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急診超音波次專長教學計劃

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林口急診醫學科 邱德發. 急診超音波次專長教學計劃. 急診超音波 是 機會 是世界潮流趨勢 彰顯急診醫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 具移動性 可同時急救 無輻射暴露 可協助穿刺. 急診超音波的應用. 以病史與理學檢查形成臆斷 (impression) 然後用急診超音波來回答 yes or no.

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急診超音波是機會是世界潮流趨勢彰顯急診醫師診斷處置能力的利器急診超音波是機會是世界潮流趨勢彰顯急診醫師診斷處置能力的利器

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大綱
  • 為什麼要有急診超音波
  • 我們的目標
  • 教學規劃
  • 研究方向
  • 評估方式
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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
    • 具移動性
    • 可同時急救
    • 無輻射暴露
    • 可協助穿刺
slide5
急診超音波的應用
  • 以病史與理學檢查形成臆斷 (impression)
  • 然後用急診超音波來回答 yes or no
rush protocol r apid u ltrasound in sh ock
RUSH protocol:Rapid Ultrasound in SHock
  • Step 1:Evaluation of the Pump
  • Step 2: Evaluation of the Tank
  • Step 3:Evaluation of the Pipes
slide15
我們的目標
  • 短程: 厚植實力、建立教學檔案
  • 中程: 提升急診醫師診斷之正確性、急診超音波報告系統
  • 長程: 急診醫師執行超音檢查縮短病程、改善照護品質
slide16
教學規劃
  • 種子教師
  • 急診醫學會指導員訓練課程
  • 急診醫學會分散式訓練
  • 急診醫學會訓練課程
  • 教學班
  • 次專長訓練
patient care
病人照顧 (Patient 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的監測
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從工作中學習與成長

品質改善的力量

持續不斷的學習,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學
  • 應用研究設計及統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、取得網路上與超音波相關醫學資訊
  • 協助住院醫師超音波相關教學
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與國際接軌
  • 參加WINFOCUS會議與workshop
  • 發表研究成果於SAEM、ACEP research forum、ICEM
slide21
超音波訓練師資

外院師資

陳國智、連婉菁、孫仁堂

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訓練場所
  • 治療區
  • 觀察區
  • MICU2
  • 臨床技能中心
  • 院內其他專科超音波室
  • 台大急診超音波室與健檢中心 (由亞東醫院孫仁堂醫師協助)
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課程
  • 急診醫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
  • 國外workshop
diagnostic accuracy
研究--Diagnostic accuracy
  • Sensitivity, specificity, positive and negative predictive values
    • Cardiac, to rule out effusion,AAA
      • Fluid evaluation: IVC
    • Pneumothorax
    • Cholelithiasis
    • Free peritoneal fluid
    • Hydronephrosis
    • Intrauterine pregnancy, gestational age
    • DVT, soft tissue infections
education
研究--Education
  • Survey of training program
    • endorsed the use of emergency US in ED
    • at least some emergency US training
    • structured emergency US rotation
  • Dedicated ED US rotation improves residents’ US knowledge and interpretation skills
education1
研究--Education
  • Feasibility of a focused ultrasound training programme for UGY or PGY students
    • didactic instruction
    • short bedside practical workshop
    • self-directed learning
    • assessed by structured viva and OSCE
education2
研究--Education
  • Integration of ultrasound in the education program in anatomy
  • Teaching musculoskeletal ultrasound in the undergraduate medical curriculum
us aid in procedure
研究--US aid in procedure
  • Intubation (TRUE)
  • CVC catheterization
  • Antecubital intravenous cannulation
  • Ultrasound-guided fascia iliaca compartment block for hip fractures
us aid in management
研究--US aid in management
  • Accuracy and outcome of EUS for AAA
  • Decreasing length of stay with EUS examination of the gallbladder
  • The role of EUS for evaluating APN in the ED
  • Variable access to immediate bedside US in ED
us aid in management1
研究--US aid in management
  • Shock– RUSH protocol
  • Dyspnea – BLUE protocol
  • Lung US in the ICU: from diagnostic instrument to respiratory monitoring tool
  • Fournier\'s gangrene
  • Assessing Central Venous Pressure
  • Drainage of abscess
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現有研究主題

Volume status and preload responsiveness assessment

1.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

lung ultrasound a new tool for the cardiologist cardiovascular ultrasound 2011 9 6
? ultrasound:

a new tool for the EP

Lung ultrasound: a new tool for the cardiologistCardiovascular Ultrasound 2011 9:6
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定期評估
  • 每半年由三位主治醫師,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
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