Ebook Basic transesophageal and critical care ultrasound: Part 2
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Ebook Basic transesophageal and critical care ultrasound: Part 2
PART nChapter 13Critical Care Ultrasound Examination of the Nervous SystemAndrea Rigamonti, Robert Chen, Ramamani Mariappan and Celine OdierINTRODUCTI Ebook Basic transesophageal and critical care ultrasound: Part 2IONMonitoring cardiovascular and respiratory function is an important aspect of patient management in the intensive care unit (ICU) and operating room. Cardiovascular and pulmonary functions are continuously monitored during anesthesia and in critical care, but the monitoring of cerebrovascular func Ebook Basic transesophageal and critical care ultrasound: Part 2tion is not routinely performed. With the availability of non-invasive monitors like transeranial Doppler (TCD). quantitative elecfroencephalographicEbook Basic transesophageal and critical care ultrasound: Part 2
monitoring and near-infrared spectroscopy, continuous monitoring of cerebrovascular function is possible. Patient care can be enhanced when the informPART nChapter 13Critical Care Ultrasound Examination of the Nervous SystemAndrea Rigamonti, Robert Chen, Ramamani Mariappan and Celine OdierINTRODUCTI Ebook Basic transesophageal and critical care ultrasound: Part 2s system including TCD. US of the optic nerve, and direct visualization of the brain using 2D echography will be presented.TRANSCRANIAL DOPPLER ULTRASOUNDTranscranial Doppler US is a simple, non-invasive, relatively cheap bedside tool that can provide real-time dynamic information regarding cerebral Ebook Basic transesophageal and critical care ultrasound: Part 2 blood flow velocity in the basal cerebral blood vessels. Since the first clinical application in 1982, 1 the use of TCD has expanded rapidly over theEbook Basic transesophageal and critical care ultrasound: Part 2
past two decades. The portability and non-invasive nature of TCD allows both monitoring during emergencies and serial monitoring in the ICU. The clinPART nChapter 13Critical Care Ultrasound Examination of the Nervous SystemAndrea Rigamonti, Robert Chen, Ramamani Mariappan and Celine OdierINTRODUCTI Ebook Basic transesophageal and critical care ultrasound: Part 2ing rooms, emergency departments, and even in outpatient settings to assess the hemodynamic changes associated with stenosis of large cerebral arteries or todetermine patients at risk of stroke with sickle cell disease. For the experienced vascular neurologist, neuro-intensivist, and neuro-anesthesi Ebook Basic transesophageal and critical care ultrasound: Part 2ologist, the small portable TCD device serves as a “stethoscope lor the brain2Table 13.1 Applications of Transcranial DopplerSettingRoleNeuro-critkalEbook Basic transesophageal and critical care ultrasound: Part 2
careCerebral vasospasm monitoring to assess progression and the treatment effect (angioplasty or medical treatment) after subarachnoid hemorrhage MoniPART nChapter 13Critical Care Ultrasound Examination of the Nervous SystemAndrea Rigamonti, Robert Chen, Ramamani Mariappan and Celine OdierINTRODUCTI Ebook Basic transesophageal and critical care ultrasound: Part 2sessment uf (he degree uf hypercinid dflci di tetiuvenuus Iiidlfotnwbuti reseclion. Cdiulid enddi leieuuniy (CEA), carotid angioplasty and stenting (CAS) and in patients with malignant hypertension and fulminant hepatic failure Diagnosis of cerebral circulatory attest and ancillary brain death confi Ebook Basic transesophageal and critical care ultrasound: Part 2rmationStroke unitDiagnosis of acute Ischemic stroke To enhance dot resolution in acute ischemic stroke and to assess the arterial patency after thromEbook Basic transesophageal and critical care ultrasound: Part 2
bolytic treatment Diagnosis of hyperemia after conversion of acute ischemic to hemorrhagic strokeOperating roomFor emboli detection during CEA CAS. anPART nChapter 13Critical Care Ultrasound Examination of the Nervous SystemAndrea Rigamonti, Robert Chen, Ramamani Mariappan and Celine OdierINTRODUCTI Ebook Basic transesophageal and critical care ultrasound: Part 2ommon and internal carotid)VariousAssessment of cerebral auto-regulation and cerebrovascular carbon dioxide reactivityDiagnosis of intracranial carotid or basilar arteries stenosisFor guiding the chronic red cell transfusion therapy in patients with sickle cell disease who arc at risk of developing Ebook Basic transesophageal and critical care ultrasound: Part 2strokeDetection of patent foramen ovaleBASIC PRINCIPLES OF TRANSCRANIAL DOPPLER■flic TCD probe works only using Doppler signals and does not acquire 2Ebook Basic transesophageal and critical care ultrasound: Part 2
D imaging.It emits a range gated, pulsed-wave Doppler US beam at a low (2 Mllz) frequency. The US beam penetrates the skull al areas called “acoustic PART nChapter 13Critical Care Ultrasound Examination of the Nervous SystemAndrea Rigamonti, Robert Chen, Ramamani Mariappan and Celine OdierINTRODUCTI Ebook Basic transesophageal and critical care ultrasound: Part 2in frequency between the transmitted and received sound waves is called the “Doppler frequency shill” (Fd) or “Doppler effect”. The reflected waves are received by the Doppler probe and transformed into an electrical signal. The computer performs a last Fourier analysis to transform this electric si Ebook Basic transesophageal and critical care ultrasound: Part 2gnal into a moving graphic display with the time on the x-axis and the blood flow velocity on the y-axis (see Chapter 2, Patient Safety’ and Imaging AEbook Basic transesophageal and critical care ultrasound: Part 2
rtifacts). Apart from insonation angle, other factors such as the vessel diameter, licmatocrit, arterial carbon dioxide tension (PaCO;). blood pressurPART nChapter 13Critical Care Ultrasound Examination of the Nervous SystemAndrea Rigamonti, Robert Chen, Ramamani Mariappan and Celine OdierINTRODUCTI Ebook Basic transesophageal and critical care ultrasound: Part 2actors such as age. gender, pregnancy, and sleep-awakepattern can also affect the CBFV. These should all be kept in mind while interpreting the CBFV in various clinical situations.5Fig. 13.1 Transcranãl Doppler devices, specialized transcramal Doppler monitoring devices are shown: (A) ST3 (Spencer T Ebook Basic transesophageal and critical care ultrasound: Part 2echnology. Seattle WA) and (B) Sonara (Natus Medical San Carlos. C'A. USA)Fig. 13.2 Power motion (M)-mode Doppler Diagram shows Ditenogation of cerebrEbook Basic transesophageal and critical care ultrasound: Part 2
al vessels with power M-mode or combined color Doppler and M-mode transcramal Dopplei (TCD). The ultrasound probe IS positioned over the left temporalPART nChapter 13Critical Care Ultrasound Examination of the Nervous SystemAndrea Rigamonti, Robert Chen, Ramamani Mariappan and Celine OdierINTRODUCTI Ebook Basic transesophageal and critical care ultrasound: Part 2ue portion rs associated with the ipsilateral left antenor cerebral artery (LACA) Doppler signal moving away from tire transducer. The lower red portion corresponds to flow in the contralateral right anterior cerebral artery' (RAC A)DEVELOPMENTS IN TRANSCRANIAL DOPPLER TECHNOLOGYThere are several me Ebook Basic transesophageal and critical care ultrasound: Part 2asurements in TCD using either specialized equipment (Figure 13.1 ) or the basic transthoracic probe. These modalities include:•Continuous and pulsedEbook Basic transesophageal and critical care ultrasound: Part 2
wave technique, which are described in Chapter 1, Ulttasound Imaging: Acquisition and Optimization.•Power motion-mode Doppler (PMD/TCD): Moehring and PART nChapter 13Critical Care Ultrasound Examination of the Nervous SystemAndrea Rigamonti, Robert Chen, Ramamani Mariappan and Celine OdierINTRODUCTI Ebook Basic transesophageal and critical care ultrasound: Part 2tracranial space simultaneously in a single spectral display (Figure 13.2). Time spent for TCD examination is reduced compared to a single channel specfral TCD. This mode simplifies the TCD examination for the inexperienced operator.• Transcranial color-coded duplex sonography (TCCS): This mode comb Ebook Basic transesophageal and critical care ultrasound: Part 2ines pulsed-wave Doppler with two-dimensional, real-time B-mode imaging (Figure 13.3). Transcranial color-coded duplex sonography allows the visualizaEbook Basic transesophageal and critical care ultrasound: Part 2
tion of all basal cerebral arteries through the intact skull and allows precise placement of the Doppler sample volume in the vessel. Transcranial colPART nChapter 13Critical Care Ultrasound Examination of the Nervous SystemAndrea Rigamonti, Robert Chen, Ramamani Mariappan and Celine OdierINTRODUCTI Ebook Basic transesophageal and critical care ultrasound: Part 2rteries, other than middle cerebral artery (MCA) or in the setting of anatomical distortions from tumor, hematoma, and edema displacing normal structures. 4 - 6Fig. 13.3 Traiiscratual Doppler coku-coded duplex sonography (TCCS). The middle cerebral artery (MCA) ISinterrogated using a transthoracic p Ebook Basic transesophageal and critical care ultrasound: Part 2robe positioned over the right temporal region. (A) A 2D Ullage of cerebral artery structure and color Doppler (Nyquist 36 cm's) flow interrogation isEbook Basic transesophageal and critical care ultrasound: Part 2
obtamed (B) Sample volume positioning 11 the vessel allows precise determination of the MCA velocity spectral Doppler profile (C) In tins patient, haPART nChapter 13Critical Care Ultrasound Examination of the Nervous SystemAndrea Rigamonti, Robert Chen, Ramamani Mariappan and Celine OdierINTRODUCTI Ebook Basic transesophageal and critical care ultrasound: Part 2m tlie transducer HR. heart rate flBJA: https. youttL be ds-a GdiixiiN IPART nChapter 13Critical Care Ultrasound Examination of the Nervous SystemAndrea Rigamonti, Robert Chen, Ramamani Mariappan and Celine OdierINTRODUCTIGọi ngay
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