進階急診超音波於頭頸部掃描之應用

彰化基督教醫院 急診醫學部超音波推廣組 教學CR蔡揚名

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頭頸部掃描之目標

新生兒腦部超音波

頸動脈超音波

穿顱超音波

眼眶超音波

呼吸道超音波

耳鼻喉科之超音波掃描應用

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Neonatal Brain Ultrasound

首要目標-辨認出血

其他目標-水腦及先天性異常

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Fontanelle compression test

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True sagittal midline

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Angled parasagittal

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Anterior horns of lateral

ventricles

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3rd ventricle

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Classification of PVH-IVH based on

radiological findings (Papile, 1983)

Grade Site of hemorrhage

I Subependymal region and/or germinal matrix

II Subependymal hemorrhage with extension into

lateral ventricles without ventricular

enlargement

III Subependymal hemorrhage with extension into

lateral ventricles with ventricular enlargement

IV Intraparenchymal hemorrhage

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Intracranial lesions in the

preterm infant

Hemorrhagic

IVH: Intraventricular hemorrhage

PVH: Periventricular hemorrhage (PVH)

(Post-hemorrhagic hydrocephlus)

Ischemic

PVL: Periventricular leucomalacia

Ventricular enlargement (cortical atrophy)

Porencephalic cysts

(Arterial infarct)

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PVH-IVH

Predominantly affects the periventricular white matter (motor tracts)

Associated with long-term disability in prematurely-born infants

Cerebral palsy

Developmental delay

Seizures

Blindness

Deafness

Decreased incidence, but more survivors

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Grade I:

bilateral germinal matrix haemorrhage

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Grade II

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Grade III IVH

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Grade IV IVH

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Carotid Ultrasound

急診Carotid Ultrasound唯一目標

-中風病患排除頸動脈剝離

-只掃兩側CCA部分

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CCA

BLUB

ICAECA

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Carotid Doppler

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Carotid Dissection

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有時會不小心看到……

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CVP placement

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Transcranial ultrasound

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Transcranial Doppler

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偵測Midline Shift為主要用途

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Midline Shift Variation

AJNR Am J Neuroradiol 20:1567–1571,

September 1999

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Acute Epidural Hematoma

Intensive Care Med. 2010 Jun;36(6):1091-2

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Ocular Ultrasound

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How to scan?

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IICP?

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IICP?

急診超音波如何判斷IICP

1. 使用high frequency, high resolution的linear

probe (7.5-10MHz)

2. 測量眼球後方3mm處的Optic Nerve Sheath

Diameter(ONSD)

3. ONSD 大於5mm和IICP有相關性

4. Sensitivity 100%, Sepcificity 63%

Annals of Emergency Medicine Volume 49, No. 4, April, 2007

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Scandinavian Journal of Trauma, Resuscitation and Emergency

Medicine 2009, 17:34

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Parotid abscess / parotitis

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Maxillary Sinusitis

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Epiglottitis

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Take Home Message

新生兒腦部超音波：偵測出血

頸動脈超音波：只看兩側CCA有無Flap，輔助中央靜脈導管置放

穿顱超音波：追蹤CVA或ICH之中線偏移

眼眶超音波：IICP，視網膜剝離，眼內感染、出血、異物

呼吸道超音波：確認氣管位置

耳鼻喉超音波：偵測唾液腺和頸部之感染、膿瘍之形成

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Special thanks to~~

新光急診陳國智醫師熱心指導

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臉書讓一群對有志於急診超音 波的同好們結合—

急重症超音波特攻隊請期待我們的論文和教材

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Thanks for your attention !!