Despite the recent publication of international consensus guidelines* concerning the use of FLUS, there is no international consensus on how to perform FLUS.

In this lesson, two approaches are described:

– LUS as a part of the E-FAST
– FLUS

LUS is also performed as a part of other focused ultrasound protocols (e.g. FATE, RUSH) – the approaches used in these protocols are not described in this lesson.

* Volpicelli, G., et al., International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med, 2012. 38(4): p. 577-91.

When performing FLUS the purpose is to diagnose and exclude acute, potentially life threatening conditions.

In comparison, when performing diagnostic LUS, the purpose is to diagnose and exclude all conditions which potentially can be visualised using LUS.

Therefore when performing diagnostic LUS, one has to scan all areas of the pleura and lungs, which can be visualised by transthoracic scanning.

This is both time consuming and requires good patient cooperation during the examination, factors which are not always compatible with settings such as the emergency department, intensive care unit or the operating suite.

When performing FLUS usually only a limited area of the surface of the pleurae and lungs are evaluated; it can therefore be performed quickly with little patient cooperation.

This lesson describes different scanning protocols for the use of focused lung ultrasound (FLUS).

FLUS findings and interpretations are described in detail in separate lessons.

As with other types of sonography, the use of LUS can roughly be divided into the following types:
– FLUS
– Diagnostic LUS
– LUS guided interventions

We hope you have enjoyed the course and we wish you good luck with your forthcoming FLUS performance in your own department to the benefit of your patients.

The patients will appreciate being examined and treated more effectively and without bias or unnecessary time delay.

This is the basic idea of FLUS in the clinical setting.

Feel free to contact USabcd if you have any supplementary questions or ideas on how we can improve the e-course.

Always be aware that lung ultrasound is a supplement to the clinical evaluation.

FLUS does not substitute a full diagnostic pulmonary examination.

The next step is to attend a FLUS hands-on workshop.

During the workshop you will obtain practical skills with a structured and systematic didactic approach:

• How to prepare the US machine
• How to chose the optimal preset and transducer
• How to display the 2D and M-mode LUS images
• How to perform a systematic focused LUS examination using scanning zones
• How to use focused LUS as a part of eFAST
• How to evaluate a patient for pneumothorax
• How to evaluate a patient for pleural effusion
• How to evaluate a patient for interstitial syndrome

The patients will benefit from your new knowledge because:

• FLUS is easily and quickly performed
• FLUS can be performed in any location
• FLUS can be performed with limited training
• FLUS can be applied in a wide range of clinical scenarios
• FLUS is a key tool for diagnosing and excluding the most common causes of respiratory failure

FLUS can be applied as a part of the eFAST in trauma and emergency medical conditions to identify pneumothorax and pleural effusion in blunt trauma and penetrating trauma, and thereby establish the need for possible emergency procedures.

During this e-course you have learned how to apply FLUS in the evaluation of patients with emergency respiratory problems.

You have learned:

• How to choose the optimal presets and transducers for FLUS
• How to recognise the normal sonographic signs of the lung and pleura
• How to generate the required FLUS images and signs
• How to perform a systematic FLUS examination using scanning zones
• How to perform FLUS as a part of eFAST
• How to recognise the most important pathology, including pneumothorax, pleural effusion, and interstitial syndrome
• How to use the findings in the clinical context

By completing the e-course successfully – verified by a high score in the final quiz – you are optimally prepared for and will be able to achieve the maximum benefit from a practical hands-on workshop.

In this lesson you have learned:

• Why you should use ultrasound for the evaluation of pleural fluid
• How to perform an ultrasound examination of the pleura on the right and the left sides
• How to confirm the presence of pleural fluid
• How to exclude the presence of pleural fluid
• How to estimate the volume of pleural effusion

You can review the lesson until you feel confident about the learning objectives.

Before you continue to the next lesson, there is a small quiz where you can test your new knowledge.

Patients with concomitant chronic pulmonary or circulatory diseases, or critically ill patients may clinically deteriorate in the presence of even relatively small pleural effusions.

Hence, the indication for a therapeutic thoracocenthesis depends on the patient’s clinical condition and not necessarily on the pleural effusion volume as estimated by FLUS.