From the Regional Trauma Services, Foothills Medical Centre, Calgary, Alta. (Kirkpatrick, McKee, Ball); the Department of Surgery, University of Calgary, Calgary, Alta. (Kirkpatrick, Clements, Ball); and the Department of Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick).
Can J Surg. 2021 Sep 1;64(5):E537-E539. doi: 10.1503/cjs.017619. Print 2021 Sep-Oct.
Traumatic pneumothoraces remain a life-threatening problem that may be resolved quickly with timely diagnosis. Unfortunately, they are still not optimally managed. The most critically injured patients with hemodynamic instability require immediate diagnoses of potentially correctible conditions in the primary survey. Point-of-care ultrasonography (POCUS) performed by the responsible physician can be a tremendous adjunct to expediting diagnoses in the primary surgery and can typically be done in seconds rather than minutes. If more detailed sonographic examination is required, the secondary survey of the hemodynamically unstable patient is more appropriate. All involved in bedside care need to be conscious to efficiently integrate POCUS into resuscitation with the right intentions and goals to avoid sono-paralysis of the resuscitation sequence. Sono-paralysis has recently been described as critical situations wherein action is delayed through unnecessary imaging after a critical diagnosis has been made or unnecessary imaging details are sought despite an urgent diagnosis being made.
创伤性气胸仍然是一种危及生命的问题，如果能及时诊断，通常可以迅速得到解决。不幸的是，目前对其的处理仍不理想。对于血流动力学不稳定的最危重患者，在初次评估中需要立即诊断出可能纠正的情况。有责任心的医师进行即时床旁超声检查（POCUS）可以极大地帮助加快初次手术中的诊断，而且通常可以在几秒钟内完成，而不是几分钟。如果需要更详细的超声检查，则更适合对血流动力学不稳定的患者进行二次评估。参与床边护理的所有人员都需要意识到，需要以正确的意图和目标将 POCUS 高效地整合到复苏中，以避免因在做出关键诊断后进行不必要的影像学检查，或在做出紧急诊断后寻求不必要的影像学细节而导致复苏顺序的“超声瘫痪”。最近，有人描述了“超声瘫痪”这种情况，即在做出关键诊断后，因进行不必要的影像学检查而导致行动延迟，或者尽管做出了紧急诊断，但仍在寻找不必要的影像学细节。
