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Marek Nalos: Lung: The Final Frontier
 

Marek Nalos: Lung: The Final Frontier

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Marek Nalos gives us the finer details of using ultrasound as a diagnostic tool for respiratory illness.

Marek Nalos gives us the finer details of using ultrasound as a diagnostic tool for respiratory illness.

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    Marek Nalos: Lung: The Final Frontier Marek Nalos: Lung: The Final Frontier Presentation Transcript

    • Lung Ultrasound Marek Nalos Department of Intensive care Nepean Hospital Penrith, NSW AUSTRALIA
    • Chest space - the final frontier • These are the voyages of the starship Ultrasound • Its continuing mission: – to explore strange new pictures – to seek out life – and new meanings • To boldly go where only horse has gone before
    • Normal lung - no lung image just artifacts just artifacts • Soft tissue/air interface 99% of ultrasound waves is reflected • Lung is full of air if normal so ultrasound cannot be used to image healthy lung, only the pleura • But... – with disease process lung loosing aeration – less US beam reflection and more penetration
    • Normal lung = air Reverberation artifact Reverberation artifact QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. A - line pleural line A - line rib shadow rib shadow
    • Asthma lung - anterior QuickTime™ and a H.264 decompressor are needed to see this picture. A - line Pleura
    • Normal - A profile - lung base QuickTime™ and a H.264 decompressor are needed to see this picture. Diaphragm Liver Lung Spine Curtain sign
    • Lung consolidation Contiguous B-lines B-lines, (lung rockets) Daniel Lichtenstein et al. Anesthesiology 2004
    • QuickTime™ and a decompressor are needed to see this picture. rib shadow rib shadow Wet lung = air/fluid interfaceReverberation artifact B - line
    • 10 Non cardiogenic pulmonary oedema QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
    • cardiogenic pulmonary oedema anterior QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture. right left
    • QuickTime™ and a H.264 decompressor are needed to see this picture. lung base QuickTime™ and a Microsoft Video 1 decompressor are needed to see this picture. spleen left kidney lung lung liver right left
    • QuickTime™ and a decompressor are needed to see this picture. Spleen Consolidated lung Vertebral column Diaphraghm
    • Consolidation - solid tissue QuickTime™ and a decompressor are needed to see this picture. Right lung base rib artifact
    • Consolidation - solid tissue QuickTime™ and a decompressor are needed to see this picture. Left lung base No pleural sliding
    • Lung consolidation - air bronchgrams QuickTime™ and a decompressor are needed to see this picture.
    • • sensitivity - 93.4% (95% CI, 89.2%-96.3%) • specificity - 97.7% (95% CI, 93.4%-99.6%) • Positive LR - 40.5 (95% CI, 13.2-123.9) • Negative LR - 0.07 (95% CI, 0.04-0.11) • A combination of auscultation and LUS increased the positive LR to 42.9 (95% CI, 10.8-170.0) and decreased the negative LR to 0.04 (95% CI, 0.02-0.09) Lung Ultrasound in the Diagnosis and Follow-up of Community-Acquired Pneumonia: A Prospective, Multicenter, Diagnostic Accuracy Study Angelika Reissig, MD; Roberto Copetti, MD; Gebhard Mathis, MD; Christine Mempel; Andreas Schuler, MD; Peter Zechner, MD; Stefano Aliberti, MD; Rotraud Neumann, MD; Claus Kroegel, MD, PhD; Heike Hoyer, MSc
    • Differentiating viral and bacterial pneumonia in children
    • Fluid bronchograms -Tracheo- esophageal fistula QuickTime™ and a decompressor are needed to see this picture.
    • Diseased lung QuickTime™ and a decompressor are needed to see this picture. pleural line B-line pleural effusion consolidation
    • Pneumothorax • Absence of lung sliding • Absence of any B-line • Potential presence of a lung point
    • Pneumothorax Lung point Lung point QuickTime™ and a decompressor are needed to see this picture. Curtesy of Dr. Martin Balik
    • Ruling out pneumothorax after subclavian line insertion QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. Presence of pleural sliding or B-lines rules out pneumothorax with 100% accuracy pleural sliding + _
    • Pleural effusion QuickTime™ and a Cinepak decompressor are needed to see this picture.
    • Differentiate basal lung field opacities on portable CXR QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture.
    • Parapneumonic effusion QuickTime™ and a Cinepak decompressor are needed to see this picture.
    • Empyema QuickTime™ and a Cinepak decompressor are needed to see this picture.
    • 28 QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture. Pneumonia - legionella QuickTime™ and a decompressor are needed to see this picture. detail
    • 51 post Tetralogy of Fallot repair acute on chronic respiratory failure
    • QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
    • 31 QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
    • 74 yrs old lady - Nissen fundoplication postoperative acute respiratory failure
    • 33 Perforated oesophagus QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
    • Mediastinitis QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
    • 21 yrs old boy - dyspnoea, can’t raise left arm
    • QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
    • 37 QuickTime™ and a Photo - JPEG decompressor are needed to see this picture. QuickTime™ and a Photo - JPEG decompressor are needed to see this picture.
    • Case • 20 y old driver, multitrauma –mild head injury –rib fractures, lung contusions, haemopneumothorax, –liver laceration and ankle fractures • One week in ICU, still intubated, febrile, sudden desaturation, tachycardia, hypotension, tachypnoea
    • QuickTime™ and a Microsoft Video 1 decompressor are needed to see this picture. • Echocardiography demonstrates normal LV and RV function and size
    • In the meantime, CXR arrived...?
    • QuickTime™ and a Microsoft Video 1 decompressor are needed to see this picture. Blunt chest trauma - sudden hypoxia. Left lower lung collapse Bronchoscopy - removal of thick sputum plug from left lower lobe bronchus
    • Failure to wean QuickTime™ and a H.264 decompressor are needed to see this picture. QuickTime™ and a H.264 decompressor are needed to see this picture. QuickTime™ and a H.264 decompressor are needed to see this picture.
    • 43 H1N1 - ARDS - TOE QuickTime™ and a decompressor are needed to see this picture.
    • You can’t hide from the frontier
    • The beautiful frontier is close and all you need is to look
    • Lung ultrasound is feasible • Bedside, point of care test • Quick, easy to repeat • No radiation exposure • Dynamic nature – visualization of pleural/lung interface during inspiration and expiration
    • Lung ultrasound in ICU • Often more useful then CXR • Steep learning curve • Provides quick answers to simple clinical questions arising from history and clinical examination • - in parallel
    • Iris Ting Daniel Lichtenstein
    • Thank you