p.2 抽出テキスト

−2−

目次目次........................................................................................................................ 2略語一覧............................................................................................................. 3 1.はじめに..................................................................................................... 3 2.FoCUS の位置づけ............................................................................. 4

2.1 FoCUS の位置づけ................................................................... 4 2.2 FoCUS とlimited echocardiography......................... 5 2.3 FoCUS とfull study................................................................ 5 3.FoCUS のプロトコール.................................................................. 5

3.1 Basic FoCUS の観察断面..................................................... 5

3.1.1 心窩部アプローチ............................................................ 6 3.1.2 傍胸骨左縁アプローチ................................................. 6 3.1.3 心尖部アプローチ............................................................ 6 3.2 Advanced FoCUS の観察断面......................................... 6

3.2.1 心窩部アプローチ............................................................ 6 3.2.2 傍胸骨左縁アプローチ................................................. 6 3.2.3 心尖部アプローチ............................................................ 6 3.2.4 M モード法........................................................................... 6 3.2.5 カラードプラ法................................................................. 7 3.2.6 パルスドプラ法................................................................. 7 3.2.7 連続波ドプラ法................................................................. 7 4.肺POCUS のプロトコール.......................................................... 8

4.1 肺 POCUS とは........................................................................... 8 4.2 肺POCUS の手技...................................................................... 8

4.2.1 スキャン部位...................................................................... 8 4.2.2 胸膜の同定............................................................................ 8 4.2.3 超音波装置の設定法...................................................... 9 5.FoCUS の評価項目............................................................................. 9

5.1 Basic FoCUS................................................................................. 9 5.2 Advanced FoCUS...................................................................11 6.肺POCUS の評価項目...................................................................12

6.1 正常所見.........................................................................................12 6.2 異常所見.........................................................................................13 7.臨床シナリオ........................................................................................15

7.1 胸痛....................................................................................................15

7.1.1 FoCUS で確認すべき疾患.......................................15 7.1.2 FoCUS/ 肺POCUS で異常が認められなかった場合....................................................................15 7.2 呼吸不全(息切れ).................................................................15

7.2.1 FoCUS で確認すべき疾患.......................................15 7.2.2 FoCUS と同時に確認すべき病歴・身体所見.........................................................................................15 7.2.3 FoCUS/ 肺POCUS で異常が認められなかった場合....................................................................16 7.3 循環虚脱・ショック..............................................................16 7.4 心肺蘇生.........................................................................................16 7.5 外傷....................................................................................................17 7.6 浮腫....................................................................................................17

7.6.1 片側性(局所性)浮腫...............................................17 7.6.2 両側性(全身性)浮腫...............................................17 7.6.3 FoCUS/ 肺POCUS で確認すべき所見..........18 7.6.4 FoCUS/ 肺POCUS で異常が認められなかった場合....................................................................18 8.疾患,病態別の活用法...................................................................18

8.1 心膜液貯留,心タンポナーデ.........................................18

8.1.1 心膜液貯留..........................................................................18 8.1.2 心タンポナーデ...............................................................19 8.1.3 心膜炎.....................................................................................19 8.2 肺塞栓・肺高血圧....................................................................19

8.2.1 閉塞性ショック...............................................................19 8.2.2 超音波所見..........................................................................19 8.3 虚血性心疾患(急性冠症候群,陳旧性心筋梗塞).......20 8.4 弁膜症...............................................................................................21

8.4.1 大動脈弁狭窄症(AS)...................................................21 8.4.2 僧帽弁閉鎖不全症(MR) およびその他の弁閉鎖不全症....................................................................21 8.5 シャント疾患(ASD, VSD, 心室中隔穿孔).........22 8.6 心不全...............................................................................................23

8.6.1 FoCUS と肺POCUS を用いた心不全診断..........23 8.6.2 エコー所見..........................................................................23 8.6.3 FoCUS を少し超えた評価法..................................24 8.7 非虚血性心筋症.........................................................................24

8.7.1 エコー所見..........................................................................24 8.7.2 FoCUS を少し超えた評価.......................................25 8.8 心筋炎...............................................................................................25

8.8.1 急性心筋炎..........................................................................25 8.8.2 慢性心筋炎..........................................................................25 8.9 循環血液量減少性ショック(出血など)................25 8.10 気胸.................................................................................................25 8.11 肺炎.................................................................................................26 9.状況別活用法........................................................................................26

9.1 救急,救命....................................................................................26 9.2 集中治療.........................................................................................26 9.3 内科病棟,当直.............................................................................27 9.4 小児領域.............................................................................................27 9.5 開業医,プライマリ・ケア..................................................28 9.6 看護領域.............................................................................................29 9.7 在宅医療.............................................................................................29 9.8 COVID-19 陽性,疑い例........................................................30 9.9 災害時..................................................................................................30 9.10 遠隔医療..........................................................................................30 10.FoCUS の教育,トレーニング.............................................31 11.コスト,対費用効果,限界.....................................................32文献......................................................................................................................33