As medical professionals we understand the intricate and nuanced process of treating a patient from start to finish. From our first encounter taking a detailed history, to completing a physical examination, to ordering appropriate tests, to making a diagnosis and treatment plan, we make decisions based on the best information available to us at that time.
In most cases, during an initial exam or interaction we evaluate the patient based on what can be seen externally, heard with a stethoscope, and felt by palpating the body.
然而，成像技术最近向我们获得了在没有额外测试或推荐的情况下在预先不可用的物理考试信息期间确定更多信息的能力。
Innovations in ultrasound
多年来，越来越多的便携式超声技术使成像的力量更广泛地提供各种医疗环境。虽然这些超声波机器有用，但医生尚未易于访问。然而，超声波领域的新创新正在为物理考试添加一个尺寸，这可能有助于改善和增强护理递送过程 - 在该初始考试期间看到患者内部的能力。
Vscan,袖珍超声波由通用电气Healthcare for use by physicians, has brought ultrasound technology to about the size of a cell phone or PDA. Vscan provides physicians with the ability to take high-quality internal images of a patient’s body directly at the point of care in the exam room.
Vscan can be used to visualize and assess the major vessels and organs such as the aorta, heart and lung, liver, spleen, kidneys and the chest, abdomen, and pelvis for free fluid. Given its size, Vscan can easily be carried from exam to exam, room to room, and used on multiple patients (with appropriate infection control measures in place, of course).
增强我们的验证和真实方法
While the traditional examination methods of observing, listening, and feeling remain crucially important to the way in which we examine, diagnose, and determine treatment options for our patients, this new tool could potentially redefine the way we conduct exams. The capability to immediately obtain internal information on a patient during the exam permits physicians to add an extra layer of information as they assess a patient. For example, for an abdominal injury, an early focused assessment with sonography in trauma (FAST) examination provides crucial information on whether there is free blood
在腹腔里。立即临床医生进行的护理点测试可以帮助确定创伤患者是否适合于进一步的成像或快速转移到手术室。
即使在非紧急常规检查期间，如腹痛的手术咨询或由初级保健医生进行的每年考试，所以获得立即形象的能力可能有助于促进诊断决策和管理计划。
便携式超声在转移到最终外科医疗或医疗之前，也可用于频繁监测患者。人们可以寻找初始快速成像的变化的迹象，而无需重复在转移或持有在急诊部门之前的更昂贵的程序，提供了一定程度的舒适性，即事物真正稳定。
Of course, this is not to say that a pocket-sized ultrasound replaces ad-vanced, clinical diagnostic imaging performed and interpreted by expert technicians and radiologists, or that it alone can diagnose a condition—this is, of course, always up to the discretion and expertise of the physician. However, with proper training and experience, it may guide decision making around the need for and timeliness of further imaging.
Scenarios of use
During the winter of 2010, we had the privilege of serving as, respectively, the Whistler Polyclinic manager for the Vancouver 2010 Olympic and Paralympic Winter Games and as chief medical officer.
At the Whistler athletes’ Village, we kept the Vscan on hand for the use of our emergency physicians and surgeons who had experience and credentialing with clinician-performed ultrasonography in their regular practices. The pocket-sized ultrasound was used routinely for scanning appropriate patients seen in the Polyclinic, including those with multi-trauma or single-system complaints of abdominal or chest pain.
仪器的访问速度，质量成像和可移植性使其适用于移动医疗单元中非常小的创伤和复苏湾的初始评估，邻近邻近的临时帐篷设施的拖车，这些拖车构成了聚临床。尽管拥有全天候进入创新设备和出色的放射技术人员和放射科学家，但在我们的较大的成像机器准备使用之前，通常完成与手持设备的初步研究。
For example, in this typical (fictitious) clinical scenario, a 25-year-old patient sustained significant blunt force trauma from a fall during a high-speed alpine skiing event. The patient had an obvious extremity fracture and was complaining of abdominal and chest pain. Following rapid scene assessment, treatment, immobilization, and evacuation, the patient arrived in the Polyclinic resuscitation bay within minutes of the incident.
Using advanced trauma life support principles, the trauma team performed the ABCs of a primary survey moving on to a secondary head-to-toe survey.
尽管有患者的最初稳定的生命体征，Tauma团队负责人希望确定是否存在腹内出血的客观证据，同时准备患者进一步成像并转移到明确的护理。在几分钟内完成了VSCAN的床头的医生 - 在几分钟内完成，在让患者允许患者进一步成像之前，将创伤团队领导一定程度的舒适度，并最终是对温哥华综合医院的直升机疏散关心。
In another fictitious example, a male skeleton athlete was brought into the mobile medical unit from the sliding centre after hitting a wall very hard on his left chest and upper abdomen. With Vscan, fluid was visible around the spleen. As the patient was hemodynamically stable, he was taken to the CT scanner, where an abdominal CT confirmed a splenic laceration with no active bleeding. The patient was then prepared for helicopter transfer to the Vancouver General Hospital’s trauma unit for definitive care.
Beyond patient care
An added benefit to point-of-care imaging with portable ultrasound is that it can be used as a teaching tool. The medical students and surgical residents we teach at the bedside are quick to understand the benefits of this technology. It provides additional information, facilitating their understanding of an individual patient case, and allows them to better link their knowledge of anatomical structure and function with the pathological or normal findings they are seeing with the device.
结论
Although traditional methods of examination are tried and true, innovations in ultrasound are enhancing the ways in which we evaluate and eventually treat patients.
我们期待着看到下一代手持式超声设备的功能，并使用它们来帮助优化患者护理。
Competing interests
温哥华综合医院和布朗博士从GE Healthcare获得了VSCAN，作为冬季游戏遗产项目的一部分。布朗博士没有收到GE Healthcare的任何财务补偿，并没有公司的任何企业利益。托敦顿议员被邀请参加加拿大健康信息奖，以GE作为年度项目的获胜者，2010年奥运冬季和残奥会。
布朗博士是加拿大军队储备，一般和创伤外科医生的指挥官，也是不列颠哥伦比亚大学大学的临床教授。他是Vancouver 2010奥运会和残奥会冬季游戏的惠斯勒临行本的经理。Taunton博士是艾伦麦格林体育医学中心的不列颠哥伦比亚省大学和体育医学医师体育医学系。他是Vancouver 2010年奥林匹克和残奥会冬季游戏的首席医务官。
Source URL:http://bcmj.org/articles/using-pocket-sized-ultrasound-tools-patient-care
Links:
[1]http://bcmj.org/author/ross-brown-om-cd-bsc-ma-md-frcsc-facs.
[2]http://bcmj.org/author/jack-taunton-msc-md.