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Lung Ultrasound in the Critically Ill
Lung Ultrasound in the Critically Ill discusses the basic technique and “signatures” of lung ultrasound and explains its main clinical applications. The tools and clinical uses of the BLUE-protocol, which allows diagnosis of most cases of acute respiratory failure, are described in detail. The protocols derived from the BLUE-protocol are also included: the FALLS-protocol for diagnosis and management of acute circulatory failure, the Pink-protocol for use in ARDS, and the SESAME-protocol for use in cardiac arrest – and to the LUCI-FLR program, a means of answering clinical questions while reducing radiation exposure.
Material from: Daniel A. Lichtenstein, LUNG ULTRASOUND IN THE CRITICALLY ILL published in 2015 by Springer reproduced with permission of SNCSC.
Author: Daniel A. Lichtenstein
Preliminary Note on Knobology. Which Setting for the BLUE-Protocol? Which Setting for the Other Protocols (FALLS, SESAME, etc.) and Whole Body Critical Ultrasound?
Step 1: The Image Acquisition
How We Hold the Probe Basically
The Elementary Movements
The Second Hand in Critical Ultrasound
Longitudinal or Transversal Scans?
Step 2: Understanding the Composition of the Image
Artifacts: One Basis of Lung Ultrasound
Dynamics: The Other Basis of Lung Ultrasound
Step 3: Image Interpretation
Impediments to Ultrasound Examination
The Seven Requirements We Ask of an Ultrasound Machine Devoted to Critical Care – A Short Version for the Hurried Reader
A Longer Version: The Seven Requirements We Ask of an Ultrasound Machine Devoted to Critical Care
The Coupling System: A Detail?
How to Practically Afford a Machine in One’s ICU
Should We Share a Unit Between Several Departments?
What Solutions Are There for Institutions Already Equipped with Laptop Technologies?
Which Machines for Those Who Work Outside the Hospital and in Confined Space?
The Solution for the Future
Some Basic Points and Reminders
Appendix 1: The PUMA, Our Answer to the Traditional Laptops
Which Equipment for the BLUE- Protocol 2. The Probe
The Critical Point to Understand for Deﬁning the “Universal Probe” in Critical Care: The Concept of the Providential (Optimal) Compromise
How to Scientiﬁcally Assess This Notion of “Domain of Interpretability”? Our High-Level Compromise Probe
Why Is Our Microconvex Probe Universal
The Strong Points of Having One Unique Probe
By the Way, Our Probe: Which Frequency?
The Usual Probes of the Laptop Machines
Some Doctors Prefer to Swap the Probes for Each Application, and Not Use the Universal Probe. Why?
Pericardial Tamponade: Time for a Nice Paradox, Just One Illustration of What is “Holistic Ultrasound”
What to Say to Those Who Still Have Only the Three Usual Probes?
An Unexpected (Temporary) Solution?
Important Notes Used as Conclusion
Disinfection of the Unit: Not a Futile Step
When Is It Time to Perform an Ultrasound Examination
Since When Do We Perform These Whole-Body Ultrasound Examinations: Some Historical Perspectives
Development of the First Principle: A Simple Method
Development of the Second Principle: Understanding the Air-Fluid Ratio and Respecting the Sky- Earth Axis
The Third Principle: Locating the Lung and Deﬁning Areas of Investigation
The Fourth Principle: Deﬁning the Pleural Line
The Fifth Principle: Dealing with the Artifact Which Deﬁnes the Normal Lung, the A-Line
The Sixth Principle: Deﬁning the Dynamic Characteristic of the Normal Lung, Lung Sliding
Development of the Seventh Principle: Acute Disorders Have Superﬁcial, and Extensive, Location
The Concept of the BLUE-Hands
Lung Zones, Their Relevance in the BLUE-Protocol, Their Combination with the Sky-Earth Axis for Deﬁning Stages of Investigation
Some Technical Points for Making Lung Ultrasound an Easier Discipline
Standardization of a Lung Examination: The BLUE-Point
Standardization of a Lung Examination: The Upper BLUE-Point
Standardization of a Lung Examination: The Lower BLUE-Point
Location of the Lung in Challenging Patients
Other Points? The Case of the Patient in the Prone Position
BLUE-Points and Clinical Information
Aside Note More Devoted to Pulmonologists
Philosophy of the BLUE-Points: Can the Users Do Without?
1. The pleural line
2. The A-line
3. Lung sliding
4–7. The quad sign, sinusoid sign, shred sign, and tissue-like sign
8. Lung rockets
9. Abolished lung sliding
10. The lung point
The Pleural Line: The Basis
Pleural Line and the Bat Sign
Variant of the Bat Sign
Subcutaneous Emphysema: The Mocelin Variant
Standardizing Lung Ultrasound: Merlin’s Space
Standardizing Lung Ultrasound: Keye’s Space
Standardizing Lung Ultrasound: The M-Mode-Merlin’s Space
The Artifact Which Defines the Normal Lung Surface: The A-line
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