急診超聲波的推行與訓練

1、急診超音波次專長教學計劃,林口急診醫(yī)學科邱德發(fā),急診超音波是機會是世界潮流趨勢彰顯急診醫(yī)師診斷處置能力的利器,大綱,為什麼要有急診超音波我們的目標教學規(guī)劃研究方向評估方式,為什麼要有急診超音波,超音波科無法 7-24 支援急診為問題導向與point-of –care超音波的特性隨時可做非侵入性即時動態(tài)具移動性可同時急救無輻射暴露可協(xié)助穿刺,急診超音波的應用,以病史與理學檢查形成臆斷 (impres

2、sion)然後用急診超音波來回答 yes or no,外傷時應用 FASTFocused assessment with sonography in trauma,Sample clinical protocol,腹主動脈瘤(AAA),水腎(Hydronephrosis),急救時應用(Cardiac Arrest),RUSH protocol:Rapid Ultrasound in SHock,Step 1: Evaluati

3、on of the PumpStep 2: Evaluation of the TankStep 3: Evaluation of the Pipes,我們的目標,短程: 厚植實力、建立教學檔案中程: 提升急診醫(yī)師診斷之正確性、急診超音波報告系統(tǒng) 長程: 急診醫(yī)師執(zhí)行超音檢查縮短病程、改善照護品質,教學規(guī)劃,種子教師急診醫(yī)學會指導員訓練課程急診醫(yī)學會分散式訓練急診醫(yī)學會訓練課程教學班次專長訓練,病人照顧 (Pat

4、ient care),以超音波做鑑別診斷，補臨床病史理學不足之處利用超音波對病患照顧做出動態(tài)的監(jiān)測,從工作中學習與成長,品質改善的力量持續(xù)不斷的學習，強化自我反省的能力及終身學習的概念,學習與超音波相關的實證醫(yī)學應用研究設計及統(tǒng)計方法來評讀與超音波相關臨床研究 (fellowship/journal club)使用資訊科技進行資訊管理、取得網(wǎng)路上與超音波相關醫(yī)學資訊協(xié)助住院醫(yī)師超音波相關教學,與國際接軌,參加WINFOCUS會

5、議與workshop發(fā)表研究成果於SAEM、ACEP research forum、ICEM,超音波訓練師資,外院師資陳國智、連婉菁、孫仁堂,訓練場所,治療區(qū)觀察區(qū)MICU2臨床技能中心院內其他?？瞥舨ㄊ遗_大急診超音波室與健檢中心 (由亞東醫(yī)院孫仁堂醫(yī)師協(xié)助),課程,急診醫(yī)學會初階與進階超音課程每周超音波教學每月Textbook reading、journal club每月邀請院外超音波專家進行演講與臨床操作指導

6、國外workshop,研究--Diagnostic accuracy,Sensitivity, specificity, positive and negative predictive valuesCardiac, to rule out effusion, AAAFluid evaluation: IVCPneumothoraxCholelithiasisFree peritoneal fluidHydronephros

7、isIntrauterine pregnancy, gestational ageDVT, soft tissue infections,研究--Education,Survey of training programendorsed the use of emergency US in EDat least some emergency US trainingstructured emergency US rotation

8、Dedicated ED US rotation improves residents’ US knowledge and interpretation skills,研究--Education,Feasibility of a focused ultrasound training programme for UGY or PGY studentsdidactic instructionshort bedside practic

9、al workshopself-directed learningassessed by structured viva and OSCE,研究--Education,Integration of ultrasound in the education program in anatomyTeaching musculoskeletal ultrasound in the undergraduate medical curricu

10、lum,研究--US aid in procedure,Intubation (TRUE)CVC catheterizationAntecubital intravenous cannulationUltrasound-guided fascia iliaca compartment block for hip fractures,研究--US aid in management,Accuracy and outcome of E

11、US for AAADecreasing length of stay with EUS examination of the gallbladderThe role of EUS for evaluating APN in the EDVariable access to immediate bedside US in ED,研究--US aid in management,Shock– RUSH protocolDyspn

12、ea – BLUE protocolLung US in the ICU: from diagnostic instrument to respiratory monitoring toolFournier's gangreneAssessing Central Venous PressureDrainage of abscess,Volume status and preload responsiveness asse

13、ssment1.IVC diameter2.IVC collapsibility index3.LV end diastolic area4.LVOT VTI variation with respiration5.Peripheral artery Vmax variation6.LVOT VTI variation with passive leg raise,現(xiàn)有研究主題,? ultrasound: a new

14、tool for the EP,Lung ultrasound: a new tool for the cardiologistCardiovascular Ultrasound 2011 9:6,定期評估,每半年由三位主治醫(yī)師，各選取三位急診或加護病房病患，進行操作超音波實作與診斷能力評估每月研究進度及影像教案收集狀況報告教學檔案整理,Welcome to join our ultrasound fellowship trai