Rippey James C R, Royse Alistair G
Emergency Department, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.
Best Pract Res Clin Anaesthesiol. 2009 Sep;23(3):343-62. doi: 10.1016/j.bpa.2009.02.011.
Point-of-care ultrasound is well suited for use in the emergency setting for assessment of the trauma patient. Currently, portable ultrasound machines with high-resolution imaging capability allow trauma patients to be imaged in the pre-hospital setting, emergency departments and operating theatres. In major trauma, ultrasound is used to diagnose life-threatening conditions and to prioritise and guide appropriate interventions. Assessment of the basic haemodynamic state is a very important part of ultrasound use in trauma, but is discussed in more detail elsewhere. Focussed assessment with sonography for Trauma (FAST) rapidly assesses for haemoperitoneum and haemopericardium, and the Extended FAST examination (EFAST) explores for haemothorax, pneumothorax and intravascular filling status. In regional trauma, ultrasound can be used to detect fractures, many vascular injuries, musculoskeletal injuries, testicular injuries and can assess foetal viability in pregnant trauma patients. Ultrasound can also be used at the bedside to guide procedures in trauma, including nerve blocks and vascular access. Importantly, these examinations are being performed by the treating physician in real time, allowing for immediate changes to management of the patient. Controversy remains in determining the best training to ensure competence in this user-dependent imaging modality.
床旁超声非常适合在急诊环境中用于评估创伤患者。目前，具有高分辨率成像能力的便携式超声机器使创伤患者能够在院前环境、急诊科和手术室进行成像。在重大创伤中，超声用于诊断危及生命的情况，并对适当的干预措施进行优先级排序和指导。评估基本血流动力学状态是超声在创伤中应用的一个非常重要的部分，但在其他地方会有更详细的讨论。创伤重点超声评估（FAST）可快速评估腹腔积血和心包积血，扩展FAST检查（EFAST）则用于探查胸腔积血、气胸和血管内充盈状态。在局部创伤中，超声可用于检测骨折、许多血管损伤、肌肉骨骼损伤、睾丸损伤，并可评估怀孕创伤患者的胎儿存活情况。超声还可在床边用于指导创伤操作，包括神经阻滞和血管通路。重要的是，这些检查由主治医生实时进行，以便能立即改变患者的治疗方案。在确定确保掌握这种依赖用户的成像方式的最佳培训方面，仍存在争议。
