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Airway and Breathing ultrasound

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พญ.สุธาพร ล้ำเลิศกุล

พญ.สุธาพร ล้ำเลิศกุล

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Airway and Breathing ultrasound Airway and Breathing ultrasound Presentation Transcript

  • Sunday, November 14, 2010
  • Suthaporn Lumlertgul MD Emergency Unir KIng Chulalongkorn Hospital Sunday, November 14, 2010
  • Airway and Lung in Ultrasound Perspective Suthaporn Lumlertgul MD Emergency Unir KIng Chulalongkorn Hospital Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Detect intubation One Lung? Wet and Dry Dyspnea Sunday, November 14, 2010
  • 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
  • One lung intubation? Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Understand Lung Pulse Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Lung Ultrasound Sunday, November 14, 2010
  • Lung Ultrasound It is really happening Sunday, November 14, 2010
  • Pleuropulmonary Ultrasound • Normal Lung Picture • Air-Fluid Ratio • A-B-C.......Z of Lung Ultrasound • Wet VS Dry dyspnea (BLUE protocol) Sunday, November 14, 2010
  • The ten signs of lung ultrasound in the critically ill : Lichtenstein Expert Rev. R esp. Med. 4(5), (2010) Sunday, November 14, 2010
  • Second Principle: Understand Air-Fluid Ratio Sunday, November 14, 2010
  • LUNG: Semiotics, Window, Pathologies Air Pneumothorax Air Water Water Pleural effusion Sunday, November 14, 2010
  • Locating area of investigation Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Air Fluid Sunday, November 14, 2010
  • Normal Lung Findings and Artifact Sunday, November 14, 2010
  • * * * * Sunday, November 14, 2010
  • Normal Lung Findings Skin Pleural line * * A line A line Sunday, November 14, 2010
  • Normal Lung Findings Skin Pleural line * * A line A line Sunday, November 14, 2010
  • Pneumothorax by Lung Ultrasound Sunday, November 14, 2010
  • 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 tail Comet 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. Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Document Pneumothorax by M mode Sunday, November 14, 2010
  • M Mode of Normal lung * * Reference ; Lichtenstein D, General Ultrasound in the Critically ill. 1st Edition Sunday, November 14, 2010
  • M Mode of Normal lung * * Reference ; Lichtenstein D, General Ultrasound in the Critically ill. 1st Edition Sunday, November 14, 2010
  • M Mode of Normal lung * * Reference ; Lichtenstein D, General Ultrasound in the Critically ill. 1st Edition Sunday, November 14, 2010
  • M Mode of Normal lung * * Reference ; Lichtenstein D, General Ultrasound in the Critically ill. 1st Edition Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • M Mode of Pneumothorax * * Strastrophere sign (or sometimes look like Barcode) 74 5 6 0 8 1 9 Sunday, November 14, 2010
  • B B A Soft tissue Soft tissue Pleural line Pleural line A: Stratrophere Sign. B; Gliding of pleura results in Granular pattern which are seperated by white pleural line are called “Seashore sign” Sunday, November 14, 2010
  • 2D M !" #$%"&$'(%)"*++,-" ./-,01/"/(%-" 2(3"4516$7" Comet tail Schematic drawing of Lung Sliding results in Granular effect below pleura line: Seashore sign in M Mode Sunday, November 14, 2010
  • 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
  • Detecting pulmonary edema by ultrasound bedside? Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Transducer Transducer Multiple US Beam Multiple US Beam Reflections Reflections NORMAL THICKENED INTERLOBULAR INTERLOBULAR SEPTA SEPTA REVERBERATIONS REVERBERATIONS NORMAL ARTIFACTS (A lines) COMET TAILS (B lines) www.WINFOCUS.org Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • B line: To detect interlobular septal thickening, infiltration Pleural line * * * * * *= 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 DIfferential Diagnosis of B line: Cardiogenic Pulmonary Edema, ARDS, Pneumonia, Lung Contusion (Trauma) Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • Falls Protocol Sunday, November 14, 2010
  • Sunday, November 14, 2010
  • The BLUE protocol To differentiate acute pulmonary disease by bedside ultrasound application Sunday, November 14, 2010
  • 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
  • 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
  • Pleural Effusion Assessment by ultrasound Lung Curtain sign obliterate liver Pleural line Effusion 31 Liver Liver Lung Diaphragm Diaphragm Sunday, November 14, 2010
  • Pleural Effusion Assessment by ultrasound LUNG ABDOMEN 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 Roch A, CHEST 2005 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 Vignon P, CRIT CARE 2005. Mark best puncture point, fixed patient position. www.WINFOCUS.org Sunday, November 14, 2010
  • Sunday, November 14, 2010