A novel systematic ABC approach to Diaphragmatic Evaluation (ABCDE)

Tsui, Jenkin; Tsui, Ban C. H.

doi:10.1007/s12630-015-0566-x

Cited by 31 publications

(23 citation statements)

References 4 publications

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“…from its non-invasive nature, being performed at the bedside of the patient [33] and with no involvement of radiation [22]. In addition, it allows images to be viewed in real time and analyse the muscle independently from the effort of the patient [16,17,23]. Using this technique, the diaphragm can be seen as two hyperechogenic layers corresponding to the peritoneal wall and the pleural wall together with an intermediate hypoechoic line corresponding to the muscle itself [16].…”

Section: Discussionmentioning

confidence: 99%

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Incidence and predictive factors of diaphragmatic dysfunction in acute stroke

2020

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Background: The most characteristic clinical signs of stroke are motor and/or sensory involvement of one side of the body. Respiratory involvement has also been described, which could be related to diaphragmatic dysfunction contralateral to the brain injury. Our objective is to establish the incidence of diaphragmatic dysfunction in ischaemic stroke and analyse the relationship between this and the main prognostic markers. Methods: A prospective study of 60 patients with supratentorial ischaemic stroke in the first 48 h. Demographic and clinical factors were recorded. A diaphragmatic ultrasound was performed for the diagnosis of diaphragmatic dysfunction by means of the thickening fraction, during normal breathing and after forced inspiration. Diaphragmatic dysfunction was considered as a thickening fraction lower than 20%. The appearance of respiratory symptoms, clinical outcomes and mortality were recorded for 6 months. A bivariate and multivariate statistical analysis was designed to relate the incidence of respiratory involvement with the diagnosis of diaphragmatic dysfunction and with the main clinical determinants. Results: An incidence of diaphragmatic dysfunction of 51.7% was observed. 70% (23 cases) of these patients developed symptoms of severe respiratory compromise during follow-up. Independent predictors were diaphragmatic dysfunction in basal respiration (p = 0.026), hemiparesis (p = 0.002) and female sex (p = 0.002). The cutoff point of the thickening fraction with greater sensitivity (75.75%) and specificity (62.9%) was 24% (p = 0.003). Conclusions: There is a high incidence of diaphragmatic dysfunction in patients with supratentorial ischaemic stroke which can be studied by calculating the thickening fraction on ultrasound. Among these patients we have detected a higher incidence of severe respiratory involvement.

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Section: Discussionmentioning

confidence: 99%

“…The ultrasonographic study of the diaphragm has been developed in recent years to evaluate the function of this muscle [21]. This technique provides a non-invasive method, independent of the effort of the patient, and allows images to be viewed in real time [17,22,23].…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictive factors of diaphragmatic dysfunction in acute stroke

2020

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“…U te svrhe lekar koristi ABCDE protokol (Airway, Breathing, Circulation, Disability, Exposure/Examination ABCDE approach) (2,(10)(11)(12). Medicinska stanja koja zahtevaju ovakav tretman moraju da se obrade tokom četiri sata od nastanka povrede, tako da je ovde veoma bitno organizovati brz transport.…”

Section: Trijaža Povređenihunclassified

Physician at sport events: First aid or something more

Rančić¹,

Pilipović²,

Savic³

et al. 2018

Medicinski časopis

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UvodPrema članu 157. stav 2. Zakona o sportu iz 2016, godine, sportska društva su u toku održavanja sportske priredbe dužna da "preduzmu mere kojima se omogućava predupređenje rizika nastanka štete za sportiste, gledaoce i druge učesnike sportske priredbe i treća lica (upozorenja, isticanje zabrana, davanje obaveštenja i uputstava i sl.), kao i mere kojima se na povećane rizike utiče (bezbednost sportskog objekta, ispravnost i adekvatnost instalirane i druge opreme, obezbeđenje hitne medicinske pomoći, odvijanje manifestacije u skladu sa propozicijama i dr.)" (1). Na osnovu ove zakonske odredbe tokom održavanja sportskih manifestacija organizatori su dužni da omoguće bezbedno odvijanje takmičenja, ali i da u slučaju nastanka bilo kakve povrede učesnika, i gledaoca i članova stručnih štabova omogući njihovo bezbedno i adekvatno zbrinjavanje. Da bi tako nešto bilo moguće, neophodno je da tokom sportskog takmičenja, a nekada i na masovnim treninzima, bude prisutan lekar koji ima iskustva u zbrinjavanju tih vrsta povreda.Klupski lekari su veoma značajni ne samo kada se odlučuje da li neko može ili ne može da učestvuje na sportskom takmičenju, nego i kada se sportsko nadmetanje odvija, kada lekar koga angažuju sportska društava i organizator takmičenja.Zbog želje i potrebe da se nadmaše drugi, što je suština sportskih takmučenja, postoji povećan rizik od povređivanja takmičara, kojima treba obezbediti najviši standard medicinske nege (2). To su razlozi za angažovanje lekara na sportskim manifestacijama i isticanje njihove značajne uloge u adekvatnom funkcionisanju manifestacije. Osim pružanja adekvatne medicinske pomoći nakon nastanka povrede ili poremećaja, sportski lekar ima ulogu i u edukaciji i davanju saveta o adekvatnim pripremama za takmičenje, ishrani sportista, upućivanju na preventivne specijalističke preglede, kao i u prepoznavanju mogućeg dopingovanja sportiste i drugo.Sportske povrede su po mnogim karakteristikama specifične, u odnosu na isti tip poremećaja u opštoj populaciji. Još 2011. godine pokazano je da se sportske povrede značajno razlikuju od nesportskih poremećaja iste etiopatogeneze, i to na primeru potresa mozga (3). Zbog toga je bitno imati iskustva, adekvatnu edukaciju, sposobnost i veštinu u radu sa sportskim povredama. Takođe je bitno obratiti pažnju i na razlike u povređivanju u odnosu na pol i starost (4), odnosno u odnosu na vrstu sporta, jer svaki sport ima svoje specifičnosti zbog većeg angažovanja određene grupe mišića i delova koštano-zglobnog sistema usled repetitivnog ponavljanja određenog pokreta (5-8).

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“…This mnemonic method simply uses step-by-step landmarking of readily recognizable features such as lung sliding, to facilitate the identifying diaphragmatic muscle and reach typical scanning site. 22 Although the use of intercostal windows has been well described and avoids the challenges associated with utilizing the hepatic or splenic acoustic window methods (such as poor reproduction and dependence on operator experience), it is important to point out that there are no published data or evidence comparing the effectiveness of the 2 approaches. 23 Thus, further well-designed clinical studies will be needed to determine the superiority and clinical merit of these techniques.…”

Section: Lus To Evaluate For Diaphragmatic Paresismentioning

confidence: 99%

Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist

Haskins

Tsui

Nejim

et al. 2017

Regional Anesthesia and Pain Medicine

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In this article, we discuss the emerging role of lung point-of-care ultrasonography for regional anesthesiologists and pain management specialists. Lung ultrasonography is a well-established clinical tool that is used on a routine basis in emergency rooms and critical care units internationally to evaluate patients with respiratory distress; however, its benefits to the regional anesthesiologist and pain specialist are not as well known and are practiced less frequently. This review article covers the clinical evidence in support of lung point-of-care ultrasonography as a rapid and superior tool to traditional imaging modalities such as chest radiography and fluoroscopy. As anesthesiologists routinely perform nerve blocks that put patients at potential risk of complications such as pneumothorax or diaphragmatic paresis, it is important to understand how to use lung ultrasonography to evaluate for these conditions, as well as to differentiate between other potential causes of respiratory distress, such as interstitial syndrome and pleural effusions. This article describes the normal and pathological findings that can be used to quickly and confidently evaluate a patient for these conditions.

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A novel systematic ABC approach to Diaphragmatic Evaluation (ABCDE)

Cited by 31 publications

References 4 publications

Incidence and predictive factors of diaphragmatic dysfunction in acute stroke

Incidence and predictive factors of diaphragmatic dysfunction in acute stroke

Physician at sport events: First aid or something more

Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist

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