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Background
Focused cardiac ultrasound (FoCUS) is accurate for determining the presence of a pericardial effusion. Using FoCUS to evaluate for pericardial tamponade, however, is more involved. Many experts teach that tamponade is unlikely if the inferior vena cava (IVC) shows respiratory variation and is not distended.Case Report
A 53-year-old woman presented to the emergency department (ED) with severe orthostatic hypotension, exertional dyspnea, and hypoxia. The evaluation did not reveal an acute cardiopulmonary etiology, but FoCUS demonstrated a pericardial effusion, with several signs consistent with tamponade. The IVC, however, was not distended. She was believed to be hypovolemic, but fluid therapy provided minimal benefit. The patient's condition improved only after aspiration of the effusion. The patient's presentation was likely a “low-pressure” pericardial tamponade. Patients with this subset of tamponade often do not have significant venous congestion, but urgent pericardial aspiration is still indicated.Why Should an Emergency Physician Be Aware of This?
Pericardial tamponade may not manifest with IVC plethora on ultrasound. Patients with low-pressure tamponade do not present with the most florid signs of tamponade, but they nonetheless fulfill diagnostic criteria for tamponade. If a non-plethoric IVC is used to rule out tamponade, the clinician risks delaying comprehensive echocardiography or other tests. Furthermore, the potential for deterioration to frank shock could be discounted, with inappropriate disposition and monitoring. 相似文献3.
目的 应用超声心动图评价自体心包条二尖瓣环成形术的早、近期疗效.方法 应用超声心动图对33例行二尖瓣环成形术的患者进行术后即刻(17例)、术后1周(33例)、术后3个月(18例)的疗效观察,并与术前超声结果相比较,评价成形术效果.结果 术后二尖瓣反流程度明显减轻(P<0.05);术后左心房、左心室内径明显缩小(P<0.05);术后1周左室射血分数略减低(P<0.05),术后3个月左室射血分数较术后1周明显提高(P<0.05);术后即刻、术后1周、术后3个月二尖瓣环成形术效果比较未见显著差异(P>0.05).结论 超声心动图实时直观、简便易行,可作为评价自体心包条二尖瓣环成形术首选的检查方法,且瓣环成形术早、近期疗效满意. 相似文献
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急诊床旁超声心动图在临床应用的价值 总被引:29,自引:1,他引:28
目的: 本文探讨急诊床旁超声心动图在临床的应用价值。方法: 我们回顾性分析了1998 年 11 月至1999 年 4 月进行的急诊床旁超声心动图检查共计60 例。结果: 床旁超声检查的诊断阳性率为87% (52/60), 其中,冠心病20 例 (33.3% , 20/60, 与心电图和临床生化检查一起协助诊断急性心梗4 例); 单发或者合并心包、胸腔积液13 例 (22% 13/60); 瓣膜病11 例 (18% , 11/60); 外科术后患者9 例 (15% , 9/60); 高血压心脏病4 例 (6.7% ,4/60); 心肌病4 例 (6.7% , 4/60); 肺心病3 例 (5% , 3/60); 先心病1 例 (1.7% , 1/60); 夹层 2 例; 其他6 例。结论: 急诊床旁超声心动图检查无论在诊断阳性率方面, 还是在对临床干预的结果方面, 均具有相当重要的临床应用价值 相似文献
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心包积液是最早应用超声技术进行诊断的病种之一。五十年代初期,Edl(?)r 首先报道了心包积液的超声诊断征象。嗣后,许多学者进一步证实其使用价值。尤其是二维超声心动图(2 DE)的出现及使用,更加提高了心包积液诊断的敏感性和特异性,本文拟对心包积液在声像图上易与混淆的某些疾病和因素进行初步的分析,并就其鉴别诊断方法加以探讨。 相似文献
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对照CT、磁共振显像(MRI)及胸部大动脉X线血管造影(TAG),分析16例食管超声心动图结果,评估其诊断胸主动脉瘤的价值。15例诊断正确,1例真性动脉瘤诊断为夹层动脉瘤DeBakeyⅢ型并血栓形成。同时检出主动脉瓣关闭不全6例、左室扩大5例。食管超声检出胸主动脉瘤的能力与CT、MRI及TAG相同,并能检出合并的主动脉瓣关闭不全、左室扩大及左室功能不全。 相似文献
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目的探讨对脑卒中病人在发病早期进行床边康复的效果观察与护理.方法将100例脑卒中偏瘫病人随机分为康复组和对照组.康复组50例病人在发病早期进行床边康复护理.主要采取卧床期康复护理:包括床上的被动运动、主动运动、桥式运动、体位转换.离床期康复护理:指导帮助病人坐起及站立平衡训练.步行期康复护理:指导病人训练行走技巧.对照组按常规治疗,执行一般常规护理.结果康复组病人有效地减少了肩痛、手腕肿、肌痉挛,足内翻并发症的发生,康复效果明显优于对照组(P<0.05).结论脑卒中偏瘫早期进行床边康复训练护理是功能恢复的重要环节,越早实施效果越好.在临床上,对减少后遗症的发生有较好的效果,提高了病人的生存质量,为病人提供了理想的康复方法. 相似文献
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对脑卒中偏偏瘫病人在发病早期进行床边康复的观察与护理 总被引:3,自引:1,他引:3
目的 探讨时脑卒中病人在发病早期进行床边康复的效果观察与护理。方法 将100例脑卒中偏瘫病人随机分为康复组和对照组。康复组50例病人在发病早期进行床边康复护理。主要采取卧床期康复护理:包括床上的被动运动、主动运动、桥式运动、体位转换。离床期康复护理;指导帮助病人坐起及站立平衡训练。步行期康复护理:指导病人训练行走技巧。对照组按常规治疗,执行一般常规护理。结果 康复组病人有效地减少了肩痛、手腕肿、肌痉孪,足内翻并发症的发生,康复过果明显优于对照组(P<0.05)。结论 脑卒中偏瘫早期进行床边康复训练护理是功能恢复的重要环节,越早实施效果越好。在临床上,对减少后遗症的发生有较好的效果,提高了病人的生存质量,为病人捉供了理想的康复方法。 相似文献
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Joseph Colla Jerome Martin Wesley Eilbert Matt Wishnoff 《The Journal of emergency medicine》2019,56(5):530-535
Background
Rapid diagnosis of acute myocardial infarction (AMI) in the emergency department (ED) is often hindered by the limitations of the electrocardiogram (ECG). Speckle tracking echocardiography (STEch) is a semiautomated, computer-assisted process that provides accurate detection of regional ventricular wall motion abnormalities and can be performed at the bedside by operators with limited experience.Case Reports
Two separate patients, each with history and ECG findings concerning for AMI, were evaluated using STEch performed by an emergency physician. Ventricular wall motion abnormalities found on STEch accurately reflected the findings of emergent cardiac catheterization, with one patient requiring urgent coronary artery revascularization and the other with no coronary artery occlusion.Why Should an Emergency Physician Be Aware of This?
STEch is a novel, easy-to-use form of echocardiography that can be used in the ED to identify patients with AMI who would benefit from emergent revascularization. 相似文献14.
严重胸外伤合并多发伤207例诊治体会 总被引:1,自引:0,他引:1
目的 探讨严重胸外伤合并多发伤的诊断和治疗。方法 对收治的严重胸外伤瘵多发伤207例患,根据病史、临床表现、体检结果和必要的辅助检查,严密观察病情变化,作出早期诊断,并在保持患呼吸道通畅,控制出血、防治休克和ARDS以及处理多发伤等方面作出相应的有效措施。结果 治愈196例,死亡11例。结论 对严重胸外伤伴多发伤患,应依据“CRASHPLAN”法顺序检查,尽量避免误诊漏诊;以VTPCO抢救程 相似文献
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LUC J. JORDAENS JOHAN F. VANDENBOGAERDE PETER VAN DE BRUAENE MARC DE BUYZERE 《Pacing and clinical electrophysiology : PACE》1990,13(8):955-957
A dual chamber pacemaker was implanted during the first trimester of pregnancy in a patient with second-degree heart block and syncope. Transesophageal echocardiography was used to confirm satisfactory position in the right atrial appendage. 相似文献
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床旁超声在肝移植术后早期并发症诊治中的价值 总被引:1,自引:0,他引:1
目的研究床旁超声在肝移植术后早期并发症诊治中的价值。方法应用彩色多普勒超声连续系统检查了12例患者肝移植术后肝脏及胸腹腔,重点检测门静脉、肝动脉、肝静脉及下腔静脉,胆管、胸腹腔。结果肝移植术后超声检查发现的常见并发症有移植肝保存性损伤并流出道梗阻1例,肝淤血2例,胆道并发症3例,腹腔积液12例,胸腔积液12例,超声引导介入检查及治疗8例。结论床旁超声在肝移植术后早期并发症诊治中起到积极有效的作用。 相似文献
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