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Ultrasound Guided Interventions
Abstracts and number of impressions were significantly elevated and reduced respectively after SEARCH 8Es We concluded that focused thoracic ultrasound, SEARCH 8Es is the useful and convenient tool that can help emergency physician make accurate decision in patients with dyspnea, chest pain, or shock. T8-15-IN05 US in Detection and Differentiation of Ileus Dieter Nuernberg Professor for Gastroenterology, Medical School Brandenburg Theodor Fontane, Neuruppin, Germany Ultrasonography has become increasingly important in the routine diagnostics of gastrointestinal diseases. It is not only assessing the lumen but more important the wall and the surrounding structures of the stomach and bowel. Furthermore, functional processes (peristalsis, blood flow) can be visualized and provide important information about passage and perfusion. With modern high resolution (compressive) sonography the gastroenterologist has an ideal method available complementary to endoscopy. Ultrasonography is an effective diagnostic tool in situation of emergency (ileus, perforation). In emergency indications sonography is the method of first choice achieving a high sensitivity. The same applies to the ileus, which can be diagnosed significantly earlier by sonography than with conservative X-ray. Meanwhile sonography can contribute considerable information to clarify genesis (e.g. invagination, intusception). Signs of mechanical small bowel ileus are dilatated and round bowel loops. In the late phase, the bowel wall is thicker, oedematous and a peristaltic. Hyper peristaltic, pendula peristalsis und atony depend on the stadium. Distal of the stenosis the bowel is empty (‘‘hunger bowel’’). Frequent causes are adhesive bands and adhesions (not visible), incarcerated hernias, invaginations (in children) or tumours (seldom foreign bodies or gall stones). Differential diagnostic peritoneal carcinosis has to be excluded as cause of the obstruction. Often the cause for he ileus can be found by detailed examination in conjunction with medical history and clinical symptoms. Differential diagnostic wide, exudate-filled, intestinal loops with hyper-motility in case of endemic sprue, but also other forms of secretory diarrhoea. Most frequently the cause of large bowel ileus is colon cancer. Typical is a lot of gas in the dilated colon. Other reasons are coprostasis, volvulus, peri-diverticulitis and IBD. In paralytic ileus, small bowel loops are enlarged and a peristaltic and also the colon is enlarged. Typical examples are postoperative bowel atony or paralytic situations in pancreatitis, peritonitis and mesenteric ischemia. The published sensitivity of sonography (89 – 97 %) is significant higher than that of X-ray (77 - 85 %). In mechanical small bowel ileus diagnosis with possible US is 6 h earlier then with X-ray. Radiological signs are considerably later apparent as the passage obstruction, detectable by sonography. In large bowel ileus, heavy flatulence of single bowel segments is the main sign, in some cases this can be demonstrated more clearly with a X-ray abdomen overview. But gas filling is usually a late sign of Ileus. Free intraabdominal fluid (interenteric ascites) is also a (late) sign of Ileus. T8-15-IN06 The US-CAB Protocol During Resuscitation Wan-Ching Lien Assistant Professor, Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, Taiwan
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Pulse check, auscultation and capnography are traditional methods for confirming the circulation-airway-breathing (C-A-B) status during cardiopulmonary resuscitation (CPR). However, application of these methods during resuscitation may have limitations. Ultrasonography has an increasingly important role in emergency conditions like CPR. We proposed a novel ultrasound C-A-B (US-CAB) protocol in an ALS-compliant manner. This systematic ultrasonographic evaluation during CPR not only serves as an adjunct to traditional C-A-B check, but also identifies potentially reversible causes of cardiac arrest and confounding factors of CPR. T8-15-IN07 A Common Misunderstanding in Lung Ultrasound: The Comet Tail Artifact Francis Lee Acute & Emergency Care Centre, Khoo Teck Puat Hospital, Singapore Lung ultrasound diagnosis depends on the interpretation of changes or loss in the natural artifacts produce by lung air. Several vertical linear lung artifacts have been described, of which two stands out as being the most important: the comet tail artifact and B-lines. The term ‘‘comet tail artifact’’ are often loosely used to describe any kind of vertical lung artifacts, creating some confusion. Comet tails, B-lines and one of their cousins: The Z-line, have been presented as ‘‘comet tails’’ in common literature and publications. However, these three entities have distinct genesis, appearances and diagnostic significance. A clarification of term ‘‘comet tail’’ goes a long way to remove the barriers of interpreting, communicating and learning lung ultrasound findings. T8-15-IN08 Ultrasound Guided Interventions Christoph F. Dietrich Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980, Bad Mergentheim The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines on interventional ultrasound (INVUS) are an expression of interdisciplinary and multiprofessional viewpoints, some of which represent different approaches; this reflects reality in all its diversity. Particular attention has been given to clinical significance (level of evidence and the more practical grade of recommendation). The principle of ‘‘do no harm’’ is expressed in repeated pleas to apply the techniques judiciously in everyday practice and not become fascinated with technology for its own sake. The decision to proceed with an interventional procedure is always an individual one and should be measured by its benefit for the patient (1). The guidelines consist of six main parts that are published in Ultraschall in der Medizin / European Journal of Ultrasound (2-10), an introduction (1) and Editorial (11) and comment papers (12-14). T8-15-IN09 Prehospital Ultrasound Jen-Tang Sun Far Eastern Memorial Hospital Ultrasound is raising star in emergency medicine, many of study were published in EM, among them, some article related prehospital condition, including FAST, pneumothorax and lung edema. Due to unique condition of prehospital environment, like the noising, can influence our physical examination. Ultrasound can provide some correct diagnosis and give more information about the patient. This presentation is review of ultrasound in prehospital use.
S107
Pulse check, auscultation and capnography are traditional methods for confirming the circulation-airway-breathing (C-A-B) status during cardiopulmonary resuscitation (CPR). However, application of these methods during resuscitation may have limitations. Ultrasonography has an increasingly important role in emergency conditions like CPR. We proposed a novel ultrasound C-A-B (US-CAB) protocol in an ALS-compliant manner. This systematic ultrasonographic evaluation during CPR not only serves as an adjunct to traditional C-A-B check, but also identifies potentially reversible causes of cardiac arrest and confounding factors of CPR. T8-15-IN07 A Common Misunderstanding in Lung Ultrasound: The Comet Tail Artifact Francis Lee Acute & Emergency Care Centre, Khoo Teck Puat Hospital, Singapore Lung ultrasound diagnosis depends on the interpretation of changes or loss in the natural artifacts produce by lung air. Several vertical linear lung artifacts have been described, of which two stands out as being the most important: the comet tail artifact and B-lines. The term ‘‘comet tail artifact’’ are often loosely used to describe any kind of vertical lung artifacts, creating some confusion. Comet tails, B-lines and one of their cousins: The Z-line, have been presented as ‘‘comet tails’’ in common literature and publications. However, these three entities have distinct genesis, appearances and diagnostic significance. A clarification of term ‘‘comet tail’’ goes a long way to remove the barriers of interpreting, communicating and learning lung ultrasound findings. T8-15-IN08 Ultrasound Guided Interventions Christoph F. Dietrich Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980, Bad Mergentheim The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines on interventional ultrasound (INVUS) are an expression of interdisciplinary and multiprofessional viewpoints, some of which represent different approaches; this reflects reality in all its diversity. Particular attention has been given to clinical significance (level of evidence and the more practical grade of recommendation). The principle of ‘‘do no harm’’ is expressed in repeated pleas to apply the techniques judiciously in everyday practice and not become fascinated with technology for its own sake. The decision to proceed with an interventional procedure is always an individual one and should be measured by its benefit for the patient (1). The guidelines consist of six main parts that are published in Ultraschall in der Medizin / European Journal of Ultrasound (2-10), an introduction (1) and Editorial (11) and comment papers (12-14). T8-15-IN09 Prehospital Ultrasound Jen-Tang Sun Far Eastern Memorial Hospital Ultrasound is raising star in emergency medicine, many of study were published in EM, among them, some article related prehospital condition, including FAST, pneumothorax and lung edema. Due to unique condition of prehospital environment, like the noising, can influence our physical examination. Ultrasound can provide some correct diagnosis and give more information about the patient. This presentation is review of ultrasound in prehospital use.