Brugge Mars 2009 P.R.E.P. Programme Rapide Échographie Polytraumatisé. Aalst - December 2009 C.F.F.E.
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1 Brugge Mars 2009 Programme Rapide Échographie Polytraumatisé Aalst - December 2009 C.F.F.E.
2 PREVIOUSLY! About «formal ultrasonography»! Ultrasonography for the diagnosis! Performed by a specialist! Long time for learning (More than 2 years)! Examines several organs (all?)! The examination duration is long! For example: obstetrical (45 min) The «opposite» on each point to formal sonography
3 ULTRASONOGRAPHY in EMERGENCY ROOM Aalst December 2009! Sonography by NON radiologists! Limited ultrasonography (targets?)! Well done by another specialist! Quick and easy to learn! Concept d image déterminante! Fast to very FAST investigation! Example of FAST, EDU and of the PREP The Is a targetted tool
4 PREP is helpfull for vitals problem! Neurologicals => T.C.D.! Respiratory => Chest and Pleuro-Pulmonary ultrasonography! Haemodynamics (shocks) => Cardiac US, Abdominals and trans-oesophagus US Srinivasan Stroke 1996 Le Moigno MAPAR 2002 Lichtenstein Int. Care. Med 1999 Mandavia Ann Emerg Med
5 Let s take off Aalst December 2009! Initial level of US knowlegde = 0! So, Please, if you already know more! Hush! Let others Learn by practice! Learn by trial & error! But feedback is very welcome! Style difference French and Anglo-Saxon course
6 PREP : The GOALS Aalst December 2009! Learn to work echo machines! The technique, What CAN you do with UltraSound (US) and what not! Structured US assessment of the thorax, abdomen, pericardium and abdominal major vessels! Recognize US anatomy! Recognize major problems in thorax and abdomen.! Aimed at vitally detrimental conditions
7 ! Patient in illness conditions?! Questions & Answers :! Is there free fluid in the abdomen?! Is there air or free fluid in thorax?! Is there free fluid in pericardium?! Is there an abdominal aortic aneuvrysm?! Is the urinary tract dilated?! Is there a proximal phlebitis?! Is the IVC «full»?! Interventional Ultrasound (localize the vessels, nervs, puncture )
8 ! BASED ON EASY METHOD! Easy! Faster! Friendly to learn! Standardized It is an extension of the physical examination
9 METHODOLOGY! 1 Theory Courses and! 2 Practical Workshops (3 trainees for 1 device)
10 PRACTICAL WORKSHOPS Workshop 1 = PREP 1 Workshop 2 = PREP 1 + PREP 2 Workshop 3 = PREP 1 + PREP 2 + PREP 3 Workshop 4 = PREP 1 + PREP 2 + PREP 3 + PREP 4 Workshop 5 = PREP 1 + PREP 2 + PREP 3 + PREP 4 + PREP 5 And Workshop review = 5 more
11 SWEEP Thoraco-Abdominal - Cranio-caudal To Search and find target picture ANECHOIC (liquid) In the lowest points «The Tanks»
12 SWEEP Thoraco-Abdominal - Cranio-caudal To Search and find target picture FREE AIR (Aeric) In the highest points «The Zenith point»
13 ! The «acoustic windows»! PREP 1 = Right Thoraco-abdominal Area! PREP 2 = Left Thoraco-abdominal Area! PREP 3 = Below Umbiliculus Area! PREP 4 = Anterior Thoracic Area! PREP 5 = Under Umbiliculus Area! Dorsal decubitus! From 2 to 5 MHz probe! B-mode
14
15 PREP 1 Morisson s pouch
16 ! Hemoperitoneum PREP 1
17 ! PREP 2 Between spleen and kidney space
18 ! And Pleura The Gliding Sign The Rings Down (line A)
19 ! PREP 3 PELVIC Douglas s pouch
20 Aalst December 2009! PREP 3 Free fluid Car crash. Hemodynamic stability. Large quantity of liquid in pelvic. Dr Ph. PÈS Dr G. MAZAIRAC
21 ! PREP 4 - Pericardium Anterior Trans Thoracic Sweep Under Xiphoid Sweep
22 Normal Pathologic
23 ! And Pleura The Gliding Sign The Rings Down (line A)
24 ! PREP 5 Aorta and ICV
25 !PREP 5 Aorta and ICV - Measures
26 Aneurysm of Abdominal Aorta
27 Aneurysm of Abdominal Aorta
28 What Else can we perform with ULTRASOUND
29 ! HELP FOR LOCATE THE VESSELS! Recomendation for :! Difficult know Patient! Junior operator! If the 1st puncture failure (with anatomical landmarks) In England = Official Recomendation for the Internal Jugular (N.I.C.E.)
30 ! Trans-Crânial Doppler! TCD recognize the stroke risk conditions! Monitoring of cerebral blood circulation in brief delay than PIC and SvJO2 Measure of blood velocity in MCA (60% of the cerebral blood flow) Temporal window Pen probe or 2 Mhz in phased array
31 ! NORMALS VALUES! - Vs = 80 ± 15 cm/s! - Vd = 40 ± 10 cm/s! - Vm = 50 ± 10 cm/s! - IP = 0,8 à 1,2! WARNING VALUES! - Vm < 30 cm/s! - Vd < 20 cm/s! - IP > 1,3
32 ! AND ALSO! Nerves (regional Anesthaesia)! Punctures and drains! Airway management (Tube position)! Cardiac Arrest and Reanimation! Bones (Rib and long bones)! Optical nerve and brain swallow!.
33 ! CONCLUSION THE Standardized Method Using Ultrasonography as a Tool to Diagnose Risk Conditions In Critical Care Patients
34 SO TAKE OFF!!! Aalst December 2009
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