Please see this article on why we should all practice ultrasound in critical care!

Watch for Basic Lung Ultrasound

Watch for Advanced Lung Ultrasound

Watch for General and Lung Pathology Ultrasound

Probe Positions

Screen Shot 2016-12-13 at 17.10.25.png

A lines – Basic

Screen Shot 2016-12-13 at 17.11.57.png

Screen Shot 2016-12-13 at 17.13.07.png

B Lines

Screen Shot 2016-12-13 at 17.15.07.png

Screen Shot 2016-12-13 at 17.19.41.png
B lines in the interlobular septa – pulmonary oedema.
Screen Shot 2016-12-13 at 17.17.12.png
Multiple B-lines that go all the way to the edge of the screen and that obliterate the A-lines is not normal. More than 5 in an area is very much abnormal and correlates with extra-vascular lung water or pulmonary oedema
screen-shot-2016-12-13-at-17-21-30
B lines – more confluent so more likely to be in alveoli as well.

screen-shot-2016-12-13-at-17-23-57

Screen Shot 2016-12-13 at 18.22.57.png

Screen Shot 2016-12-14 at 08.52.30.png

PLEURAL EFFUSIONS

Use your echo cardiac phased array probe for this!

Screen Shot 2016-12-13 at 19.51.41.png

Screen Shot 2016-12-13 at 19.52.18.png

Screen Shot 2016-12-13 at 19.53.03.png
Move the probe caudad and cephalad until you can see the diaphragm clearly
Screen Shot 2016-12-13 at 19.54.47.png
No fluid here, so liver and lung look the same above and below the diaphragm

screen-shot-2016-12-13-at-19-58-18

Screen Shot 2016-12-13 at 20.00.09.png

PNEUMONIA

Screen Shot 2016-12-13 at 20.01.46.png

Screen Shot 2016-12-13 at 20.02.15.png

Screen Shot 2016-12-13 at 20.02.59.png

Screen Shot 2016-12-13 at 20.03.42.png

Screen Shot 2016-12-13 at 20.04.11.png

screen-shot-2016-12-14-at-08-36-01screen-shot-2016-12-14-at-08-36-14

screen-shot-2016-12-13-at-20-05-16

PNEUMOTHORAX

See also our section on images in pneumothorax

In a blunt trauma series, pneumothorax detection:

  • CXR sensitivity 75%, specificity 100%
  • EUS sensitivity 98%, specificity 99%
    • Using multiple windows, we are able to assess the size of the pneumothorax with good correlation.
    • You can do this by mapping out “lung point” which is the point where the lung drops away from the chest wall. And doing this you can get a good idea of what size the pneumothorax is.
      13:54: Pneumothorax Scanning Technique
  • Linear high frequency probe needed
    • Place the probe cephalad-caudad with the indicator towards the head.
    • Place it in the 2nd intercostal space in the mid-clavicular line in (again) a vertical orientation.
      You want to watch four to five respiratory cycles.
  1. Identify the pleural line
  2. Observe lung sliding
  3. Sky-Ocean-Beach interface on M-mode

Other causes of absent lung sliding:

  • Effusions
  • Consolidation with pleural adhesions
  • Chest tubes
  • Advanced COPD

screen-shot-2016-12-13-at-19-39-05

screen-shot-2016-12-13-at-19-41-43

Screen Shot 2016-12-13 at 19.42.43.png

Screen Shot 2016-12-13 at 19.43.34.png

Screen Shot 2016-12-13 at 19.44.32.png

Screen Shot 2016-12-13 at 19.45.17.png

Screen Shot 2016-12-14 at 08.28.35.png
Horizontal lines replace the granular looking lung = probable pneumothorax

Screen Shot 2016-12-14 at 09.08.18.png

Screen Shot 2016-12-13 at 19.46.53.png

Screen Shot 2016-12-13 at 19.47.34.png

Screen Shot 2016-12-14 at 08.34.05.png

Screen Shot 2016-12-14 at 09.08.18.png

Screen Shot 2016-12-14 at 08.52.30.png