Stolz Lori A, Mosier Jarrod M, Gross Austin M, Douglas Matthew J, Blaivas Michael, Adhikari Srikar
University of Arizona, Department of Emergency Medicine, Tucson, Arizona.
University of Arizona, Department of Emergency Medicine and Internal Medicine, Tucson, Arizona.
West J Emerg Med. 2015 Mar;16(2):255-9. doi: 10.5811/westjem.2015.1.24301. Epub 2015 Feb 26.
Common carotid flow measurements may be clinically useful to determine volume responsiveness. The objective of this study was to assess the ability of emergency physicians (EP) to obtain sonographic images and measurements of the common carotid artery velocity time integral (VTi) for potential use in assessing volume responsiveness in the clinical setting.
In this prospective observational study, we showed a five-minute instructional video demonstrating a technique to obtain common carotid ultrasound images and measure the common carotid VTi to emergency medicine (EM) residents. Participants were then asked to image the common carotid artery and obtain VTi measurements. Expert sonographers observed participants imaging in real time and recorded their performance on nine performance measures. An expert sonographer graded image quality. Participants were timed and answered questions regarding ease of examination and their confidence in obtaining the images.
A total of 30 EM residents participated in this study and each performed the examination twice. Average time required to complete one examination was 2.9 minutes (95% CI [2.4-3.4 min]). Participants successfully completed all performance measures greater than 75% of the time, with the exception of obtaining measurements during systole, which was completed in 65% of examinations. Median resident overall confidence in accurately performing carotid VTi measurements was 3 (on a scale of 1 [not confident] to 5 [confident]).
EM residents at our institution learned the technique for obtaining common carotid artery Doppler flow measurements after viewing a brief instructional video. When assessed at performing this examination, they completed several performance measures with greater than 75% success. No differences were found between novice and experienced groups.
测量颈总动脉血流在临床上可能有助于确定容量反应性。本研究的目的是评估急诊医生（EP）获取颈总动脉超声图像并测量其速度时间积分（VTi）的能力，以便在临床环境中用于评估容量反应性。
在这项前瞻性观察性研究中，我们向急诊医学（EM）住院医师展示了一段五分钟的教学视频，演示获取颈总动脉超声图像并测量颈总动脉VTi的技术。然后要求参与者对颈总动脉进行成像并获取VTi测量值。专业超声检查人员实时观察参与者的成像过程，并根据九项性能指标记录他们的表现。一名专业超声检查人员对图像质量进行评分。记录参与者的检查时间，并询问他们关于检查的难易程度以及获取图像的信心的问题。
共有30名EM住院医师参与了本研究，每人进行了两次检查。完成一次检查所需的平均时间为2.9分钟（95%置信区间[2.4 - 3.4分钟]）。除了在收缩期进行测量外，参与者在超过75%的时间内成功完成了所有性能指标，收缩期测量在65%的检查中完成。住院医师对准确进行颈动脉VTi测量的总体信心中位数为3（范围为1[不自信]至5[自信]）。
我们机构的EM住院医师在观看一段简短的教学视频后学会了获取颈总动脉多普勒血流测量的技术。在评估他们进行这项检查时，他们完成了几项成功率超过75%的性能指标。新手组和经验丰富组之间未发现差异。
