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General ultrasound In the critically ill - part 9

Các tĩnh mạch cổ đã được nghiên cứu trong Chap. 12. Động mạch thăm dò động mạch cảnh có thể hữu ích trong một bệnh nhân hôn mê. Một bóc tách chấn thương sẽ được tìm kiếm, mặc dù Doppler là kỹ thuật thông thường. | The Neck 155 The Neck The neck veins were studied in Chap. 12. Carotid artery exploration can be useful in a comatose patient. A traumatic dissection will be sought although the Doppler is the usual technique. Does the two-dimensional approach not give already basic information in some or a majority of cases This could make the Doppler information redundant in first-line analysis in these cases. Another application of a two-dimensional scanning can be the evaluation of vascular injury by screening for calcifications at the carotid arteries a marker of the arterial system. A retropharyngeal abscess can be sought 10 . In this area traumatic hematomas other abscesses or cervicofacial cellulitis can be documented. However CT is preferred here. The trachea is perfectly detectable at the cervical level anterior and median with posterior air artifacts. Applying pressure that is more than very light can be very unpleasant in moderately sedated patients. The trachea is quickly lost since it takes a posterior direction when entering the thorax. Via the anterior or lateral approach one can study its external configuration Fig. 21.8 . Its anteroposterior and lateral diameters can be measured at inspiration and expiration. Tracheomalacia may be detected this way. Since the tracheal wall is fibrocartilaginous nothing prevents the ultrasound analysis of the tracheal content the ultrasound beam encounters the wall then the air which stops beam progression. If the anterior wall is thickened by a granuloma or other causes of tracheal stenosis or obstruction this obstacle will be accurately detected and analyzed. Within the lumen itself secretions accumulated above an inflated balloon can be detected Fig. 21.9 . This finding may have clinical outcome. Of course fibroscopy will remain the reference test for tracheal disorders but the principle remains the same give the patient a first noninvasive rapid approach that can alter the usual management depending on the operator s skill. .