Getting images of muscle, nerve and vascular by ultrasound, not only clear, buy also radiation-free,

Dispel the concerns of patients and doctors about health hazards. Therefore, the mastery of ultrasound technology is likely to be an essential skill for future physicians.Since 2015, application of wireless portable ultrasound equipment in my usual clinical work, teaching and primary consultation (anesthesia and pain diagnosis and treatment). Realize that wireless portable ultrasound equipment may be the same as the stethoscope is the essential professional instrument for doctor , and also deeply understand the importance of professional portable devices for accurate treatment.

First time of Show

The first application of wireless portable ultrasound with a case of Zhejiang Haining work that patients with renal failure need to be placed peritoneal dialysis tube. This procedure is performed by the nephrologist, mainly puncture peritoneal tube through the peritoneal stoma, the muscle layers of the abdominal wall until peritoneum, into the abdominal cavity. Because of such patients with renal failure, recovery of general anesthesia slow metabolism, spinal anesthesia risk is also scruples. The traditional method of anesthesia is infiltrated by the operating physician layer by layer, often moaning in patients with pain during operation. I think the most appropriate choice should be the use of ultrasound to guide the precise injection of local anesthetics into the indwelling catheter side of the abdominal transverse abdominal fascia surface should be able to accurately block the corresponding abdominal sensory nerve. Just a wireless ultrasound probe in the backpack, as cell phone size, easy to see under the ultrasound transverse fascia, 0.375% ropivacaine 15 ml precise injection into the abdominal oblique and transverse abdominal muscle between the exact block The patient's abdominal pain, the patient calmly accepted the operation, and the analgesic effect lasted until one night after surgery.  To become the first case of Haining region under the complete block of painless peritoneal dialysis indwelling patients. This technique has since become the standard method of anesthesia for this type of surgery in this hospital.

Image 1 Abdominal wall sensory nerve distribution in the transverse fascia surface, the use of portable ultrasound can easily local anesthetic injection in the transverse fascia surface, that is, TAP (transversus abdominis plane block) nerve block, for patients with renal failure via the abdominal wall indwelling abdominal Through the catheter is more appropriate anesthesia program.

Clinical teaching application

As a teacher in a large teaching hospital, the most puzzling question I encountered in teaching was how to ensure the safety of patients and practice inpatient training at the same time. Using portable ultrasound can solve this problem. For example, before having a student take a jugular vein puncture, first ask the student to indicate his or her puncture point and puncture direction, then take the portable ultrasonography to test after marking. Several cases were found to student mark located the direction is internal carotid artery, we promptly correct the operation of students to avoid the patient's injury. The corresponding method is gradually applied to the teaching of puncture operation such as arterial puncture, spinal anesthesia and cricothyroid membrane puncture, which has ensured the safety of patients when hands-on operation by students. The safety of clinical teaching and the success rate of teaching increased.

Image 2  Intern’s operation, wireless ultrasound probe to ensure patient safety

Application of pain diagnosis and treatment

In the past pain treatment did not emphasize the application of ultrasound, mainly in the location of anatomical landmarks blindly inject the drug into the possible area, the effect will be greatly reduced. As the portable ultrasound portable, compact, can be used in the pain clinic treatment room, greatly improving the accuracy of diagnosis and treatment. When suspected patients with a layer of muscle inflammation, carpal tunnel syndrome, compression of the median nerve or face radicular disease and frozen shoulder caused by shoulder pain symptoms difficult to identify. Directly in the clinic can accurately inject a small amount of anti-inflammatory drugs to the suspected inflammatory pain points, the patient's symptoms are improved and the corresponding complaint can provide the basis for diagnosis and treatment.

Image3 Patients with carpal tunnel syndrome under the guidance of portable ultrasound release the oppressive median nerve, finger numbness symptoms gradually eased.

Image 4 Low back pain patients, history of lumbar disc disease, but suspected this low back pain is caused by sacroiliac arthritis, directly use wireless ultrasound-guided diagnostic treatment in clinic, the patient's symptoms quickly relieved, ruled out herniation caused by disc herniation, a clear treatment direction .

In short, with the progress and further popularization of wireless portable ultrasound technology, it is believed that every anesthetist, pain physician and even all clinicians will carry a wireless portable ultrasound as a stethoscope. Ultrasound technology is essential for every professional clinician and can begin accurate diagnosis and treatment at the patient's bedside at the first time. It is recommended that young doctors now have to master the ultrasound technology, in the future clinical work will certainly take a lot less detours, growing more rapidly.

【About the Author】

Ma Yu, graduated from the Second Military Medical University, MD, Changhai Hospital, Second Military Medical University anesthesiology and pain associate chief physician, associate professor, concurrently Haining branch of Haining City, Zhejiang Province Haining Branch anesthesia pain director. Good at neck and lumbar pain management, critically ill patients with anesthesia and perioperative management, cardiovascular interventional anesthesia, difficult airway management.