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Ultrasonography Fundamentals In Critical Care: Lung Ultrasound, Pleural Ultrasound, Other Potetial Utilities of Ultrasound

  1. Ultrasonography Fundamentals in Critical Care Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow University of Illinois Medical Center at Chicago
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  3. Bassel Ericsoussi, MD
  4. Normal Lung few Comet Tails in the lower lung zone Acute pulmonary edema closely spaced comet-tail artifacts Diffuse interstitial fibrosis comet-tail artifacts are 7 mm apart Bassel Ericsoussi, MD
  5. 7.5-10 MHz Superficial structures (vessels) 1.0-5.0 MHz Cardiac Lung Abdomen Bassel Ericsoussi, MD
  6. Lung Ultrasonography Bassel Ericsoussi, MD
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  9. Normal Lung few Comet Tails in the lower lung zone Acute pulmonary edema closely spaced comet-tail artifacts Diffuse interstitial fibrosis comet-tail artifacts are 7 mm apart Bassel Ericsoussi, MD
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  12. SEASHORE SIGN Bassel Ericsoussi, MD
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  14. STRATOSPHERE SIGN Bassel Ericsoussi, MD
  15. Using Ultrasound to Evaluate for a Pneumothorax American Academy of Emergency Medicine : Chan SSW et al Acad Emerg Med Jan 2003 Vol.10 1. Bassel Ericsoussi, MD Ultrasound Feature Patient Population Sensitivity Specificity No Lung Sliding 328 Surgical And Trauma 95.5% 100% No Lung Sliding 111 Medical ICU 95.3% 91.1% No B Lines “ Comet Tails” 114 Med-surgical Unit 100% 60% Combined 617 100% 96.5% Lung Point 233 Med-surgical Unit 66% 100%
  16. Probe Position for Right Sided Pleural Fluid Evaluation Bassel Ericsoussi, MD
  17. Normal View Right Pleura and Lung Bassel Ericsoussi, MD
  18. Sonographic Hepatization AIR BRONCHOGRAMS LIVER Bassel Ericsoussi, MD
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  21. Probe Position for Left Sided Pleural Fluid Evaluation Bassel Ericsoussi, MD
  22. Pleural Effusion Next to Left Diaphragm and Spleen PLEURAL EFFUSION LUNG SPLEEN DIPHRAGM Bassel Ericsoussi, MD
  23. THE SHRED LINE Bassel Ericsoussi, MD
  24. Lichtenstein et al. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. CHEST July 2008 vol. 134 no. 1 117-125 Anterior predominant bilateral B lines with lung sliding Anterior predominant bilateral A lines associated with lung sliding Scan zone 3 posterolateral chest wall looking for PLAPS posterolateral alveolar and/or pleural syndrome A/B: Anterior predominant B lines on one side, predominant A lines on the other C: Anterior alveolar consolidation Predominant bilateral B lines without lung sliding ??? Bassel Ericsoussi, MD
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  26. Lung Movement Lung Flapping Sign or Jelly Fish Sign Bassel Ericsoussi, MD
  27. Pleural Effusion with Alveolar Consolidation Bassel Ericsoussi, MD
  28. Pleural Effusion with Atelectasis Bassel Ericsoussi, MD
  29. Parapneumonic effusion with Thick Septations Bassel Ericsoussi, MD
  30. Complex Pleural Effusion with Septations caused by a Malignant Mesothelioma. Bassel Ericsoussi, MD
  31. The Role of Ultrasound in the Assessment of Pleural Effusion Bassel Ericsoussi, MD
  32. The Role of Ultrasound in the Assessment of Pleural Effusion Bassel Ericsoussi, MD
  33. The Role of Ultrasound in the Assessment of Pleural Effusion Bassel Ericsoussi, MD
  34. The Role of Ultrasound in the Assessment of Pleural Effusion Bassel Ericsoussi, MD
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  37. HEPATORENAL RECESS Bassel Ericsoussi, MD
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  39. Boussuges et al. Diaphragmatic Motion Studied by M-Mode Ultrasonography Methods, Reproducibility, and Normal Values. CHEST February 2009 vol. 135 no. 2 391-400 Diaphragm Movement and Contractility Evaluation by Thoracic Ultrasound Ultrasonography Determination of Diaphragmatic Excursion Bassel Ericsoussi, MD
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  42. Diaphragm inspiratory time Diaphragm expiratory time Diaphragm inspiratory amplitude Boussuges et al. Diaphragmatic Motion Studied by M-Mode Ultrasonography Methods, Reproducibility, and Normal Values. CHEST February 2009 vol. 135 no. 2 391-400 Bassel Ericsoussi, MD
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  44. The majority (66%) of lesions were seen in the posterior basal segments of the lung. Bassel Ericsoussi, MD
  45. 2 or more typical lesions 1 typical lesion + pleural effusion Small subpleural lesions (< 5 mm) or a single pleural effusion Bassel Ericsoussi, MD
  46. Results Thoracic ultrasound for diagnosing pulmonary embolism. Chest. 2005 Sep;128(3):1531-8 Bassel Ericsoussi, MD
  47. Transverse view showing ETT Bassel Ericsoussi, MD
  48. Longitudinal view showing ETT Bassel Ericsoussi, MD
  49. ETT Position Tube position OK Confirm with auscultation, ETCO2 Translaryngeal Ultrasound Tip visible Intratracheal Remove and reintubate May be too high, measure distance below VC Pleural Ultrasound Bilateral sliding pleura Unilateral sliding pleura Mainstem intubation Pull tube back 1-2 cm Yes Yes No No Bassel Ericsoussi, MD
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