這一期的ICM刊出了一篇很實用的教學文,
教你如何進行Diaphragm Ultrasound的掃描和判讀,
對ICU的重症而言應該會很有幫助。
那對急診呢 ?
如果呼吸衰竭沒有明顯原因可解釋時,
這也是一個可以用來評估的地方,
尤其是像重症肌無力這類型的患者,
如果兩側有顯著差異時,
也要考慮是不是有diaphragmatic injury or phrenic nerve injury的可能。
之前我也有貼過幾篇和diaphragm有關的貼文:
Diaphragm can tell us important information
在這篇貼文中分享了Subcostal view觀察到的三種影像
Normal diaphragm / Pulmonary fibrosis / Pneumonia
Respiratory muscle ultrasonography (ICM review)
2020 ICU也有一篇呼吸肌超音波的文章,
有附詳細的圖解和說明。
Acute dyspnea in the emergency department: a clinical review
Internal and Emergency Medicine (2023)的這篇文章中,
對於Lung US有很好的整理和很棒的超音波圖示。
我也有附上Apache wireless ultrasound 所記錄的超音波影像,
Diaphragm movement (Subcostal approach)
Diaphragm thickness (intercostal approach)
本文ICM全文官網連結 和PDF全文
How I perform diaphragmatic ultrasound in the intensive care unit | Intensive Care Medicine
Take Home Message (from ICM)
Diaphragm ultrasound is a valuable, bedside non-invasive method for diagnosing or excluding diaphragm dysfunction in difcult-to-wean patients.
It also plays a role in identifying diaphragm weakness as a cause of respiratory failure in select cases and diagnosing traumatic phrenic nerve injury.
以下為ICU這篇editorial內所附的大圖QR code連結