Ultrasound under pressure.
Abstract/OtherAbstract:
Dear
Editor, I enjoyed the review article "Ultrasound in diving and hyperbaric
medicine".1 Gawthrope correctly asserts that ultrasound (US) is an
excellent method to detect pneumothorax, pleural effusion, and adequacy of
vascular filling, and that these skills are easily learnt. He also mentions
more advanced uses of US in the hyperbaric chamber - intravascular bubble
detection and cardiac function. The hyperbaric chamber is a potentially hostile
environment in the sense that some of the usual clinical aids are often
unavailable, and deterioration of the patient may produce a quandary as to
whether the treatment session requires early cessation. I would like to mention
other potential uses suitable for the hyperbaric environment. US accurately
confirms safe placement of endotracheal tubes - the tube can be visualized
within the trachea and bilateral lung sliding shows both main bronchi are being
ventilated.2-4 If there is clinical concern for raised intracranial pressure,
US measurement of optic nerve sheath diameter may provide good guidance as to
the need for urgent CT and/or neurosurgical intervention. A measurement greater
than 5 mm is considered positive for intracranial hypertension.5,6 US can be
very useful to assist in obtaining both peripheral and central venous access in
the unwell patient. If central venous access has been obtained and the patient
deteriorates subsequently, US can be used to exclude pneumothorax, haemothorax
and cardiac tamponade. I believe US is an important tool for use both prior to
hyperbaric treatment and also within the course of hyperbaric treatment for
critically ill patients. Many machines that are relatively inexpensive, easy to
use and robust are available, but not all may be suitable or safe in a
hyperbaric environment, and so each model must be carefully assessed prior to
use.
Authors:
Anthony Dilley
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Publication Detail:
Type: Letter
Journal Detail:
Title: Diving and hyperbaric
medicine : the journal of the South Pacific Underwater Medicine Society
Volume: 42 ISSN: 1833-3516
ISO Abbreviation: Diving Hyperb Med
Publication Date: 2012 Sep
Date Detail:
Created Date: 2012-09-18
Completed Date: - Revised
Date: -
Medline Journal Info:
Nlm Unique ID: 101282742
Medline TA: Diving Hyperb Med Country:
Australia
Other Details:
Languages: eng
Pagination: 182-3 Citation Subset:
IM
Affiliation:
Paediatric
Surgeon, Sydney Children's Hospital E-mail: avdilley@optusnet.com.au.
Ditayangkan
ulang olh dr.Erick Supondha (Hyperbaric&Diving Medicine Consultant) Jakarta
Indonesia, hyperbaric&diving medicine hotline 021 99070050
www.indodivinghealth.com
