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I love love LOVE scanning the heart 😍, but when it comes to bang for your buck for ultrasound novices, lung ultrasound is such a winner 🏆
It's time for another #POCUS basics #tweetorial 🧵
Let's talk about common pitfalls in #LungUltrasound and how to correct these ✔️ x.com
I love love LOVE scanning the heart 😍, but when it comes to bang for your buck for ultrasound novices, lung ultrasound is such a winner 🏆
It's time for another #POCUS basics #tweetorial 🧵
Let's talk about common pitfalls in #LungUltrasound and how to correct these ✔️ x.com
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First, let's talk about probe selection.
You simply cannot scan the entire lung in adults with the linear probe - it doesn't give you enough depth ❌
The clips in this 🧵 are done with the phased array (abdo preset), but my current preference is the curvilinear for better pleural visualization 👀
First, let's talk about probe selection.
You simply cannot scan the entire lung in adults with the linear probe - it doesn't give you enough depth ❌
The clips in this 🧵 are done with the phased array (abdo preset), but my current preference is the curvilinear for better pleural visualization 👀
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The generation of artifacts - like A and B lines - and the proper visualization of lung pathology depends on having our beam perpendicular to the pleura ⬇️
And - the contour of the pleura is not always the same as the contour of the chest wall!
This is what happens if we're NOT perpendicular:
The generation of artifacts - like A and B lines - and the proper visualization of lung pathology depends on having our beam perpendicular to the pleura ⬇️
And - the contour of the pleura is not always the same as the contour of the chest wall!
This is what happens if we're NOT perpendicular:
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The key movement in #LUS is therefore FANNING 💨
If you are seeing a non-A non-B pattern (sometimes called Z lines), FAN your beam until the pleura becomes crisp and you see one of our 4 patterns ✔️
This is the same clip: but now with some adjustment, we see that it's full of B lines!
The key movement in #LUS is therefore FANNING 💨
If you are seeing a non-A non-B pattern (sometimes called Z lines), FAN your beam until the pleura becomes crisp and you see one of our 4 patterns ✔️
This is the same clip: but now with some adjustment, we see that it's full of B lines!
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Another very common trouble spot are the dependent views - also called the PLAPS points.
This is where pathology likes to hide, especially in bedbound patients 🛌
Here, we always need to visualize 3 things:
- the intra-abdominal organ
- the diaphragm
- the lung
Another very common trouble spot are the dependent views - also called the PLAPS points.
This is where pathology likes to hide, especially in bedbound patients 🛌
Here, we always need to visualize 3 things:
- the intra-abdominal organ
- the diaphragm
- the lung
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Commonly, a rib gets in the way here and obscures the diaphragm.
Do your best to adjust to optimize visualization: sliding or rotating your probe, or moving rib spaces, can help ↪️ x.com
Commonly, a rib gets in the way here and obscures the diaphragm.
Do your best to adjust to optimize visualization: sliding or rotating your probe, or moving rib spaces, can help ↪️ x.com
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It's also very common in these views to be too anterior with the probe - especially on the left!
The spleen is always more superior and posterior than you think ❗
If you are seeing heterogenous stuff (stomach/bowel) instead of a nice homogenous spleen, slide posterior and superior
It's also very common in these views to be too anterior with the probe - especially on the left!
The spleen is always more superior and posterior than you think ❗
If you are seeing heterogenous stuff (stomach/bowel) instead of a nice homogenous spleen, slide posterior and superior
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Make sure you're also giving yourself enough depth in these dependent views to properly see the diaphragm.
This is often 15-21cm in adults, though of course this can vary x.com
Make sure you're also giving yourself enough depth in these dependent views to properly see the diaphragm.
This is often 15-21cm in adults, though of course this can vary x.com
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Next - don't be fooled by the ribs! 🩻
The ribs themselves can actually generate "A lines" (as they are a specular reflector).
Remember that the pleural line always lies deep to the ribs x.com
Next - don't be fooled by the ribs! 🩻
The ribs themselves can actually generate "A lines" (as they are a specular reflector).
Remember that the pleural line always lies deep to the ribs x.com
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Finally, I'd be remiss not to mention the importance of scanning the entire lung.
Don't be the person who takes only 1 clip of 1 rib space! 🤦♀️
The exact protocol you use matters less; but make sure you are scanning enough points to get a good representation of pathology throughout both lungs 👩⚕️
Finally, I'd be remiss not to mention the importance of scanning the entire lung.
Don't be the person who takes only 1 clip of 1 rib space! 🤦♀️
The exact protocol you use matters less; but make sure you are scanning enough points to get a good representation of pathology throughout both lungs 👩⚕️
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Again, there's lots more to talk about here - and we actually have a whole screencast about it on the ubcimpocus website! 🤩
ubcimpocus.com
Again, there's lots more to talk about here - and we actually have a whole screencast about it on the ubcimpocus website! 🤩
ubcimpocus.com
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Thanks for reading! 🙏
Drop your favourite #LungUltrasound teaching pearls here ⬇️
#MedTwitter #POCUSTwitter #tweetorial #FOAMed
Thanks for reading! 🙏
Drop your favourite #LungUltrasound teaching pearls here ⬇️
#MedTwitter #POCUSTwitter #tweetorial #FOAMed
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