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
Kaynakça
- Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, et al. Focused Cardiac Ultrasound in the Emergent Setting: A Consensus Statement of the American Society of Echocardiography and Ameri- can College of Emergency Physicians. J Am Soc Echocardiogr 2010; 23: 1225-30. [Crossref]
- American College of Emergency Physicians. Emergency ultrasound guidelines 2008. Available at: http://www.acep.org. Accessed Novem- ber 1, 2009.
- Ciccone TJ, Grossman SA. Cardiac ultrasound. Emerg Med Clin N Am 2004; 22: 621-40. [Crossref]
- Levitt MA, Jan BA. The effect of real time 2-D-echocardiography on medical decision-making in the emergency department. J Emerg Med 2002; 22: 229-33. [Crossref]
- Kimura BJ, Bocchicchio M, Willis CL, Demaria AN. Screening cardiac ul- trasonographic examination in patients with suspected cardiac disease in the emergency department. Am Heart J 2001; 142: 324-30. [Crossref]
- Wang HK, Tsai MS, Chang JH, Wang TD, Chen WJ, Huang CH. Cardiac ultrasound helps for differentiating the causes of acute dyspnea with available B-type natriuretic peptide tests. Am J Emerg Med 2010; 28: 987-93. [Crossref]
- Zengin S, Yıldırım C, Al B, Genc S, Kılıc H, Doğan M. The Effectiveness of Ultrasound in Patients with Non-Traumatic Cardiopulmonary Arrest. JAEM 2012; 11: 68-72. [Crossref]
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
Kaynakça
- Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, et al. Focused Cardiac Ultrasound in the Emergent Setting: A Consensus Statement of the American Society of Echocardiography and Ameri- can College of Emergency Physicians. J Am Soc Echocardiogr 2010; 23: 1225-30. [Crossref]
- American College of Emergency Physicians. Emergency ultrasound guidelines 2008. Available at: http://www.acep.org. Accessed Novem- ber 1, 2009.
- Ciccone TJ, Grossman SA. Cardiac ultrasound. Emerg Med Clin N Am 2004; 22: 621-40. [Crossref]
- Levitt MA, Jan BA. The effect of real time 2-D-echocardiography on medical decision-making in the emergency department. J Emerg Med 2002; 22: 229-33. [Crossref]
- Kimura BJ, Bocchicchio M, Willis CL, Demaria AN. Screening cardiac ul- trasonographic examination in patients with suspected cardiac disease in the emergency department. Am Heart J 2001; 142: 324-30. [Crossref]
- Wang HK, Tsai MS, Chang JH, Wang TD, Chen WJ, Huang CH. Cardiac ultrasound helps for differentiating the causes of acute dyspnea with available B-type natriuretic peptide tests. Am J Emerg Med 2010; 28: 987-93. [Crossref]
- Zengin S, Yıldırım C, Al B, Genc S, Kılıc H, Doğan M. The Effectiveness of Ultrasound in Patients with Non-Traumatic Cardiopulmonary Arrest. JAEM 2012; 11: 68-72. [Crossref]
Ayrıntılar
| Diğer ID | JA32FE99HK |
|---|---|
| Bölüm | Case Report |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Nisan 2013 |
| Gönderilme Tarihi | 1 Nisan 2013 |
| Yayımlandığı Sayı | Yıl 2013 Cilt: 4 Sayı: 2 |