Argirios Argiriou notes on the video "Po int of Care Lung Ultrasound (PO CUS)"
https://www.youtube.com/watch?v=8V649L5Q368
0:29 B-lines can be because of Pulmonary Edema or because of Pneumonia
01:25 Linear probe but it works with other probes as well.
01:50 Scan preferably with the patient lying flat.
02:07 Place the probe across a couple of rib spaces.
02:35 If you see "walking ants" then you can say with 100% certainty that there is NO pneumothorax.
02:58 Comparison Pictures:
Pleural Interface: No sliding = It may be pneumothorax, it may be other things as well
Pleural interface: Normal sliding (Normal-sliding ("walking ants ") = 100% ingen pneumothorax)
( you must see carefully INTO the white line (the diaphragm). If there is move INTO the white line, then it is NORMAL SLIDING i.e. 100% no pneumothorax).
04:14 How to look for pleural effussion.
It is pretty easy to see, and it is very sensitive (more sensitive than x-rays).
You can use either a cardiac probe or a curvilinear (but he prefers a cardiac)
05:12 The probe indicator, by convention, towards the patients head (cranially)
Put the probe between the mid axillary and the post axillary line.
05:25 Find the liver and then aim the beam up to the chest.
06:10 - 06:37 ???
06:40 Left side
07:30 You want to find the spleen and it is similarly between the midaxillary and posterior axillary line.
08:14 ??? Since I do not see the spine under the diaphragm I feel pretty sure that there is no effusion.
08:26 ??? A different approach: Ask the patient to Breath deeply. If it is getting dark all over the screen it is air and there is essentially no effusion.
09:24 Picture with Pleural fluid (the spine continues past the diaphragm = "spine sign")
09:53 Picture with Liver, Pleural Effusion, Atelectatic Lung
10:35 A-lines B-lines
10:48 A- lines = normal
11:32 ?? If you see A-line you have ruled out pathology upp to the A-line, not deeper than that.
11:38 The probe must be perpendicular to the pleura in order to se A-lines.
11:47 B-lines (= vertical lines that are in motion back and forth = pathologic but you cannot say if it depends on pulmonary edema or on pneumonia).
12:15 B-lines must be in motion back and forth. If they are fixed in place then they are no B-lines.
12:20 ??? what is he saying???
12:36 Count the B-lines that you see. The more, the worse it is.
12:40 ??? The more place they take in the screen, the worse it is.
12:52 It is not an one defined way to scan the lungs.
(it depends on how sick the patient is)
14:20 The video instructor will use a cardiac probe here (for A-lines and B-lines) but he can use other probes as well.
14:24 Many machines now have a lung ultrasound setting (and that helps, it will settle your depth)
14:35 By convention, the probe indicator must point up (cranially). You place the probe between the rib spaces.
14:51 On the left side of the thorax the placement of the probe must avoid the heart, in order to get useful pictures.
15:20 It is not especially difficult technique. It is usually enough to have the probe perpendicular.
16:40 So, the technique is easy. The problem is how to interpret the findings.
You must use your clinical skills/clinical settings.
18:41 The End.
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