Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Sep 2009
Historical ArticleTraining guidelines for ultrasound: worldwide trends.
Sound travels through objects that block light. Only very recently has technology advanced enough to decipher ultrasound for medical use. Machines have become smaller, cheaper, more versatile and more advanced than ever before. ⋯ There also needs to be an understanding of when broad experience and advanced technical skills are required or when limited skills will do. In addition, some procedures can be performed more safely with ultrasound where the knowledge of ultrasound is not paramount. This article covers current provision of training in echocardiography and ultrasound in areas relevant to anaesthetists who are working in critical care (including accident and emergency) and complex surgery (mainly cardiac).
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The haemodynamic state refers to the integration of myocardial and vascular systems, and involves both left and right hearts, and systolic and diastolic phases. The assessment of the haemodynamic state can be performed with echocardiography, and provides a higher level of diagnosis than conventional pressure- and flow-based monitoring. Whilst hypotension alerts the practitioner about the existence of haemodynamic abnormality, it does not provide sufficient information to identify the cause or the underlying haemodynamic state. ⋯ Patients may have an abnormal haemodynamic state (such a systolic failure), but may not need active treatment if they are haemodynamically stable. However, if treatment is required, it can be directed according to the underlying haemodynamic state. For example, a patient with systolic failure may benefit from inotrope support, whereas an empty state acquires volume infusion and vasodilation requires vasopressor support.