ill patients.

Application status of bedside ultrasound at home and abroad

1. There are more and more intensive ultrasound training in the world. At present, a basic and reasonable training system has been formed, and the World Intensive Ultrasound Alliance (WINFOCUS) has been established.
2. The American College of Emergency Physicians requires that emergency physicians must master emergency ultrasound technology, and 95% of the level 1 trauma centers in the United States (190) perform emergency ultrasound
3. Emergency physicians in Europe and Japan have widely used ultrasound to assist patients in diagnosis and treatment
4. China started late, but progress is fast.

Application of portable ultrasound in trauma first aid and acute abdomen

01 Primary inspection
Screening for life-threatening airway, breathing and circulation. - First aid, emergency

02 Secondary inspection
Identify obvious injuries in all parts of the body - emergency, ICU, ward

03 Triple check
Comprehensive systematic inspection to avoid missing trauma -ICU, ward

Focus Ultrasound Assessment of Trauma (FAST) : Six points (subxiphoid, left epigastric, right epigastric, left renal area, right renal area, pelvic cavity) were selected for rapid identification of fatal trauma.

1. Detection of acute blunt force or acute air injury in the trunk and free fluid in the abdomen: FAST examination is used for preliminary detection of pleural bleeding, and to determine the bleeding site and amount (pericardial effusion, pleural effusion, abdominal effusion, pneumothorax, etc.).
2.Common injuries: liver, spleen, pancreas injury
3. Common non-traumatic: acute appendicitis, acute cholecystitis, gallstones and so on
4. Common gynecology: ectopic pregnancy, placenta previa, pregnancy trauma, etc
5. Pediatric trauma
6. Unexplained hypotension and so on require FASA tests

Application of portable ultrasound in cardiac

Rapid and effective assessment of the overall size and function of the heart, the size of the individual chambers of the heart, myocardial status, presence or absence of regurgitation, valve function, ejection fraction, blood volume status assessment, cardiac pump function assessment, rapid detection of causes of hypotension, left and right ventricular systolic/diastolic function, guiding fluid therapy, volume resuscitation, guiding cardiopulmonary monitoring, Trauma patients have no heart rupture and rapid treatment of pericardial effusion and blood, etc

1. Pericardial effusion: Rapid identification of pericardial effusion, pericardial tamponade, ultrasound-guided pericardial puncture
2. Massive pulmonary embolism: Echocardiography can help rule out conditions with symptoms similar to pulmonary embolism, such as cardiac tamponade, pneumothorax, and myocardial infarction
3. Left ventricular function assessment: Left ventricular systolic function was assessed by rapid scan of left major axis, left minor axis, apical four-chamber heart, and left ventricular ejection fraction.
4. Aortic dissection: Echocardiography can detect the location of the dissection, as well as the site of involvement
5. Myocardial ischemia: Echocardiography can be used to examine the heart for abnormal wall movement
6. Valvular heart disease: Echocardiography can detect abnormal valve echoes and changes in blood flow spectrum

Application of portable ultrasound in lung

1. Used to assess the severity of early-middle stage pneumonia, small flaks of pulmonary hydrosis appear in the lungs
2. Both lungs diffuse fusion line B, showing "white lung" sign, severe lung consolidation
3. Guide the setting of ventilator and observe the condition    of lung reexpansion
4. For the diagnosis of pneumothorax: stratospheric sign, lung point and other signs suggest the possible presence of pneumothorax

Application of portable ultrasound in muscle tendon

1. Ultrasound can assess whether the tendon is torn and the extent of the tear
2. For patients with pain and swelling of the hands and feet, ultrasound can quickly and reliably diagnose tenosynovitis, which helps to improve the quality of care and select the appropriate treatment
3. Assess joint involvement in chronic arthritis
4. Accurately guide tendon and bursae aspiration and soft tissue injection

Application of portable ultrasound in clinical guidance

1. Ultrasound-guided central vein catheterization (internal jugular vein, subclavian vein, femoral vein)
2. Ultrasound guided PICC puncture
3. Ultrasound-guided catheterization of the invasive artery
4. Ultrasound guided thoracic puncture drainage, ultrasound guided abdominal puncture drainage
5. Ultrasound-guided pericardial effusion puncture
6. Ultrasound-guided percutaneous hepatogallbladder puncture

It can be seen that the portable color Doppler ultrasound diagnostic instrument has an extremely wide range of applications in emergency severe cases, providing a reliable basis for further clinical diagnosis and treatment, and realizing that critical patients can complete the bedside cardiac ultrasound examination without leaving the care ward, greatly improving the diagnosis and treatment level of serious patients.