2013年的個案，
早上抬東西時突然昏厥，現場沒有目擊者，
自行醒來後，右顳部腫痛。
CT看到右側skull bone fracture，
pneumocranium, SAH & SDH.
心電圖如下，無法明顯解釋昏厥的原因
因為昏厥，所以進行床邊超音波快速掃描，
腹腔沒有AAA，沒有ascites。
雖然當時單位內仍沒有心超探頭，
好在當時有microconvex的探頭可以進行心臟的掃描。
PSLA下可見LA內有一高回音的mass lesion
Apical 4 chamber下也可見LA內有一高回音的mass lesion
進一步安排的正式心超更是清楚的記錄了這個病灶
依這個流程圖而言，這個cardia mass最有可能是myxoma
有興趣的人可以去看這篇review article
Cardiac Tumors: JACC CardioOncologyState-of-the-Art Review
那Syncope時如果要用POCUS來協助臨床決策時該怎麼做呢 ?
2023年American Journal of Emergency medicine的這篇文章或許可以參考看
The diagnostic efficiency of whole-body bedside ultrasonography protocol for syncope patients in the emergency department
【152 patients were included in the study. The median age of the patients was 61.5 years (IQR: 41–71.8) and 52.6% were female. The most common (64.3%) abnormal sonographic finding was >50% collapse of vena cava inferior during inspiration. In addition, abnormal sonographic findings thought to cause syncope/presyncope were detected in 35.5% of the patients. Bolus fluid resuscitation were given in in 62 patients (40.8%) with increased inferior vena cava collapse. Critical interventions other than fluid resuscitation were performed for abnormal sonographic findings in 35 (23%) of the patients. Advanced age, increased heart rate and the presence of high-risk criteria in the ‘European Society of Cardiology Guidelines for Syncope’ were independent risk factors for detection of abnormal ultrasonographic findings related to syncope/presyncope.】
WHOBUS-Syncope (whole-body ultrasonography for syncope) protocol包含了
1. Focused lung ultrasonography
2. Focused cardiac ultrasonography
3. Focused abdominal ultrasonography
4. Limited Compression Ultrasonography
5. Restricted Carotid Ultrasonography
6. Measurement of inferior vena cava ( IVC) diameter and collapsibility during respiration
