6. Airway by ultrasound
• Direct visual trachea position
• Direct visual of Endotracheal tube, cuff
• Assess absent of lung movement in one
lung intubation
• Assess Diaphragm movement
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36. Comet tail
Reference ; Lichtenstein D, MÉZIÈRE G., The comet tail artifact, an ultrasound sign of aloveolar-interstitial syndrome.
Am J Respir Crit Care Med 1997. Vol156:1640–1646.
Comet tail artifacts results from sliding of patrietal against visceral pleura. Lack of Lung sliding
occur in (inflammatory adherences, loss of lung expansion, atelectasis,apnea, chronic symphysis)
or is separated (pneumothorax, pneumonectomy
Comet
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44. **
Strastrophere sign
M Mode of Pneumothorax
(or sometimes look like Barcode)
7 54 6 0 8 1 9
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45. A: Stratrophere Sign.
B; Gliding of pleura results in Granular pattern
which are seperated by white pleural line are called
“Seashore sign”
Pleural line
Soft tissue
A
B
Pleural line
Soft tissue
B
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47. When the collapsed lung is not contact chest wall, it will create horizontal pattern(before and
after yellow arrow). On the contray, when it expands and in contact with chest wall, it will
create granular pattern(below the arrow). This is called the lung point, which is a specific sign
of pneumothorax.
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53. *= B line narrow-based hyperechoic column laser like arise from bright pleural line as vertical to
the edge of the screen moving during breathing indicated interlobular septal
infiltration
*
* *
*
Pleural line
B line:To detect interlobular septal thickening, infiltration
DIfferential Diagnosis of B line: Cardiogenic Pulmonary Edema, ARDS,
Pneumonia, Lung Contusion (Trauma)
*
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60. The BLUE protocol
To differentiate acute pulmonary disease by bedside ultrasound application
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61. The BLUE protocol
Reference: Lichtenstein D. and Gilbert A. Relevance of Lung Ultrasound in the
diagnosis of Acute Respiratory Failure. Chest 2008;134;117-125
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62. The BLUE protocol
Reference: Lichtenstein D. and Gilbert A. Relevance of Lung Ultrasound in the
diagnosis of Acute Respiratory Failure. Chest 2008;134;117-125
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63. Pleural Effusion Assessment by ultrasound
Pleural line
Curtain sign obliterate liver
Liver
Diaphragm Diaphragm
Liver
Effusion
Lung
Lung31
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64. Pleural Effusion Assessment by ultrasound
ABDOMEN
LUNG
PLEURAL
EFFUSION
Semiquantitative assessment of pleural effusion volume(IP=Interpleural space)
End expiratory distance IP at 5th intercostal space at > 5 cm estimated > 500 cc
End Expiratory IP at Basal lung > 4.5 cm (Right lung base)
> 5 cm (Lt lung base)
→estimated pleural effusion volume > 800 cc
Best thoracocentesis point
1.Safe puncture area : ultrasound check > 3 intercostal spaces with IP distance > 1.5 cm
2.Absence of interposition of lung, heart, liver, spleen
3.Interpleural distance variation
Mark best puncture point, fixed patient position.
Roch A, CHEST 2005
Vignon P, CRIT CARE 2005.
www.WINFOCUS.org
Sunday, November 14, 2010