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Ultrasound under pressure.
MedLine Citation:
PMID:  22987464     Owner:  NLM     Status:  In-Data-Review    
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.
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