Acil Serviste Kardiyak Ultrasonografi Kullanımının Klinik Karar Üzerine Etkisi: İki Olgu Sunumu

Öz

Acil servislerde yatakbaşı kardiyak ultrasonografi, belirli endikasyonlarla Focused Cardiac Ultrasound (FOCUS) adı altında sıkça kullanılmaktadır. Nefes darlığı ile başvuran 72 yaşında hastanın konjestif kalp yetmezliği, koroner arter hastalığı, atriyal fibrilasyon öyküsü vardı. Bir ay önce yapılan EKO’sunda pulmoner HT, LVEF: %35-40 saptanmıştı. Fizik muayene ve akciğer filmi sonrası akut akciğer ödemi düşünülen hastaya acil hekimi tarafından yatakbaşı FOCUS yapıldı. Global hipokinezi ve yeni sağ atriyal trombüs saptanması üzerine hasta interne edildi. Yumuşak doku sarkomlu 55 yaşında diğer hasta sol kol ve bacakta güçsüzlük yakınması ile başvurdu. Sol hemiparezisi vardı ve sağ üst ekstremitede nabızları alınmıyordu. Beyin tomografisinde patoloji yoktu. Yatakbaşı yapılan kardiyak ultrasonografisinde aortta trombüs olduğu görüldü. Sonrasında yapılan torokoabdominal anjio BT ve formal doppler incelemede; sağ subclavian arter ve sağ üst ekstremite arter sisteminde tam tromboz, sağ İCA intrakraniyal bölümünde tromboz varlığını düşündüren bulgular görüldü. Hasta periferik vasküler cerrahi planlanarak interne edildi. İyi bilinen FOCUS endikasyonu “nefes darlığı” yanı sıra ikinci olgudaki uygulamada olduğu gibi olgu bazlı yatakbaşı kardiyak ultrasonografi kullanımı acil serviste güvenli ve hızlı hasta bakımına katkı sağlayabilmektedir. Bu bağlamda FOCUS’un yakın gelecekte daha geniş endikasyonlarla kullanımı söz konusu olabilir.

Anahtar Kelimeler

• Kardiyak ultrasonografi, acil tıp, FOCUS

The Impacts of Using Cardiac Ultrasonography in the Emergency Department (ED) for Clinical Decision-Making: Two Case Reports

Öz

Bedside cardiac ultrasonography in emergency departments (ED) is used frequently, with the name of Focused Cardiac Ultrasound (FOCUS) for certain indications. A 72 year old man with congestive heart failure, coronary artery disease and atrial fibrillation presented to the ED with the chief complaint of dyspnoea. Pulmonary hyertension and a left ventricular ejection fraction of 35-40% was determined by echocardiography one month previously. The emergency physician applied bedside FOCUS to the patient who was diagnosed to have pulmonary oedema after examination and chest x-ray. The patient was hospitalised as global hypokinaesia and a new atrial thrombus was determined. A 55 year old patient presented to the ED with soft tissue sarcoma in his left arm and leg. He had left hemiparaesis and pulses were not palpable in the right upper extremity. The head computerised tomography (CT) was normal. In the bedside ultrasonography, an aortic thrombus was determined. In the latter examination by computed tomographic pulmonary angiography and formal doppler evaluation, complete thrombus at the right subclavian artery and at the arteries of right upper extremity were detected with signs that were indicative of thrombus in the intracranial part of right internal carotid artery. The patient was hospitalised within the plan of peripheral vascular surgery. Dyspnoea is a well known indication for FOCUS. However, the use of bedside cardiac ultrasonography with patient-based decision can contribute to safe and fast service delivery in ED as in the second case. Thus, the wider use of FOCUS can be indicated in the future

Anahtar Kelimeler

• Cardiac ultrasonography, emergency medicine, FOCUS

Kaynakça

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