急診超聲波的推行與訓(xùn)練

1、急診超音波次專長教學(xué)計(jì)劃,林口急診醫(yī)學(xué)科邱德發(fā),急診超音波是機(jī)會(huì)是世界潮流趨勢(shì)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(biāo)教學(xué)規(guī)劃研究方向評(píng)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(dǎo)向與point-of –care超音波的特性隨時(shí)可做非侵入性即時(shí)動(dòng)態(tài)具移動(dòng)性可同時(shí)急救無輻射暴露可協(xié)助穿刺,急診超音波的應(yīng)用,以病史與理學(xué)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(shí)應(yīng)用 FASTFocused assessment with sonography in trauma,Sample clinical protocol,腹主動(dòng)脈瘤(AAA),水腎(Hydronephrosis),急救時(shí)應(yīng)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(biāo),短程: 厚植實(shí)力、建立教學(xué)檔案中程: 提升急診醫(yī)師診斷之正確性、急診超音波報(bào)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(hù)品質(zhì),教學(xué)規(guī)劃,種子教師急診醫(yī)學(xué)會(huì)指導(dǎo)員訓(xùn)練課程急診醫(yī)學(xué)會(huì)分散式訓(xùn)練急診醫(yī)學(xué)會(huì)訓(xùn)練課程教學(xué)班次專長訓(xùn)練,病人照顧 (Pat

4、ient care),以超音波做鑑別診斷，補(bǔ)臨床病史理學(xué)不足之處利用超音波對(duì)病患照顧做出動(dòng)態(tài)的監(jiān)測(cè),從工作中學(xué)習(xí)與成長,品質(zhì)改善的力量持續(xù)不斷的學(xué)習(xí)，強(qiáng)化自我反省的能力及終身學(xué)習(xí)的概念,學(xué)習(xí)與超音波相關(guān)的實(shí)證醫(yī)學(xué)應(yīng)用研究設(shè)計(jì)及統(tǒng)計(jì)方法來評(píng)讀與超音波相關(guān)臨床研究 (fellowship/journal club)使用資訊科技進(jìn)行資訊管理、取得網(wǎng)路上與超音波相關(guān)醫(yī)學(xué)資訊協(xié)助住院醫(yī)師超音波相關(guān)教學(xué),與國際接軌,參加WINFOCUS會(huì)

5、議與workshop發(fā)表研究成果於SAEM、ACEP research forum、ICEM,超音波訓(xùn)練師資,外院師資陳國智、連婉菁、孫仁堂,訓(xùn)練場(chǎng)所,治療區(qū)觀察區(qū)MICU2臨床技能中心院內(nèi)其他?？瞥舨ㄊ遗_(tái)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(xué)會(huì)初階與進(jìn)階超音課程每周超音波教學(xué)每月Textbook reading、journal club每月邀請(qǐng)?jiān)和獬舨▽＜疫M(jìn)行演講與臨床操作指導(dǎo)

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(píng)估,每半年由三位主治醫(yī)師，各選取三位急診或加護(hù)病房病患，進(jìn)行操作超音波實(shí)作與診斷能力評(píng)估每月研究進(jìn)度及影像教案收集狀況報(bào)告教學(xué)檔案整理,Welcome to join our ultrasound fellowship trai