Emergency Ultrasound (EUS)教學_急診超音波在感染控制之應用_講義

Emergency Ultrasound (EUS)教學

急診超音波在感染控制之應用

新光醫院急診醫學科

陳國智醫師

中華民國醫用超音波學會指導醫師

Scenario

• 49歲女性，糖尿病患者，發燒及左側腰痛二週，診所診斷為泌尿道感染，但患者對於口服抗生素反應不佳

• Your impression ??

• Next step ??

• Role of EUS ??

2008 ACEP EUS scope of practice

Whole-Body approach at the bedside

Fever of Unknown Sonographic Origin (FUSO)

EUS application (abdomen)

Role of US in infection control

Identify infection sources

Guide therapeutic procedures

Sepsis workup

• Lung and pleural spaces

• Genitourinary system

• Intra-abdominal infection

– Solid organs

– Hollow organs

– Peritoneal cavity

• Skin and soft-tissue

Chest

Normal US appearance of the chest

Bat / Lung sliding / Seashore sign

Pleural effusion

Basic US patterns of PLE

Purulent Pleurisy

Simple PLE

Empyema

Alveolar consolidation

Pneumonia

Necrotizing Pneumonia

Fluid-bronchogram

Pyopneumothorax

Air-bronchogram

Lung abscess

Lung and chest wall abscess

X-ray 不明顯的肺炎

Back scan for consolidation

Dynamic air-bronchogram

Necrotizing pneumonia

Lung abscess

Fungal infection

Hydronephrosis

Pyonephrosis

Renal abscess

Pyonephrosis

Infected cyst

Renal abscess

Gas within kidney

Psoas muscle abscess

Fournier’s gangrene

BTI

CBD stone with obstruction

GB stone

Acute cholecystitis

Cardiac gallbladder and

acute acalculous cholecystitis

Acute calculous cholecystitis

GB empyema

Liver abscess

Infected hepatic cyst

Liver abscess

小心Subphrenic area

未液化不易看

未液化易miss

Gas: comet-tail artifact

Liver abscess ?

Subphrenic abscess

Complicated pancreatitis

Spleen

If A × B is >20 cm2, splenomegaly is considered.

Splenic abscess

Abscess & Gas

Paracentesis

Clear ascites

Postoperative peritonitis

Dirty ascites

Pneumoperitoneum

Fever with AMS

Pseudomembranous colitis

Colitis

Diverticulitis with abscess

Retrocecal appendicitis rupture

Post-appendectomy fever

Post-LC fever

Epigastric pain with fever

Skin and soft tissue

18 y/o M, R’t leg cellulitis

Thigh abscess

Soft tissue abscess

Gas-forming abscess

Urachal cyst infection

Thigh abscess

Padding

43M with fever and right hip pain

Localize & Assist aspiration

Fever with left inguinal pain

56M with left inguinal pain and fever

73M, NF, Aeromonas hydrophila

78M, NF (KP)

Infected Thrombophlebitis

Floating Thrombosis

Right subclavian thrombosis

Maxillary Sinusitis

Intracranial hypertension in bacterial

meningitis

62M with fever and septic shock

Right eye redness

Vegetation

Clinical Decision Making

57 y/o M,

HR 119, BP 69/34, SpO2 82%

Take Home Message

Recognize four patterns

Gas

Fluid

Solid

Movement

EUS for Sepsis

Integrated Application

Diagnose lesion

Assist procedure

Guide therapy