Ultrasound: Lungs: Difference between revisions
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==Technique== | |||
*Use vascular probe | |||
**Can use curvilinear or phase probe, but will need to decrease depth | |||
*Place the probe vertically (marker toward head) over the 2nd intercostal space and midclavicular line | |||
*Adjust your view in order to see a rib on each side of the screen (designated by rib shadow) | |||
*Look between the ribs for "lung sliding" | |||
**To document sliding on a single image, use M mode ("waves on a beach") | |||
*Can continue to evaluate each intercostal space for sliding if needed | |||
==Pneumothorax== | |||
*No lung sliding seen | |||
*May also identify "lung point:" distinct point where you no longer see lung sliding | |||
*Evaluate other intercostal spaces because pneumothorax may only be seen in least dependent area of thorax | |||
==Pulmonary edema== | ==Pulmonary edema== | ||
*A lines and B lines | *A lines and B lines |
Revision as of 22:14, 31 December 2013
Technique
- Use vascular probe
- Can use curvilinear or phase probe, but will need to decrease depth
- Place the probe vertically (marker toward head) over the 2nd intercostal space and midclavicular line
- Adjust your view in order to see a rib on each side of the screen (designated by rib shadow)
- Look between the ribs for "lung sliding"
- To document sliding on a single image, use M mode ("waves on a beach")
- Can continue to evaluate each intercostal space for sliding if needed
Pneumothorax
- No lung sliding seen
- May also identify "lung point:" distinct point where you no longer see lung sliding
- Evaluate other intercostal spaces because pneumothorax may only be seen in least dependent area of thorax
Pulmonary edema
- A lines and B lines
- A lines:
- Appear as horizontal lines
- Indicate dry interlobular septa.
- Predominance of A lines has 90% sensitivity, 67% specificity for pulmonary artery wedge pressure <= 13mm Hg
- A line predominance suggests that intravenous fluids may be safely given without concern for pulmonary edema
- B lines ("comets"):
- White lines from the pleura to the bottom of the screen
- Highly sensitive for pulmonary edema, but can be present at low wedge pressures
- A lines:
BLUE (Bedside Lung Ultrasound in Emergency) Protocol[1]
- Predominant A lines + lung sliding = Asthma/COPD
- Multiple predominant B lines anteriorly with lung sliding = Pulmonary Edema
- Normal anterior profile + DVT = PE
- Anterior absent lung sliding + A lines + lung point = Pneumothorax (PTX)
- Anterior alveolar consolidations, anterior diffuse B lines with abolished lung sliding, anterior asymmetric interstitial patterns, posterior consolidations or effusions w/o anterior diffuse B lines = Pneumonia (PNA)
Further Reading
References
- ↑ http://ccm.anest.ufl.edu/files/2012/08/BLUELung.pdf Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure - The BLUE Protocol