Point of Care Ultrasound (Pocus) : Introduction: George A. Fox
Point of Care Ultrasound (Pocus) : Introduction: George A. Fox
Point of Care Ultrasound (Pocus) : Introduction: George A. Fox
• Actelion
• Astra-Zeneca
• Bayer HealthCare
• Boehringer Ingelheim
• InterMune
• Novartis
Learning Objectives:
At the end of this session and workshop, the
participant(s) will:
Definition:
– An ultrasound examination provided
and performed at the bedside by the
primary care physician (or their
designate), usually as an adjunct to
the physical examination, to identify
the presence or absence of a limited
number of specific findings.
CAR, 2013. www.car.ca
PoCUS
• Findings from the PoCUS examination
MUST be correctly integrated into the
clinical decision making process.
Thoracic/Pleural Ultrasound
George
A.
Fox
MD,
MSc,
FRCPC,
FCCP
Learning Objectives:
At the end of this session and workshop, the
participant(s) will be able to:
• Discuss the appropriate choice of ultrasound probes
• Identify the structures when examining the lung and pleural space
hFp://westernsono.ca/tutorials-‐3/lung-‐ultrasound-‐image-‐interpretaOon-‐tutorial
Thoracic Ultrasound:
hFp://westernsono.ca/tutorials-‐3/lung-‐ultrasound-‐image-‐interpretaOon-‐tutorial
Thoracic Ultrasound:
B-mode:
hFp://www.jrheum.org/content/39/8/1641
Thoracic Ultrasound:
M-mode:
hFp://www.icmteaching.com/ultrasound/lung%20ultrasound/styled-‐125
Thoracic Ultrasound:
hFp://www.ncbi.nlm.nih.gov/pubmed/?term=lung+ultrasound
Thoracic Ultrasound:
Probes:
hFp://westernsono.ca/tutorials-‐3/lung-‐ultrasound-‐basics-‐tutorial
Thoracic Ultrasound:
Probe Location:
Pleural 94 97 95 90
Effusion
Alveolar
Consolidation 90 98 88 95
(Pneumonia)
Interstitial
Syndrome 93 93 87 99
(CHF, ARDS)
Pulmonary 81 99 94 98
Embolism
Lichtenstein, D., Ann Int Care, 2014; 4:1-12
Thoracic Ultrasound:
Present
http://westernsono.ca/tutorials-3/lung-ultrasound-image-interpretation-tutorial
Thoracic Ultrasound:
Lung Sliding:
Present? Absent
http://westernsono.ca/tutorials-3/lung-ultrasound-image-interpretation-tutorial
Thoracic Ultrasound:
Lung Sliding, B-mode:
Thoracic Ultrasound:
Absent Lung Sliding, B-mode:
Thoracic Ultrasound:
Lung Sliding (B-mode/M-mode)
http://www.acep.org/
Thoracic Ultrasound:
Absent Lung Sliding:
Other causes:
– Pleural adhesion
– Atelectasis
– Lobectomy/Pneumonectomy
– Main-stem intubation
http://www.pneumon.org
Thoracic Ultrasound:
A Lines:
Thoracic Ultrasound:
B Lines:
• Hyperechoic rays projecting vertically
from pleural line to bottom of screen
– Obliterate A Lines
• Identifies fluid in interlobular septum
• “Interstitial” Syndrome
– Bilateral
• CHF, ARDS, ILD
– Unilateral
• Pneumonia
Thoracic Ultrasound:
B Lines:
hFp://westernsono.ca/tutorials-‐3/lung-‐ultrasound-‐image-‐interpretaOon-‐tutorial
Thoracic Ultrasound:
B Lines:
http://www.criticalecho.com
Thoracic Ultrasound:
B Lines:
http://www.criticalecho.com
Thoracic Ultrasound:
B Lines:
Thoracic Ultrasound
B Lines:
Fluid “Intolerant”
vs
Fluid “Tolerant”
Thoracic Ultrasound:
A Lines vs B Lines:
hFp://www.scielo.br/scielo
Thoracic Ultrasound:
Consolidation:
http://westernsono.ca/tutorials-3/lung-ultrasound-image-interpretation-tutorial
Thoracic Ultrasound:
Consolidation:
Air bronchograms
Chest. 2009;135(6):1421-1425
Thoracic Ultrasound:
Consolidation:
hFp://www.criOcalecho.com/content/tutorial-‐9-‐lung-‐ultrasound
Thoracic Ultrasound:
Consolidation:
hFp://www.criOcalecho.com/content/tutorial-‐9-‐lung-‐ultrasound
Thoracic Ultrasound:
Pleural Effusion:
http://westernsono.ca/tutorials-3/lung-ultrasound-image-interpretation-tutorial
Thoracic Ultrasound:
Pleural Effusion:
Thoracic Ultrasound:
Pleural Effusion:
Thoracic Ultrasound:
Pleural Effusion:
“Jelly Fish” sign
http://www.critcaresono.com
Thoracic Ultrasound:
Pleural Effusion:
“Jelly Fish” sign / Lung Flapping
Thoracic Ultrasound:
Pleural Effusion:
Septations “Plankton” sign
Thoracic Ultrasound:
Thoracentesis:
http://www.critcaresono.com/
Thoracic Ultrasound:
Thoracentesis:
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/bedside-applications-of-ultrasound/
Thoracic Ultrasound:
Thoracentesis:
Must Identify:
- Anechoic free space
- Chest wall
- Diaphragm
- Above vs below
- Respiratory Movement
- Compressed Lung
- “Flapping”
http://link.springer.com/referenceworkentry
Thoracic Ultrasound:
Thoracentesis:
http://www.critcaresono.com/
Thoracic Ultrasound:
Thoracentesis:
http://www.pocustoronto.com/articulate/thora/story.html
Thoracic Ultrasound:
Thoracentesis:
http://www.med.uottawa.ca/courses/
Thoracic Ultrasound:
Thoracentesis:
http://www.med.uottawa.ca/courses/
Thoracic Ultrasound:
Thoracentesis:
Pearls
&
Pidalls:
– IdenOfy
anatomic
boundaries:
• Anechoic
free
space
• Chest
wall
• Diaphragm
– Diaphragm
movement?
• Compressed
lung
– Lung
flapping?
– R/O
ascites:
• Hepatorenal/splenorenal
space
vs
pleural
space?