Lung US: Upcoming trend in ED - อ.พญ.สุธาพร ล้ำเลิศกุล

1. Point of care bedside ultrasound in
critical decision making
Basics and upcoming trends
Suthaporn Lumlertgul M.D.!
Emergency unit, King Chulalongkorn Hospital!
WINFOCUS Thailand director

2. Quick history of lung
ultrasound

5. Emergency Thoracic
Ultrasound
• Pneumothorax!
• Pulmonary Edema!
• Pleural Effusion !
• Pneumonia!
• ARDS

6. Air
Pleural effusion
In the supine patient, fluid will be in the posterior dependent
segments while air will be more apparent in the anterior
segments.

9. rib shadow
pleural line

11. Pneumothorax
• Spontaneous!
• Chest trauma!
• Mechanical ventilation
patients!
• Iatrogenic!
• Thoracenteses!
• Central line placements

12. Pneumothorax
1. Probe
2. Location
3. Orientation
Technique

13. Pneumothorax
Diagnosis
Sensitivity Limitations
Physical Exam 58% when compared to CXR
CXR 20-75% supine films
CT 98+% cost, radiation, transport, time
Chen SC et al. Hemopneumothorax missed by auscultation in penetrating chest injury. J Trauma.
1997 Jan; 42 (1):86-9

14. rib shadow
pleural line

15. M M
Lung
Sliding
No
Lung
Sliding

16. M M

18. A: Stratrophere Sign. B; Gliding of pleura results
in Comet tail artifact which produce as Granular
pattern in M Mode below pleural line called;
Seashore sign
Pleural line
Soft tissue
A
B
Pleural line
Soft tissue
Pneumothorax

19. Lung point

20. normal lung sliding

21. Normal Pneumothorax
Lung
Lung
Lung

22. Lung sliding
Lung
no
Lung sliding
Lung point

23. Case
• A 45 years old come in with alteration of
conscious
• The diagnosis is intracranial hemorrhage, u
design to intubate
• After intubate the patient saturation is 90-92%
• You wonder if your tube is in the right place

24. Lung
Sliding
M
No
Lung
Sliding
Lung pulse
M
Seashore
sign

26. A-lines
Pulmonary Edema
• Hyperechoic lines!
• Horizontal !
• Parallel to pleura!
• Regular intervals!
• Normal artifact

27. Reverberation

29. pleural line
A line
A line

30. • Hyperechoic lines!
• Vertical, radial!
• Originates at pleura!
• Extends to bottom of
screen without fading!
• Erases A-lines!
• Sign of interstitial
thickening
B-lines
Pulmonary Edema
sensitivity and specificity of 94 and 92%,

31. Dry Dyspnea Wet Dyspnea

33. Dry Dyspnea Wet Dyspnea

34. Rapid, noninvasive, inexpensive, reproducible, safe,
and accurate way
In the case of pulmonary edema, with a positive
likelihood ratio of 12.4 and a negative likelihood ratio
of 0.06

39. Ultrasound Enhancedresuscitation; pocket Manual

40. US does not replace medical history, physical examination, or clinical
judgment. It rather serves as a tool to increase or decrease the
probability of the disease to a level that could prompt finalizing the
diagnosis and streamlining the treatment.

42. Emergency Thoracic
Ultrasound
• Pneumothorax!
• Pulmonary Edema!
• Pleural Effusion !
• Pneumonia!
• ARDS

43. Rt Lt
pleural line
A line
A

47. Emergency Thoracic
Ultrasound
• Pneumothorax!
• Pulmonary Edema!
• Pleural Effusion !
• Pneumonia!
• ARDS

48. B5 ?

49. B3 VS B7
7 mm
{
B7 Interlobular - septa process, Diffuse pulmonary fibrosis!
3 mm
{
B3 Interlobular - alveolar process, ARDS/pulmonary edema

52. In the land of blind , the one eye man is king

54. https://www.facebook.com/EDKCMH

55. https://www.facebook.com/EDKCMH