Critical care medicine
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Critical care medicine · May 2007
ReviewUltrasound-guided interventional radiology in critical care.
Ultrasound-guided intervention is becoming an increasingly popular and valuable tool in the critical care setting. In general, image-guided procedures can expedite wait times and increase the accuracy, safety, and efficacy of many procedures commonly performed within intensive care units. ⋯ These include central venous catheter deployment, thoracentesis, paracentesis, and drainage of a wide variety of abscesses, and percutaneous nephrostomy, percutaneous cholecystectomy, and inferior vena cava filter placement. Although we believe ultrasound is significantly underutilized in critical care today, we anticipate that with the improvement of ultrasound technology and the innovation of new ultrasound-guided procedures, the role of ultrasound in the intensive care unit will continue to expand, with bedside ultrasound-guided interventions increasingly becoming the norm.
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Using simple and standardized semiology, the lung appears accessible to ultrasound, despite previous opinions otherwise. Lung ultrasound allows the intensivist to quickly answer to a majority of critical situations. Not only pleural effusion but also pneumothorax, alveolar consolidation, and interstitial syndrome will have accurate ultrasound equivalents, the recognition of which practically guides management. ⋯ It is believed that by using this tool, the intensivist may more confidently manage acute dyspnea and make emergency therapeutic decisions based on reproducible data. Further benefits include reduced requirements for computed tomographic scans, therefore decreasing delay, irradiation, cost, and above all, discomfort to the patient. Thus, ultrasound of the lung can also be added to the classic armamentarium as a clinical tool for emergency use.
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Critical care medicine · May 2007
ReviewPoint-of-care ultrasound: Infection control in the intensive care unit.
Ultrasound provides a diagnostic modality that allows a whole-body approach at the bedside of a critically ill patient in the search for infectious foci. Both common sites of infection, such as the lung and pleura, central veins, and maxillary sinuses, and also less common sites, such as gastrointestinal perforation, sepsis due to mesenteric ischemia, or even meningitis, provide characteristic ultrasound patterns. ⋯ Experience has shown that fevers of unknown origin in the critical care unit often have ultrasound equivalents. Thus, if a comprehensive ultrasound examination is negative, it is now appropriate to speak of fever of unknown sonographic origin.
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Transcranial Doppler has several practical applications in neurocritical care. It has its main application in the diagnosis and monitoring of vasospasm in patients with subarachnoid hemorrhage. ⋯ Its ability to measure CO2 reactivity and autoregulation may ultimately allow intensivists to optimize cerebral perfusion pressure and ventilatory therapy for the individual patient. Transcranial Doppler findings of brain death are well described and can be useful as a screening tool.
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Critical care medicine · May 2007
ReviewUltrasound applications in mass casualties and extreme environments.
A mass-casualty incident is one in which the number of patients with injuries exceeds the available medical resources to care for them in a timely manner. In such a situation, the numerous advantages of ultrasonography make it an ideal triage tool for helping clinicians rapidly screen patients. ⋯ In addition, ultrasound applications have been demonstrated to aid in the diagnosis of various conditions, including pneumothorax, in the International Space Station. Ultrasound's portability, reproducibility, accuracy, and ease of use will make it an important diagnostic instrument for future space missions.