Peh Wee Ming, Lok Teng Joo
Department of General Medicine, Seng Kang General Hospital, Singapore, Singapore.
Department of General Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.
Eur J Case Rep Intern Med. 2019 Jul 29;6(8):001193. doi: 10.12890/2019_001193. eCollection 2019.
Point-of-care ultrasound is increasingly important in the management of acute medical emergencies. An elderly man was brought to the emergency department after 2 days of fever and urinary retention. He was drowsy and had peri-arrest arrhythmia. He was hypoperfused peripherally with a systolic blood pressure of 45 mmHg and so was managed as for septic shock with no obvious aetiology. Chest and abdominal physical examinations were unremarkable. The source of sepsis was unclear. A point-of-care abdominal ultrasound was performed by the reviewing internist which detected a pneumoperitoneum, leading to a change in diagnosis to a perforated viscus which was confirmed later by a CT of the abdomen and pelvis.
Pneumoperitoneum leading to septic shock is a medical emergency, but diagnosis is frequently delayed as the physical examination and chest and abdominal x-rays may fail to detect the condition in the critically ill patient, leading to delayed medical and surgical intervention.There is a role for point-of-care abdominal ultrasound for the early diagnosis of pneumoperitoneum with the air reverberation artefact.Point-of-care ultrasound of the abdomen to identify intra-abdominal air is an important physical examination adjunct in undifferentiated septic shock and should be incorporated into the routine care of patients and included in the acute medicine training syllabus.
即时超声检查在急性医疗紧急情况的管理中日益重要。一名老年男性在发热和尿潴留2天后被送往急诊科。他嗜睡，有濒死期心律失常。他外周灌注不足，收缩压为45 mmHg，因此按照无明显病因的感染性休克进行处理。胸部和腹部体格检查无异常。脓毒症的来源不明。会诊内科医生进行了即时腹部超声检查，发现有气腹，诊断改为内脏穿孔，后来腹部和骨盆CT证实了这一诊断。
导致感染性休克的气腹是一种医疗紧急情况，但由于体格检查以及胸部和腹部X线检查可能无法在重症患者中检测到这种情况，诊断常常延迟，导致医疗和手术干预延迟。即时腹部超声检查对于利用空气混响伪像早期诊断气腹有作用。腹部即时超声检查以识别腹内气体是未分化感染性休克中重要的体格检查辅助手段，应纳入患者的常规护理，并纳入急性医学培训大纲。
