The document discusses the use of point-of-care ultrasound (POCUS) for diagnosing respiratory issues like dyspnea, chest pain, or shock, with emphasis on the Blue Protocol. It details probe selection and interpretation of ultrasound findings, including lung sliding, B lines, and A/B profiles to diagnose conditions such as pneumonia and pulmonary edema. The information aims to enhance clinical integration and effective decision-making in emergency and critical care settings.

1. POCUS for dyspnea
Hye Won Kim

2. • 참고:
• https://www.youtube.com/watch?v=K2ZLjv8I2-U
• http://famus.org.uk/modules/blue-protocol
• Review: Clinically integrated multi-organ POCIS for
undiff respiratory difficulty, chest pain, or shock :
critical
• International evidence based rec for POCUS lung

3. Choice of probe
• individual choice
• curvilinear (abdominal probe)
• high frequency vascular probe
• greater resolution
• to initially determine the presence of lung sliding
• to see the fairly superficial pleural surface.

4. The BLUE points

5. BLUE Protocol

7. BLUE Protocol

8. Lung point

9. BLUE Protocol
non ventilating lung (absent
lung sliding, in this case due
to dense consolidation) with
evidence of increased lung
water/inflammation
evidenced by B lines
=> then the diagnosis is
pneumonia (B’ profile)

10. BLUE Protocol
if A lines are seen on one side
and B lines on the other, then
the diagnosis should be
pneumonia (the A/B profile).
Again, this makes sense; a
unilateral increase in lung
water/inflammation indicated
by B lines is only likely to be
caused by a local process (eg
pneumonia).The other
diagnosis that can be made at
this point is if anterior
consolidation is seen (C profile)

11. BLUE Protocol

12. A simplified version of the BLUE protocol (+sliding)

13. BLUE Protocol

14. The PLAPS point
• move from the lower BLUE point around the chest
wall to approximately the posterior axillary line
PLAPS represents posterior and/or lateral alveolar and/or pleural syndrome.
In other words, the presence of consolidation or pleural effusion at the postero-lateral
aspect of the lung.

15. Bat sign

16. Probe positions

17. B-pattern : Diffuse interstitial
syndrome
• Pulmonary edema
• Cardiogenic
• Non-cardiogenic (ARDS): pleural line, spared area,
absence of lung sliding, consolidation
• Diffuse parenchymal lung disease
• Pulmonary fibrosis
• Interstitial pneumonia or pneumonitis

19. Multi organ POCUS
Ha and Toh Journal of Intensive care (2016) 4:54