作为医疗专业人员，我们了解从头到尾治疗患者的复杂和细微差别。从我们第一次遇到详细的历史记录，完成体格检查，订购适当的测试，再制定诊断和治疗计划，我们都根据当时的最佳信息做出决定。
在大多数情况下，在初次检查或互动期间，我们根据外部可以看到的内容，听到听诊器并通过触诊身体来评估患者。
However, imaging technology has recently advanced to the point where we are gaining the ability to ascertain more information during the physical exam—information previously unavailable without additional testing or a referral.
超声波的创新
For years, increasingly portable ultrasound technology has made the power of imaging more broadly available in a variety of medical settings. While these ultrasound machines are helpful, they have not been readily accessible to physicians. However, new innovations in the field of ultrasound are adding a dimension to the physical exam that could potentially aid in improving and enhancing the care delivery process—the ability to see inside of a patient during that initial exam.
VSCAN是GE Healthcare供医生使用的袖珍大小超声波，已将超声技术带到了手机或PDA的大小。VSCAN使医生能够直接在检查室的护理点直接拍摄患者身体的高质量内部图像。
VSCAN可用于可视化和评估主动脉，心脏和肺，肝脏，脾脏，肾脏以及胸部，腹部和骨盆的主要血管和器官。鉴于其尺寸，VSCAN可以轻松地从考试到考试，房间到房间，并用于多个患者（当然有适当的感染控制措施）。
Enhancing our tried-and-true methods
尽管传统的观察，聆听和感觉的检查方法对于我们检查，诊断和确定患者的治疗选择的方式至关重要，但该新工具可能会重新定义我们进行考试的方式。在考试期间，立即获得有关患者的内部信息的能力允许医生在评估患者时添加额外的信息。例如，对于腹部损伤，在创伤（快速）检查中进行超声检查的早期重点评估提供了有关是否有自由血液的关键信息
in the abdominal cavity. Immediate clinician-performed point-of-care testing can help ascertain if a traumatized patient is appropriate for further imaging or rapid transfer to the operating room.
Even during a non-emergency routine exam, such as a surgical consultation for abdominal pain or a yearly exam conducted by a primary care physician, the ability to obtain an immediate image could help to facilitate diagnostic decisions and management plans.
A portable ultrasound is also useful for frequent monitoring of the patient before transfer to definitive surgical or medical care. One can be looking for signs of change of the initial FAST imaging without having to repeat more expensive procedures before transfer or holding in the emergency department, providing some degree of comfort that things really are stable.
当然，这并不是说袖珍大小的超声替代了专家技术人员和放射科医生进行和解释的广告，临床诊断成像，或者单独使用它可以诊断出病情 - 当然，这总是可以达到医师的酌处权和专业知识。但是，通过适当的培训和经验，它可以指导围绕进一步成像的需求和及时性的决策。
使用方案
在2010年冬季，我们有特权分别担任温哥华2010年奥运会和残奥会冬季运动会和首席医疗官的惠斯勒多诊所经理。
在惠斯勒运动员村庄，我们将VSCAN保留在急诊医师和外科医生中，这些医生和外科医生在定期实践中具有经验和证书。袖珍大小的超声通常用于扫描在多诊所中看到的适当患者，包括那些具有多创伤或腹痛或胸痛的单一系统抱怨的患者。
The speed of access, quality imaging, and portability of the instrument made it well suited for initial assessments in a very small trauma and resuscitation bay within the Mobile medical unit, a trailer adjacent to and part of our temporary tent facility that made up the Polyclinic. Despite having 24/7 access to innovative equipment and outstanding radiology technicians and radiologists, a preliminary study with the handheld device was often completed before our larger imaging machines were ready for use.
例如，在这种典型的（虚构的）临床情况下，一名25岁的患者在高速高山滑雪事件期间因跌倒而遭受了显着的钝力创伤。该患者明显肢体骨折，并抱怨腹痛和胸痛。经过快速的场景评估，治疗，固定和撤离后，患者在事件发生后几分钟内到达了多克林复苏湾。
创伤小组使用高级创伤生命支持原则，进行了一项主要调查的ABC，进行了次要的从头到脚调查。
Notwithstanding the patient’s initial stable vital signs, the trauma team leader wanted to determine if there was objective evidence of intra-abdominal bleeding while concurrently preparing the patient for further imaging and transfer to definitive care. A bedside physician-performed FAST with Vscan was completed in minutes, giving the trauma team leader a degree of comfort before allowing the patient to be moved to the CT scanner for further imaging and, ultimately, a helicopter evacuation to the Vancouver General Hospital for definitive care.
在另一个虚构的例子中，一名男性骨骼运动员在他的左侧胸部和上腹部撞上一堵墙后，从滑动中心带入移动医疗部门。使用VSCAN，脾周围可见液体。由于患者在血液动力学上稳定时，他被带到CT扫描仪，在那里，腹部CT证实了脾裂缝，没有活跃的出血。然后，准备该患者将直升机转移到温哥华综合医院的创伤部门进行确定护理。
超越患者护理
便携式超声检查可以用来将其用作教学工具的额外的好处。我们在床边教书的医学生和外科居民很快就能理解这项技术的好处。它提供了其他信息，从而促进了他们对单个患者病例的理解，并使他们能够更好地将其对解剖结构和功能的知识与他们在设备中看到的病理或正常发现联系起来。
Conclusion
尽管传统的考试方法是尝试且真实的，但超声波的创新正在增强我们评估并最终治疗患者的方式。
We are looking forward to seeing the capabilities of the next generation of hand-held ultrasound devices and using them to help optimize patient care.
利益争夺
Vancouver General Hospital and Dr Brown have had access to the Vscan on consignment from GE Healthcare as a part of the Vancouver 2010 Winter Games Legacy project. Dr Brown has not received any financial compensation from GE Healthcare and does not have any corporate interests in the company. Dr Taunton was invited to speak at the Canadian Health Informatic Awards with GE as the winner of the Project of the Year with 2010 Olympic Winter and Paralympic Games.
布朗博士是加拿大军队指挥官Reserve, a general and trauma surgeon, and clinical professor at the University of British Columbia. He was the manager of the Whistler Polyclinic for the Vancouver 2010 Olympic and Paralympic Winter Games. Dr Taunton is a professor in the Division of Sports Medicine, Faculty of Medicine at the University of British Columbia and sport medicine physician at the Allan McGavin Sports Medicine Centre. He was the chief medical officer for the Vancouver 2010 Olympic and Paralympic Winter Games.
来源URL：http://bcmj.org/articles/using-pocket-sized-sized-ultrasound-tools-patient-care
链接：
[1]http://bcmj.org/author/ross-brown-omm-cd-bsc-ma-md-frcsc-facs
[2]http://bcmj.org/author/jack-taunton-msc-md