Jelic Tomislav, Baimel Melanie, Chenkin Jordan
Department of Emergency Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Emergency Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
J Emerg Med. 2017 Nov;53(5):722-725. doi: 10.1016/j.jemermed.2017.08.011.
Pulmonary embolism can be difficult to diagnose, particularly in those who are hemodynamically unstable and cannot be imaged to confirm the diagnosis. Echocardiography can allow for rapid assessment of patients in shock, but requires adequate transthoracic windows to obtain clinically useful information. Emergency physician-performed transesophageal echocardiography (TEE) may be a useful tool when transthoracic echocardiography fails.
An 86-year-old woman presented to the emergency department after a fall at home. She rapidly decompensated in the emergency department and sustained a pulseless electrical activity cardiac arrest. Attempts made during the resuscitation to obtain transthoracic echocardiographic views to elicit the cause of the patient's cardiac arrest were unsuccessful. An emergency physician, with previous focused training in TEE, performed emergent TEE. The TEE examination rapidly revealed a dilated right ventricle and an empty, hyperdynamic left ventricle, suggestive of an unsuspected massive acute pulmonary embolism. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With continued growth and utility of point-of-care ultrasound in emergency medicine, TEE provides an attractive means to assess critically ill patients that may not otherwise be assessable.
肺栓塞可能难以诊断，尤其是在血流动力学不稳定且无法进行影像学检查以确诊的患者中。超声心动图可用于快速评估休克患者，但需要有足够的经胸超声窗才能获取临床有用信息。当经胸超声心动图检查失败时，由急诊医生进行的经食管超声心动图（TEE）可能是一种有用的工具。
一名86岁女性在家中跌倒后被送往急诊科。她在急诊科迅速出现病情恶化，并发生了无脉电活动心脏骤停。在复苏过程中尝试获取经胸超声心动图图像以查明患者心脏骤停原因但未成功。一名接受过TEE专项培训的急诊医生进行了紧急TEE检查。TEE检查迅速显示右心室扩张，左心室空虚且动力增强，提示存在未被怀疑的大面积急性肺栓塞。
急诊医生为何应了解这一点？：随着床旁超声在急诊医学中的不断发展和应用，TEE为评估可能无法通过其他方式进行评估的危重症患者提供了一种有吸引力的手段。
