Now universal distribution of ultrasonic diagnostic methods and maintenance of manipulations in anesthesiology and an intensive care is noted. In many intensive care units there are portable ultrasonic scanners which in many situations can help with delivery of health care to the patient considerably. Besides, there is a change of some classical techniques of ultrasonic diagnostics to their adaptation under practical workers of health care, step-by-step algorithms of diagnostics in this or that situation are developed.
In an intensive care ultrasonic diagnostics possesses a significant role as this method allows to carry out quickly diagnostic search and to receive data on a condition of an organism, important for the doctor. For example, fast performing ultrasonography by the portable scanner can borrow much less time, than the organization and carrying out X-ray inspection.
Special protocols for urgent ultrasonic diagnostics, such as FAST protocol (urgent ultrasonic inspection are drafted at a trauma) or the BLUE protocol (assessment of a condition of easy and pleural cavities). They allow is systematized and to quickly make assessment of a condition of the patient and can directly be carried out in the accident ward or in intensive care unit.
At ultrasonography in an intensive care it is important to make assessment of an abdominal cavity (liquid search, a bladder degree of admission, diameter of the lower vena cava), a thorax (search of liquid and air in pleural cavities, assessment of a condition of lungs) and hearts (search of liquid in pericardium cavities, assessment of a condition of the valve device of heart).
By search of free liquid in an abdominal cavity the sensitivity of ultrasonography is rather high. The place of a congestion of peritoneal liquid depends on position of a body of the patient and an etiology of a disease. In a prone position at a sonografiya it is the easiest to define peritoneal liquid in a pelvic cavity or in Morrison's pocket. Besides, the splenorenalny pocket is investigated.
Together with search of liquid at a research of an abdominal cavity carry out also assessment of a degree of admission of a bladder and also a research of diameter of the lower vena cava. The last allows to estimate the volemichesky status of the patient in a certain measure.
At a thorax research the doctor is faced by a problem of search of liquid and air in a pleural cavity and also assessment of a condition of lungs. Assessment of existence of an exudate in pleural cavities can be made already at a research of an abdominal cavity as pleural cavities are visible at survey of anatomical structures of its top floor (a liver, spleens, Morrison's pocket and a splenorenalny pocket). Besides, there is an opportunity to calculate quantity of a pleural exudate by a special formula. Ultrasonography represents very sensitive method in assessment of a pleural exudate and by means of ultrasound it is possible to find even insignificant amounts of liquid in position of the patient on spin, unlike a X-ray analysis. By search of air in a pleural cavity ultrasonography is also more sensitive in comparison with a X-ray analysis and is capable to find even a small amount of air in position of the patient on spin.
At assessment of a condition of lungs pay attention to existence of ultrasonic artifacts and also to structure of a pulmonary parenchyma. At attentive carrying out a research, ultrasonography allows to diagnose such pathology as the fluid lungs and states which are followed by consolidation of pulmonary fabric, for example, of pneumonia.
Ultrasound examination of heart in urgent medicine pursues the aim of search of liquid in cavities of a pericardium and evaluation of the work of the valve device of heart. Timely detection of liquid in a cavity of a pericardium is vital if there is a speech about suspicion on a cardiac tamponade. Assessment of contractility of heart allows to estimate its work in general and also to reveal sites of a hypokinesia or an akineziya. Evaluation of the work of the valve device allows to estimate an intracardial hemodynamics and in compliance to these to make treatment correction if necessary. There is a separate protocol for carrying out an echocardiography in the conditions of the operating room, intensive care unit and resuscitation or reception.
In addition to everything listed, ultrasonic the research can be used when evaluating the upper airways, assessment of a degree of admission of a stomach and also for maintenance of various medical manipulations in intensive care units and an intensive care.