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<br /> Ultrasound<br /> Point-of-care lung ultrasound<br /> Philips tutorial<br /> Michael B. Stone, MD, RDMS<br /> Director, Division of Emergency Ultrasound<br /> Department of Emergency Medicine<br /> Brigham and Women’s Hospital, Boston, MA<br /> Contents<br /> Point-of-care lung ultrasound<br /> 1 Introduction 3<br /> 2 Clinical cases 4<br /> 3 Fundamentals 6<br /> 4 Transducer selection 16<br /> 5 Image optimization 17<br /> 6 The lung exam 18<br /> 7 Pneumothorax 23<br /> 8 M-mode and color Doppler 31<br /> 9 References 36<br /> 10 Consolidations 39<br /> 11 Pleural effusions and thoracentesis 41<br /> 1<a title="Point-of-care Lung Ultrasound page 1" href="http://viewer.zmags.com/publication/1f3688e9?page=1"> Ultrasound Point-of-care lung ultrasound Philips</a> <a title="Point-of-care Lung Ultrasound page 2" href="http://viewer.zmags.com/publication/1f3688e9?page=2"> Contents Point-of-care lung ultrasound 1 In</a> <a title="Point-of-care Lung Ultrasound page 3" href="http://viewer.zmags.com/publication/1f3688e9?page=3"> 1 Introduction Emergency medicine and crit</a> <a title="Point-of-care Lung Ultrasound page 4" href="http://viewer.zmags.com/publication/1f3688e9?page=4"> 2 Clinical cases Clinical case 1 A 22-year-</a> <a title="Point-of-care Lung Ultrasound page 5" href="http://viewer.zmags.com/publication/1f3688e9?page=5"> Clinical case 2 A 72-year-old female with a past </a> <a title="Point-of-care Lung Ultrasound page 6" href="http://viewer.zmags.com/publication/1f3688e9?page=6"> 3 Fundamentals Fundamentals of the lung ultras</a> <a title="Point-of-care Lung Ultrasound page 7" href="http://viewer.zmags.com/publication/1f3688e9?page=7"> </a> <a title="Point-of-care Lung Ultrasound page 8" href="http://viewer.zmags.com/publication/1f3688e9?page=8"> © 2015 Koninklijke Philips N.V. All rights are re</a> <a title="Point-of-care Lung Ultrasound page 9" href="http://viewer.zmags.com/publication/1f3688e9?page=9"> [ Video 1 ] Video demon</a> <a title="Point-of-care Lung Ultrasound page 10" href="http://viewer.zmags.com/publication/1f3688e9?page=10"> Nomenclature and definition of terms There are tw</a> <a title="Point-of-care Lung Ultrasound page 11" href="http://viewer.zmags.com/publication/1f3688e9?page=11"> [Figure 3] Ultrasound image demonstrating A-lines</a> <a title="Point-of-care Lung Ultrasound page 12" href="http://viewer.zmags.com/publication/1f3688e9?page=12"> • B-lines occur when sound waves pass through the</a> <a title="Point-of-care Lung Ultrasound page 13" href="http://viewer.zmags.com/publication/1f3688e9?page=13"> [Figure 4a] Two ultrasound images demonstrating B</a> <a title="Point-of-care Lung Ultrasound page 14" href="http://viewer.zmags.com/publication/1f3688e9?page=14"> [Figure 4b] Ultrasound image demonstrating a B-li</a> <a title="Point-of-care Lung Ultrasound page 15" href="http://viewer.zmags.com/publication/1f3688e9?page=15"> The air/fluid ratio determines the appearance of </a> <a title="Point-of-care Lung Ultrasound page 16" href="http://viewer.zmags.com/publication/1f3688e9?page=16"> 4 Transducer selection There has been a great </a> <a title="Point-of-care Lung Ultrasound page 17" href="http://viewer.zmags.com/publication/1f3688e9?page=17"> 5 Image optimization Most currently available</a> <a title="Point-of-care Lung Ultrasound page 18" href="http://viewer.zmags.com/publication/1f3688e9?page=18"> 6 The lung exam The exam can be performed in a</a> <a title="Point-of-care Lung Ultrasound page 19" href="http://viewer.zmags.com/publication/1f3688e9?page=19"> In most cases, the exam begins in the mid-clavicu</a> <a title="Point-of-care Lung Ultrasound page 20" href="http://viewer.zmags.com/publication/1f3688e9?page=20"> The transducer is adjusted until a view that incl</a> <a title="Point-of-care Lung Ultrasound page 21" href="http://viewer.zmags.com/publication/1f3688e9?page=21"> Once the desired view is acquired, fanning or ang</a> <a title="Point-of-care Lung Ultrasound page 22" href="http://viewer.zmags.com/publication/1f3688e9?page=22"> Of note, the operator should be mindful of the cu</a> <a title="Point-of-care Lung Ultrasound page 23" href="http://viewer.zmags.com/publication/1f3688e9?page=23"> 7 Pneumothorax Lung sonography is an invalu</a> <a title="Point-of-care Lung Ultrasound page 24" href="http://viewer.zmags.com/publication/1f3688e9?page=24"> [Figure 9] The patient is in a supine position wi</a> <a title="Point-of-care Lung Ultrasound page 25" href="http://viewer.zmags.com/publication/1f3688e9?page=25"> If lung sliding is observed, there is no pneumoth</a> <a title="Point-of-care Lung Ultrasound page 26" href="http://viewer.zmags.com/publication/1f3688e9?page=26"> [ Video 2 ] Ultrasound </a> <a title="Point-of-care Lung Ultrasound page 27" href="http://viewer.zmags.com/publication/1f3688e9?page=27"> Key point Many authorities teach that lung slidin</a> <a title="Point-of-care Lung Ultrasound page 28" href="http://viewer.zmags.com/publication/1f3688e9?page=28"> • There is a pneumothorax present. If the clinici</a> <a title="Point-of-care Lung Ultrasound page 29" href="http://viewer.zmags.com/publication/1f3688e9?page=29"> [ Video 3 ] Video with </a> <a title="Point-of-care Lung Ultrasound page 30" href="http://viewer.zmags.com/publication/1f3688e9?page=30"> [ Video 4 ] Video with </a> <a title="Point-of-care Lung Ultrasound page 31" href="http://viewer.zmags.com/publication/1f3688e9?page=31"> 8 M-mode and color Doppler A discussion of t</a> <a title="Point-of-care Lung Ultrasound page 32" href="http://viewer.zmags.com/publication/1f3688e9?page=32"> [Figure 10] Side by side M-mode and 2D of the che</a> <a title="Point-of-care Lung Ultrasound page 33" href="http://viewer.zmags.com/publication/1f3688e9?page=33"> When lung sliding has been abolished, the superfi</a> <a title="Point-of-care Lung Ultrasound page 34" href="http://viewer.zmags.com/publication/1f3688e9?page=34"> When a lung point is encountered, a pattern that </a> <a title="Point-of-care Lung Ultrasound page 35" href="http://viewer.zmags.com/publication/1f3688e9?page=35"> [Figure 13] Side by side M-mode and 2D tracing de</a> <a title="Point-of-care Lung Ultrasound page 36" href="http://viewer.zmags.com/publication/1f3688e9?page=36"> 9 Interstitial syndromes Diffuse interstitial</a> <a title="Point-of-care Lung Ultrasound page 37" href="http://viewer.zmags.com/publication/1f3688e9?page=37"> A diffuse B-line pattern does not always enable t</a> <a title="Point-of-care Lung Ultrasound page 38" href="http://viewer.zmags.com/publication/1f3688e9?page=38"> [ Video 5 ] Diffuse int</a> <a title="Point-of-care Lung Ultrasound page 39" href="http://viewer.zmags.com/publication/1f3688e9?page=39"> 10 Consolidations Lung consolidations may be </a> <a title="Point-of-care Lung Ultrasound page 40" href="http://viewer.zmags.com/publication/1f3688e9?page=40"> [ Video 6 ] Right lower</a> <a title="Point-of-care Lung Ultrasound page 41" href="http://viewer.zmags.com/publication/1f3688e9?page=41"> 11 Pleural effusions and thoracentesis </a> <a title="Point-of-care Lung Ultrasound page 42" href="http://viewer.zmags.com/publication/1f3688e9?page=42"> [ Video 7 ] Right pleur</a> <a title="Point-of-care Lung Ultrasound page 43" href="http://viewer.zmags.com/publication/1f3688e9?page=43"> [ Video 8 ] Loculated r</a> <a title="Point-of-care Lung Ultrasound page 44" href="http://viewer.zmags.com/publication/1f3688e9?page=44"> 12 Clinical case resolutions Case 1 resolution</a> <a title="Point-of-care Lung Ultrasound page 45" href="http://viewer.zmags.com/publication/1f3688e9?page=45"> [ Video 9 ] Absent lung</a> <a title="Point-of-care Lung Ultrasound page 46" href="http://viewer.zmags.com/publication/1f3688e9?page=46"> Case 2 resolution Despite the presence of bilater</a> <a title="Point-of-care Lung Ultrasound page 47" href="http://viewer.zmags.com/publication/1f3688e9?page=47"> [ Video 10 ] Multiple B</a> <a title="Point-of-care Lung Ultrasound page 48" href="http://viewer.zmags.com/publication/1f3688e9?page=48"> 13 Summary Summary and key points • The interf</a> <a title="Point-of-care Lung Ultrasound page 49" href="http://viewer.zmags.com/publication/1f3688e9?page=49"> • A diffuse B-line pattern may represent cardioge</a> <a title="Point-of-care Lung Ultrasound page 50" href="http://viewer.zmags.com/publication/1f3688e9?page=50"> Lung ultrasound findings Normal lung • Lung slidi</a> <a title="Point-of-care Lung Ultrasound page 51" href="http://viewer.zmags.com/publication/1f3688e9?page=51"> 14 Bibliography 1. Lichtenstein. Ultrasound </a> <a title="Point-of-care Lung Ultrasound page 52" href="http://viewer.zmags.com/publication/1f3688e9?page=52"> Additional resources For additional resources r</a> <a title="Point-of-care Lung Ultrasound page 53" href="http://viewer.zmags.com/publication/1f3688e9?page=53"> This paper reflects the opinion of the author, no</a>