Airway and Breathing ultrasound

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พญ.สุธาพร ล้ำเลิศกุล

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Airway and Breathing ultrasound

  1. 1. Sunday, November 14, 2010
  2. 2. Suthaporn Lumlertgul MD Emergency Unir KIng Chulalongkorn Hospital Sunday, November 14, 2010
  3. 3. Airway and Lung in Ultrasound Perspective Suthaporn Lumlertgul MD Emergency Unir KIng Chulalongkorn Hospital Sunday, November 14, 2010
  4. 4. Sunday, November 14, 2010
  5. 5. Detect intubation One Lung? Wet and Dry Dyspnea Sunday, November 14, 2010
  6. 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 Sunday, November 14, 2010
  7. 7. One lung intubation? Sunday, November 14, 2010
  8. 8. Sunday, November 14, 2010
  9. 9. Sunday, November 14, 2010
  10. 10. Sunday, November 14, 2010
  11. 11. Understand Lung Pulse Sunday, November 14, 2010
  12. 12. Sunday, November 14, 2010
  13. 13. Sunday, November 14, 2010
  14. 14. Sunday, November 14, 2010
  15. 15. Sunday, November 14, 2010
  16. 16. Sunday, November 14, 2010
  17. 17. Sunday, November 14, 2010
  18. 18. Sunday, November 14, 2010
  19. 19. Sunday, November 14, 2010
  20. 20. Sunday, November 14, 2010
  21. 21. Sunday, November 14, 2010
  22. 22. Lung Ultrasound Sunday, November 14, 2010
  23. 23. Lung Ultrasound It is really happening Sunday, November 14, 2010
  24. 24. • Normal Lung Picture • Air-Fluid Ratio • A-B-C.......Z of Lung Ultrasound • Wet VS Dry dyspnea (BLUE protocol) Pleuropulmonary Ultrasound Sunday, November 14, 2010
  25. 25. The ten signs of lung ultrasound in the critically ill : Lichtenstein Expert Rev. R esp. Med. 4(5), (2010) Sunday, November 14, 2010
  26. 26. Second Principle: Understand Air-Fluid Ratio Sunday, November 14, 2010
  27. 27. LUNG: Semiotics,Window, Pathologies Air Water Air Water Pleural effusion Pneumothorax Sunday, November 14, 2010
  28. 28. Locating area of investigation Sunday, November 14, 2010
  29. 29. Sunday, November 14, 2010
  30. 30. Air Fluid Sunday, November 14, 2010
  31. 31. Normal Lung Findings and Artifact Sunday, November 14, 2010
  32. 32. * * * * Sunday, November 14, 2010
  33. 33. Normal Lung Findings A line A line Pleural line * * Skin Sunday, November 14, 2010
  34. 34. Normal Lung Findings A line A line Pleural line * * Skin Sunday, November 14, 2010
  35. 35. Pneumothorax by Lung Ultrasound Sunday, November 14, 2010
  36. 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 Sunday, November 14, 2010
  37. 37. Sunday, November 14, 2010
  38. 38. Document Pneumothorax by M mode Sunday, November 14, 2010
  39. 39. M Mode of Normal lung * * Reference ; Lichtenstein D, General Ultrasound in the Critically ill. 1st Edition Sunday, November 14, 2010
  40. 40. M Mode of Normal lung * * Reference ; Lichtenstein D, General Ultrasound in the Critically ill. 1st Edition Sunday, November 14, 2010
  41. 41. M Mode of Normal lung * * Reference ; Lichtenstein D, General Ultrasound in the Critically ill. 1st Edition Sunday, November 14, 2010
  42. 42. M Mode of Normal lung * * Reference ; Lichtenstein D, General Ultrasound in the Critically ill. 1st Edition Sunday, November 14, 2010
  43. 43. Sunday, November 14, 2010
  44. 44. ** Strastrophere sign M Mode of Pneumothorax (or sometimes look like Barcode) 7 54 6 0 8 1 9 Sunday, November 14, 2010
  45. 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 Sunday, November 14, 2010
  46. 46. !" #$%"&$'(%)"*++,-" ./-,01/"/(%-" 2(3"4516$7" Comet tail Schematic drawing of Lung Sliding results in Granular effect below pleura line: Seashore sign in M Mode 2D M Sunday, November 14, 2010
  47. 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. Sunday, November 14, 2010
  48. 48. Detecting pulmonary edema by ultrasound bedside? Sunday, November 14, 2010
  49. 49. Sunday, November 14, 2010
  50. 50. Sunday, November 14, 2010
  51. 51. Transducer Multiple US Beam Reflections NORMAL INTERLOBULAR SEPTA Transducer THICKENED INTERLOBULAR SEPTA Multiple US Beam Reflections REVERBERATIONS NORMAL ARTIFACTS (A lines) REVERBERATIONS COMET TAILS (B lines) www.WINFOCUS.org Sunday, November 14, 2010
  52. 52. Sunday, November 14, 2010
  53. 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) * Sunday, November 14, 2010
  54. 54. Sunday, November 14, 2010
  55. 55. Sunday, November 14, 2010
  56. 56. Sunday, November 14, 2010
  57. 57. Sunday, November 14, 2010
  58. 58. Falls Protocol Sunday, November 14, 2010
  59. 59. Sunday, November 14, 2010
  60. 60. The BLUE protocol To differentiate acute pulmonary disease by bedside ultrasound application Sunday, November 14, 2010
  61. 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 Sunday, November 14, 2010
  62. 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 Sunday, November 14, 2010
  63. 63. Pleural Effusion Assessment by ultrasound Pleural line Curtain sign obliterate liver Liver Diaphragm Diaphragm Liver Effusion Lung Lung31 Sunday, November 14, 2010
  64. 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
  65. 65. Sunday, November 14, 2010

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