LUS

1 – Equipment, preparation and skills


This includes:

Equipment – Ultrasound system:
– Ultrasound machine
– Transducer selection
– Preset selection
– Orientation marker (OM) presentation on screen (Left/Right)

Skills:
– Placement of the transducer, and finding the right windows
– Optimisation of the ultrasound image by changing depth, gain and focus
– Identify structures, and looking for pathology

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Schematic illustration of equipment needed for ultrasound examination

7 – Please provide feedback

USabcd continuously works to improve the quality of this e-course

As a part of this process the feedback provided by the users of the e-course is very important

Each slide has a box for comments where you can give your feedback regarding the content of the slide

Feel free to give us any feedback you may have

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6 – Learning objectives

Understanding and performing basic lung ultrasound requires knowledge about:

– How to prepare the ultrasound system

– How the lung, pleura and chest wall structures appear on the ultrasound screen in 2D and M-mode mode

– The basic sonographic signs and artefacts used in lung ultrasound

– How to perform a basic lung examination using scanning zones

– How to identify or rule out pneumothorax, pleural effusion, and interstitial syndrome

– How to use lung ultrasound as an integrated part of goal directed patient assessment

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The image shows the concept of the “bat-sign”

5 – Contents of the e-course

This e-course describes the clinical application of focused LUS (FLUS) in the evaluation of the critical care patient with respiratory problems

The course describes the use of ultrasound to include or exclude the presence of:
– Pneumothorax
– Pleural effusion
– Interstitial syndrome

Focused LUS should be an integrated part of goal directed patient assessment

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The image shows FLUS being used to evaluate the patient for a possible pneumothorax

4 – Definitions

The terms point-of-care and focused ultrasonography are often used in medical literature

Point-of-care ultrasonography can been defined as ultrasonography brought to the patient and performed by the provider in real time

Often the term focused ultrasound is used in the same context; it can be defined as ultrasonography performed in a focused manner in order to answer specific and clinically relevant yes/no questions

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The image demonstrates an ultrasound machine prepared for point-of-care ultrasonography in the OR

3 – Focused LUS (FLUS)

LUS is among the most innovative ultrasound applications

The latest developments in LUS are based on the interpretation of a few signs (mostly artefacts) rather than on technological advances

It is especially interesting for intensivists, emergency medicine physicians, respiratory physicians, pulmonologists, anesthesiologists, and radiologists

We call the use of lung ultrasound in emergency and critical care patient care “Focused Lung Ultrasound” (FLUS)

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Image demonstrates one of the important LUS artifacts: the B-line

2 – The clinical use of LUS

LUS can be used in a broad range of clinical settings: as a diagnostic tool, for procedure guidance, and for monitoring

Examples of some of the conditions in which LUS can be used to diagnose and monitor:
– Pneumothorax
– Pleural effusion
– Interstitial syndrome
– Alveolar consolidation (pneumonia and pulmonary embolism)*
– Atelectasis*
– Pulmonary contusion*

Examples of LUS guided procedures:
– Guidance in pleural drainage*
– Intubation guidance*

* Not covered in this focused LUS module

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The video demonstrates a large right sided pleural effusion

1 – Introduction to lung ultrasound (LUS)

In recent years, lung ultrasound has become popular as a clinical point-of-care tool in a variety of settings

The application of ultrasound for lung diagnostics has been considered impossible due to the air content of the normal aerated, as opposed to the sonographic examination of e.g. muscular and subcutaneous tissue not containing air

Deeply situated and aerated chest structures covered by bone can easily be examined with conventional ionising techniques like conventional X-ray and computed tomography (CT)

This accessibility of alternative techniques has been an obstacle to the development of lung ultrasound

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The image demonstrates lung ultrasound of the left hemithorax