專科護理師運用超音波於創傷性氣胸病患評估

Using Ultrasound Assessment Traumatic Pneumothorax by Nurse Practitioner

胸部X光攝影 (AP view) 對於創傷性氣胸患雖然有高度特異性，但敏感性只有28-75%，對於微量氣胸不容易偵測。胸部超音波擁有快速且非侵入性的特性，適合於多重器官創傷病患之評估。胸部超音波利用Sliding lung sign、Comet tail artifacts、Lungpoint偵測氣胸，在創傷性微量氣胸的評估已有顯著成效，且操作簡易。創傷團隊成員需相輔相成，急診專科護理師不但是團隊中重要之角色，更應發揮多元的功能，醫療院所培訓專科護理師評估胸部創傷病患的技巧，從超音波的原理、探頭的選擇、檢查的位置、異常影像的發現，運用超音波於多重器官創傷病患之評估輔助醫療偵測微量氣胸，可避免病患進一步演變成致命的張力性氣胸。專科護理師多元化發展應以一般理學檢查為基礎，將超音波視為進階的評估工具，有助成本控制以及病患安全之考量，並提升臨床照護之品質。

Chest X-ray photography (AP view) in traumatic pneumothorax, although there is a high degree of specificity, but sensitivity of only 28-75%, pneumothorax is not easy to trace detection. Chest ultrasound have quick and non-invasive characteristics, the Sliding lung sign, Comet tail artifacts, Lung point can detect pneumothorax, it is suitable for multi- organ trauma patient's assessment. Chest ultrasound in the evaluation of traumatic pneumothorax has significant effectiveness, and ease of operation. Trauma resuscitation team members need to complement each other, the nurse practitioners of emergency department are not only important to the team, but also should play diverse functions. Medical institutions providing nurse practitioners receive a good training system from the principle of ultrasound, choose the probe, examination position and abnormal images found. Used ultrasound to assess the patients who with multiple organ trauma and trace pneumothorax, patients can avoid further expand into an extremely tension pneumothorax. Nurse practitioners diversified general physical examination should be based on the ultrasound treated as advanced assessment tools, patient safety and help control the cost considerations, and to enhance the quality of clinical care.