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POCUS Made Easy: Lung

Lung Ultrasound Examination looks for pulmonary pathology including acute pulmonary oedema, pneumonia, pleural effusion, pleural abnormalities such as pneumothorax


Pre-reading

1. Rt Anterior Superior Chest

  • Labelled RIGHT ANT SUP
  • Longitudinal view 
  • Demonstration of pleural sliding
  • Demonstration of lung field (most sensitive for pneumothorax assessment) 

2. Rt Anterior Inferior Chest

  • Labelled RIGHT ANT INF 

3. Rt Lateral Superior Chest • Labelled RIGHT LAT SUP 

4. Rt Lateral Inferior Chest

  • Labelled RIGHT LAT INF
  • + assess lung-diaphragm interface (more sensitive for dependent lung pathology) 

5 to 8. Same as Above on Left Chest *LEFT 

POCUS made easy LUNG

Image Sets

  • Minimum 10 Video Loops
    • 8x Lung Field (4 each side)
    • 2x Pleural Assessment (1 each side)
  • 10-14 Video Loops +/- 2 Images
  • Optional extra views including:
    • Posterior Inferior and Superior Views
    • Focussed views to highlight Pathology

Machine Settings

  • CURVILINEAR Probe 
  • LUNG setting for all images 

Documentation – POCUS LUNG

  • Views: Adequate/ Inadequate
  • Findings: NAD / Abnormal
  • Pleura: NAD / Abnormal (no pleural sliding / lung point / barcode sign on M-Mode / thickened/ irregular)
  • Lung Fields: NAD / Abnormal (B-Lines / Effusion / Hepatisation / Shred Sign / Other – and describe)

Anatomical views
Pleura Assessment with A Line (Reverberation artefact in normal aerated lung)
Pleura Assessment with A Line (Reverberation artefact in normal aerated lung)
Lung Field Assessment with B Line (Reflection artefact, <3 B Lines is normal)
Lung Field Assessment with B Line (Reflection artefact, <3 B Lines is normal)
Lung Pulse normal rhythmic movement of Pleura from transmitted cardiac vibrations
Lung Pulse normal rhythmic movement of Pleura from transmitted cardiac vibrations

Diagnostic Flow Chart
POCUS made easy lung flow chart

Positive Findings (always consider clinical context) 

References and Further reading

[cite]

POCUS

made easy

MBChB FACEM CCPU. Emergency Physician at Bendigo Hospital and Royal Melbourne Hospital, Victoria. Australia.
I studied in Scotland before completing my Emergency Medicine training in Melbourne. I have a big interest in point-of-care ultrasound use and training in Emergency Medicine. I'm also interested in Choosing Wisely and sustainability initiatives in healthcare.
In my free time you'll find me playing tennis and soccer, or heading outdoors on camping trips.

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