As life-threatening emergencies, shock often requires urgent assessment, analysis and the development of treatment strategies by clinicians. When it comes to shock, it’s serious blood flow mechanics. In the blood flow mechanics theory, “target orientation, continuous dynamic assessment” is required. The severe ultrasound is based on the assessment of capacity responsiveness, the assessment of the heart structure and function, and the assessment of the lung and outer vascular vessels, which can be achieved by rapid identification of different types of shock and targeted treatment.
The severe ultrasound, in the form of a hemodynamic shock, adds to the expansion of part of the theoretical basis.
1, cavity morphology and central vein pressure
2 A conic of cardiac myocardial constriction and a contour curve.
3. Assessing capacity responsiveness – capacity responsiveness based on heart function.
i. The cavity. The upper and lower cavity veins. The upper cavities collect the upper half of the veins of the neck, upper limbs and chest (except for the heart and lungs). The lower cavity vein collects the lower body vein. The changes in the morphology of the cavity vein, the pressure, as an end vein of blood flow back, have a significant effect on clinical blood flow mechanics. Because according to Starling and Guyton. The amount of ivory blood is determined by the size of the pre-heart load, which is related to the size of the charge. The CVP is being used more frequently to monitor the upper cavity thorax to replace the pressure in the right room and even the right room to assess the front load capacity of the right room. But the relationship is only about equal. Severe ultrasound is assessed by monitoring the size of the lower cavity vein, variability rate (DDIVC). The normal human lower cavity diameter varies between 13 and 28 mm, with an average of 20 mm.
1. Relationship of CVP to lower cavity veins. Ciozda summarized 21 studies on the relationship between CVP and IVC, right-hand room pressure. It was summarized that the IVC inner diameter of a patient who breathes in peace with his or her own self-respiration had a moderate strength in relation to the CVP, right room pressure. In the case of electromechanical aerobic patients, it is difficult to predict effectively the size of the IVC inner diameter in relation to CVP, right-hand room pressure because of the increase in IVC as a result of the reduction of the venomal reflow during pressure.
For self-respiratory patients. IVC-CVP relationship: 1 when IVC 50% for right room 3mmHg; 2 when IVC > 21mm for right room (<DIVC) 21mm, variation rate (>DIVC) > 50% or IVC < 21mm for right room 50 per cent, corresponding to the CVP value > 10 mmHg, can be found in low blood capacity and distributed shock; the IVC diameter > 2 cm with respiratory variability 10 mmHg, can be found in heart source and resistance shock.
2. Lower cavity VVictoral Predictive Capacity Reactivity. Capacity resuscitation is a preliminary interpretation of clinical liquid resuscitation, with only half of patients in clinical shock having a capacity resuscitation and requiring liquid resuscitation treatment. For self-respiring patients, when inhaled, the reduction of the thoracic pressure was transmitted to the right-heart room, resulting in higher pressure gradients for the IVC and right-door pressure, which contributed to an increase in the flow back of the vein and a decrease in the diameter of the lower vein IVC. In cases of insufficient blood capacity, greater changes in the pressure margin result in greater changes in the diameter of the lower cavity IVC, which is the physiological basis of the lower cavity as a volume reaction.
1 For mechanically ventilated patients, when the patient’s self-respiration is weak. DIVC = (Dmax-Dmin)/Dmin. It can be used to interpret mechanical aerobic patient capacity responsiveness. When DIVC > 18% indicates that the patient has a capacity reaction, sensitivity and specificity > 90%. Or lower cavity vibrate (∆DIVC) = (Dmax-Dmin)/(Dmax+Dmin)/2). When >12%, the projection is 93%, and when it is negative, the projection is 92%. When the above measurements are performed, 1 needs to set the tide >8ml/kg; 2 does not breathe autonomously; and 3 does not suffer from cardiac disorders. Studies have shown that the sensitivity and specificity of the indicator can be reduced for patients with heart disorders. Sensitivity 57.1 per cent, specificity 89.9 per cent, still has some credibility.
2 For mechanically ventilated patients, when the patient breathes strongly. The effectiveness of lower cavity-related indicators has decreased significantly. Considerations are related to the movement of muscular muscles, the movement of chests, the lack of consistency of tides, etc. But we can assess the relationship between CVP and the thoracic abdominal pressure gradients by studying their lower cystal vibrating properties, which can collapse when CVP is very low or when the thoracic pressure is clearly negative.
3 At extreme times in the lower cavity diameter, the patient ‘ s capacity is reflected. When the patient is in low blood capacity, the IVCmax average is 15 mm, and when IVCmax≥25mm, only 12.5% of the patient has a capacity reaction.
4 lower cavity vein combined pulmonary ultrasound line A or B. The combined pulmonary ultrasound allows for early identification of the risks and possibilities of pulmonary oedema. A cap on the quantity of liquids recovered. Line A represents dry small leaf spacing and low or normal left-heart pressure, and line B is associated with pneumo-intermediate syndrome, usually associated with pulmonary oedema.
3. For lower cavity veins:
1 The standard sword drops down in the lower cavity and hepatics at the intersection point, approaching the opening of the right heart chamber of 0.5-3 cm.
2. The right abdominal middle line is measured at the liver level.
II. Clinical lower and lower cavity vibrating factors:
The lower cavity is susceptible to cross-wall pressure effects (respiratory pressure is pneumatic pressure PEEP, condensed pneumatic chest, cardiac pressure, constriction pressure, constrictive cardiac inflammation, high abdominal pressure, large thoracic fluids, pulmonary embolism, right-door pressure, vascular content and adaptability), resulting in incorrect data. It is worth noting that changes in the diameter of the IVC are determined by the extent to which the pressure of the vein, the pressure of the right heart, the internal pressure of the chest cavity follows the change of the breath. When ivultitude increases (suppression vascular palsy), low right-wing pressure, or rapid respiratory activity leads to large changes in inner thoracic pressure, this leads to an increase in lower ivultrastatic variability, which may not be relevant for volume reaction. (b) When the venom is reduced (abdominal high pressure), high right pressure (right heart failure, heart pressure). The low internal pressure in the chest due to a condensed pneumatic chest, high PEEP, constricted CPR) or abnormal breathing causes a decrease in the lower cavity viliary variability, which is not related to capacity reaction.
1 If the patient’s agitation, inability to cooperate, inability to maintain a standard position or severe breathing can influence the results of the measurement and thus the assessment of the condition. When the patient inhales hard, the avionic muscle drops, lowers the internal pressure of the chest cavity, expands the right heart chamber, and increases in the blood flow leads to the “fall” of the IVC. Measurements obtained from healthy volunteers show that the deeper the breathing, the greater the cross-sectional motion, the more visible the lower cavity is, but not the capacity state. Slight breath reduces the sensitivity of the IVC to predict the reaction of liquids and increases the collapse of the IVC, which reduces the specificity of the IVC to predict the reaction of liquids.
2. Increased internal pressure when patients with asthma or COPD press their breath increases the IVC, leading instead to the collapse of the IVC gas, which also interferes with the specificity of the IVC predictive liquid reaction.
3. ARDS patients, with high PEEP, increase internal and cross-pulmonary pressure in the atmosphere, the patient ‘ s inhalation is passive inhalation, higher thoracic pressure leads to higher pressure in the right room, a relative decrease in upper cystal repulsive blood count, higher pressure in the lower cavity vein, resulting in a larger internal and lower flow of veins, which leads to a difference in the relationship between the lower cavity vein and the reaction of the liquid. The larger the PEEP, the greater the deviation.
The effect of heart function: sodium sodium retention, increased blood capacity of patients with cardiac failure, significant increase in pre-heart loads, cardiac repulsion disorder, increase in right-door pressure, intolerantness, circulatory siltation and the surrounding oedema, increase in IVC and decrease in inhalation, in which case IVC expansion is not related to capacity status.
5. Cardiac pressure causes cardiac siltation, causing the lower cavity to be wide and fixed, but this does not amount to no liquid reaction and does not reflect the state of capacity.
