Page 43 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars

ABCDE of prehospital ultrasonography 41
2
7
A-profile with DVT(c)
. lung sliding
. A-lines(a)
. DVT
. NO lung sliding – lung sliding abolished by separation of the visceral pleura from the parietal pleura
Pulmonary embolism
8 A’-profile
Anterior chest wall
Pneumothorax when the mandatory ‘lung point’(e) is visualized
A-profile with-
. A-lines(a) – an indication of the presence of air below the parietal pleura . lung sliding
. A-lines(a)
. no DVT
out DVT and 9 no PLAPS
Asthma or COPD
(nude profile)
. no PLAPS
This table is an adaptation of the work by Lichtenstein.39
The bedside lung ultrasound in emergency (BLUE) protocol defines nine profiles. They are defined by their sonographic appearance and are associated with the different diagno- ses as described in the right-most column.
a. A-lines – horizontal repetition of the pleural line appearing below the pleural line at multiples of the skin-pleural line distance. Their appearance is an indication of air below the parietal pleura, either in or outside of the lung. They are particularly apparent in the absence of B-lines potentially obscuring the A-lines.
b. B-lines – a long, well-defined, hyperechoic comet-tail artifact arising from the pleural line that obliterates the A-lines.
c. DVT – deep venous thrombosis. Has to be separately found or excluded at the lower extremities
d. PLAPS – posterolateral alveolar and/or pleural syndrome (posterolateral consolidations or pleural effusions)
e. Lung point – the location where the visceral pleura is only partially in contact with the parietal pleura. With respirations, the A’ profile (without lung rockets) is inter-
mittently replaced with the A profile (lung rockets are possible). The lung point is a pathognomonic sign for the diagnosis of pneumothorax! This is displayed in Video 2.1.
Video 2.1 Ultrasound video clip of the lung point
The part of the lung and visceral pleura that is still in contact with the parietal pleura is seen in the left side of the video clip. The right side of the clip shows the signs of a
pneumothorax. The point where contact is lost, is called the lung point. With breathing, this point shifts back and forth. Watch the video at https://bit.ly/thelungpoint/