Department of Emergency Medicine, Jikei University School of Medicine, Minato-ku, Japan
Department of Intensive Care Medicine, Tokyo Women's Medical University, Shinjuku-ku, Japan.
BMJ Case Rep. 2022 Feb 28;15(2):e246923. doi: 10.1136/bcr-2021-246923.
A man in his fifties was injured in a traffic accident and diagnosed with traumatic subarachnoid haemorrhage, liver injury, and fractures of the rib, right clavicle, right scapula and right femur. He also presented with motor and sensory disturbances of the right upper extremity and was suspected of having a brachial plexus injury. After undergoing mechanical ventilation due to multiple traumas, he was extubated. However, he developed acute respiratory failure and required reintubation. Respiratory symptoms were not clear until just before reintubation. The diagnosis of right diaphragm paralysis was made using point-of-care ultrasound with no other findings that could cause respiratory failure. MRI led to the diagnosis of brachial plexus injury, which likely caused diaphragm paralysis. Point-of-care ultrasound provided a clear visualisation and rapid bedside diagnosis of diaphragm paralysis, which can be challenging to diagnose while ruling out other causes of respiratory failure.
一位 50 多岁的男性在交通事故中受伤，被诊断为创伤性蛛网膜下腔出血、肝损伤以及肋骨、右锁骨、右肩胛骨和右股骨骨折。他还出现了右上肢运动和感觉障碍，疑似臂丛神经损伤。由于多处创伤，他接受了机械通气，随后拔管。但他出现了急性呼吸衰竭，需要重新插管。在重新插管前，呼吸症状并不明显。使用即时超声检查诊断为右侧膈肌麻痹，没有其他导致呼吸衰竭的发现。MRI 诊断为臂丛神经损伤，可能导致膈肌麻痹。即时超声提供了膈肌麻痹的清晰可视化和快速床边诊断，在排除其他呼吸衰竭原因时，这可能具有挑战性。
