2014-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/658933摘要：依據 2010年美國心臟學會準則，於心跳停止病患急救復甦過程中，建立確切氣道(airway)、適當通氣(ventilation)及有效循環(circulation)為急救成功的第一步，在急救過程中這三個重要環節如果延遲處置，甚至錯誤的操作，不僅不能挽救病患的生命，更增加了病患的併發症與死亡率，因此熟習氣道、通氣及循環的處置是在急救復甦訓練中的首要任務，然而如何確認已完成「氣道-通氣-循環」三步驟，目前仍仰賴聽診及脈搏檢查，而在急診吵雜的環境下，實有其侷限性。 超音波是一種非侵入性且低放射性之診療儀器，在急重症環境常做為診察之工具，近年來，許多國際知名之研究已證實超音波在處理創傷病患及休克病患流程中佔有不可或缺之角色，心跳停止之病患若是呈現無脈搏之電氣活動(pulseless electrical activity)時，超音波也可利用來尋找可能之致病因，如低血容、心包填塞或是張力性氣胸等。目前已經有一些小型的研究將超音波統合至急救復甦過程，但是多著重於心臟超音波，並未有包含「氣道-通氣-循環」整合性超音波掃描。 本研究團隊成員除均為超音波醫學會資深講師，具備多年授課與實地演練示範之經驗，並基於長期協助住院醫師學習急重症病患照護與超音波臨床技能之經驗，已有相當系統性之整合訓練課程。有鑑於資淺醫師之培訓為教學系統重要的一環，本研究預估為期兩年，第一年即結合本部累積之臨床超音波教學經驗與臨床技能中心之擬真情境設施，進行資淺醫師「氣道-通氣-循環」整合性超音波掃描訓練，並建立醫學模擬情境教學模組，修正以病患為教材的傳統臨床教學模式，學習將超音波整合於急救程序內，除能探討臨床醫學教育之前瞻領域，亦有提昇醫療品質之積極用意。第二年則依醫學模擬情境教學模組進行演練，嘗試引入模擬情境，能使資淺醫師能熟悉醫學模擬教育模式，並於實際參與臨床作業時，明確自身能力與角色，及時配合急救作業，；並期待建立線上學習架構，除方便資淺醫師學習與複習，教材範圍亦將提供資深醫護人員長期在職教育，並期能因應未來醫學教育理念演進與社會需求的提昇。<br> Abstract: According to 2010 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC), early CPR and effective advanced life support (ALS) can improve prognosis of cardiac arrest (CA) patients. Establishing a definite airway, adequate ventilation and effective circulation, so called “Airway-Breathing-Circulation, A-B-C” are essential in ALS for CA patients. However, confirmation of the A-B-C steps, such as auscultation of breathing sound, capnography and pulse check manually, has limitation in emergency settings. Ultrasound is an indispensable and easily accessible tool in emergency departments. Recent evidence showed that ultrasound had an important role in managing patients with trauma or shock. Additionally, ultrasound can be used to find out the potentially reversible causes, such as hypovolemia, cardiac tamponade or tension pneumothorax, for patients with pulseless electrical activity. Although the interest of ultrasound in resuscitation is strongly recommended, the modality for achieving possible complete evaluation, especially for A-B-C evaluation, remains poorly codified. Therefore, this study is conducted for integration of ultrasound for A-B-C evaluation in ALS for junior physicians. Our researchers are the senior instructors in the Taiwan Society of Ultrasound in Medicine, having excellent experience for emergency ultrasound examinations and in emergency ultrasound training for many years. This study will be lasted for two years. In the first year, we will introduce ultrasound application and start training for A-B-C management by formal curriculum and hand-on practice. The questionnaire is designed to evaluate the efficacy of ultrasound training and revise training programs. Additionally, we will establish simulation modules for ultrasound A-B-C evaluation at resuscitation. In the 2nd year, we will introduce simulation modules to junior physicians and provide them to practice. The results will be reviewed and could be filed as a reference for the following teaching program. Junior physicians will be familiar with resuscitation skills and incorporate ultrasound into resuscitation. Moreover, we will try to establish on-line simulation programs for further education and provide them to other departments and hospitals to improve resuscitation quality and patients’ care.