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The column opens with great luck~~
Hello everyone, I am "hemp small is not hemp small", the column name is hemp elementary school ultrasound
.
The main content of this column is transesophageal ultrasound (TEE).
Make an agreement in advance, and the content is mainly for perioperative anesthesia and intensive care physicians
.
The cardiac ultrasound mentioned in this column defaults to transesophageal ultrasound
.
Let's talk about the indications for TEE first
Indications written in the Expert Consensus on Perioperative Transesophageal Echocardiography Monitoring (2020 edition):
Patients
with persistent hypotension, low pulse oximetry, and low end-expiratory partial pressure of carbon dioxide (EtCO2) during surgery are difficult to correct.Close hemodynamic monitoring is required, including: heart rate/rhythm, preload, diastolic function, afterload
.The differential diagnosis
of the type of circulatory dysfunction, such as shock type, heart failure type, needs to be confirmed.Direct and indirect signs required for perioperative acute PE decision-making
.Differential diagnosis of chest pain in emergency surgery, such as dissection aneurysm, pulmonary embolism, and myocardial infarction
.Anesthesia for traumatic emergency surgery requires exclusion of cardiac and macrovascular complications such as heart rupture and aortic transection
.Heart valve function tests
.Transthoracic ultrasonography is difficult to visualize, and it is difficult to identify various abnormal patterns and functions of major blood vessels
of the heart.
In general, regardless of cardiovascular surgery or non-cardiovascular surgery, any hemodynamic and circulatory instability can be used to assist in judging the circulatory state, providing certain clues for the patient's diagnosis or the circulatory state at that time, and the basis for
treatment.
Of course, heart surgery is more meaningful, judging heart function, evaluating valve status and function, volume evaluation, etc.
, and even changing the surgical method
.
Contraindications
Luffy Medical Channel
In addition, we also have to look at the contraindications, that is, when not to do it
1.
Absolute contraindications: patient refusal, active upper gastrointestinal bleeding, esophageal obstruction or stricture, esophageal mass lesions, esophageal tears and perforations, esophageal diverticula, hiatal hernia, congenital esophageal malformations, shortly after esophageal surgery, pharyngeal abscess, pharyngeal mass lesions
.
2.
Relative contraindications: esophageal varices, coagulation disorders, history of mediastinal radiotherapy, cervical spine disease, pharyngeal abscess, pharyngeal mass lesions
.
Relative contraindications require a comparison of the benefits of TEE testing and the risk of relative contraindications to determine whether to perform TEE monitoring
.
“
Uh-huh, we must pay attention to remember!!! Esophageal injury is an important complication, once it occurs, the mortality rate is very high, the operation process must be gentle, avoid unnecessary bending of the probe, and the probe temperature is too high may lead to esophageal damage
.
When using, avoid long-term use caused by excessive probe temperature, when the temperature is high, when not in use, it should be frozen
in time.
Generally speaking, ultrasound ah, will be from
the principle of ultrasound and so on.
Generally, I am sleepy after listening to it, and I can't remember it
.
Let's skip it first, and when it comes to it later, let's
learn it.
Let's talk about esophageal probes and their use
The probe is like
this.
Put another abbreviated version:
It is mainly composed of
plugs, connecting wires, control knobs, operating handles, pipe bodies, transducers and other parts.
The plug is the part that connects the
probe to the ultrasound machine.
The control knob has a large wheel and a small wheel that can control forward bend, back bend, left or right bend
respectively.
In addition, at the top of the probe is a transducer that can emit and receive ultrasonic waves
.
\ | /
★
The esophageal probe has the following dimensions of action:
1.
Forward and backward: It is easy to understand that the probe is advancing towards the deep part of the esophagus, or retreating
to a shallower position.
As we will talk about later, there is a mid-esophageal plane and a transgastric plane, and the difference between these two planes is the difference in depth, that is, it is necessary to adjust the view
by moving forward and backward.
As shown in the figure
.
2.
Turn left, turn right: This is also a common operation, that is, rotate the probe counterclockwise or clockwise
.
It is most commonly used to switch between the left and right heart planes, and of course there are many uses, which we will mention
in the chapter on planes.
3.
Change of angle: This is the difficulty of this article
.
From the beginning, the general ultrasonic probe is a straight line or curved surface, and every time you see an image, it is a single plane; The esophageal ultrasound probe has great limitations, one is that the probe must enter the esophagus, so the probe cannot be very large, and secondly, the probe cannot change the direction (or angle)
of observation by moving or rotating the probe like ordinary probes.
Then the big guys thought of it for us, that is, to make an integrated crystal, that is, an ultrasonic probe that can release ultrasound to different angles, and then switch the angle
by switching the angle of ultrasonic waves emitted by the crystal.
Generally, the image of transesophageal ultrasound, next to the image, will have a semicircle, the range is 0~180°, showing the angle of
the current plane.
Through this angle, it can be assisted to determine what plane
it is.
I guess some children's shoes still don't understand, let's
go to a few more pictures.
Suppose my finger is the tip of the probe, the white fan is the observation plane of the esophageal ultrasound, and the first figure is the plane
of 0°.
The second one is the 30° plane.
The third picture is a plane of 90°, (don't be too surprised if you post it crookedly)
The fourth image is a plane
of 120°.
I hope you can understand the meaning
of the angle.
The probe does not move under the naked eye, but the plane of the ultrasonic wave changes
.
4
.
Pre-song, back-song: This one, the frequency of use is obviously low.
Bend
the head of the probe slightly forward or backward.
It is usually less commonly used
in the mid-esophageal plane.
The corresponding echosound plane is obtained only through the gastric or deep fundar plane
, or with appropriate anterior curvature.
5.
Left bend, right bend: This one, the frequency of use is lower
.
Bend
the tip of the probe slightly to the left or right.
Only when the gastric or deep fundar plane is transgenerated, when the corresponding plane has been properly curved and the corresponding plane has not been played, you can occasionally try to bend left to obtain the corresponding ultrasonic plane
.
Pediatric probes simply canceled this function
.
Anterior or posterior bends, as well as left and right bends, are relatively high-risk operations that can easily cause damage
to the esophagus.
If there is no special need, it is recommended not to try it for the time being, and then start using it
after reaching a certain level.
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Hello
Let's stop here for the first article~
Thank you all!
Welcome to give valuable comments~
Thank you all for your support and encouragement ~ ^^
Moderator / hemp small is not hemp small
Typesetting/jingle balls
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