亀田 徹

Toru KAMEDA

安曇野赤十字病院　救急科

Department of Emergency Medicine, Red Cross Society Azumino Hospital

キーワード : point-of-care ultrasound (POCUS), shock, focused assessment with sonography for trauma (FAST), focused cardiac ultrasound (FOCUS), rapid ultrasound in shock (RUSH)

Point-of-care ultrasound （POCUS）はショックの初期診療に有用である．外傷初期診療の場面では，ショックの原因となる心タンポナーデ，血胸，腹腔内出血の早期検出のためにfocused assessment with sonography for trauma （FAST）が行われる．また多くの臨床研究を通じて，心臓超音波検査を専門としない臨床医が行う心臓POCUSの有効性，実行性が明らかになり，focused cardiac ultrasound（FOCUS）と呼ばれるようになった．さらにショックの分類に基づいた包括的な評価法としてrapid ultrasound in shock （RUSH）が知られている．POCUSは呼吸困難の迅速評価，急性期診療で必要な手技の確認やガイド下手技としても有用性は高い．気道（airway），呼吸（breathing），循環（circulation）アプローチに基づいたPOCUSフレームワーク（ABC-POCUS）は，ショックと呼吸困難の初期診療で有効な領域別POCUS全体を系統的に示したものであり，臨床推論に基づきフレームワーク内の領域別POCUSを使い分けるか，プロトコルとして利用するのが妥当である．

Point-of-care ultrasound (POCUS) is useful for initial management of shock. Focused assessment with sonography for trauma (FAST) is performed for the rapid detection of cardiac tamponade, hemothorax, and hemoperitoneum, which can cause shock. Many clinical studies have shown the effectiveness and feasibility of cardiac POCUS performed by clinicians who are not specialized in echocardiography, which is now called focused cardiac ultrasound (FOCUS). Rapid ultrasound in shock (RUSH) is a comprehensive assessment method based on the classification of shock. POCUS is also useful for the rapid assessment of dyspnea and the confirmation and guidance of procedures in acute care settings. A POCUS framework based on the airway, breathing, and circulation approach (ABC-POCUS) systematically lays out all POCUS applications that are useful for the initial management of shock and dyspnea. It is appropriate to select POCUS applications from the framework or to use the framework as a protocol based on the clinical reasoning.