Understanding when to image the lung in point-of-care ultrasound (POCUS)

After watching this video, you will understand the indications for lung ultrasound in point-of-care ultrasound (POCUS).

This video was taken from our POCUS Essentials course taught by Viveta Lobo, MD who is an attending emergency medicine physician and Associate Director, Emergency Ultrasound Fellowship at Stanford University Medical Center in California, USA.

Check out the course by registering for a free trial account!

[00:00:00] It was not that long ago when you considered lung ultrasound impossible. We thought that due to air impeding your ultrasound beams, you couldn't actually visualize your lung on ultrasound. But over the last few years, due to some innovative research work. We've actually realized that you can, in fact, ultrasound lung tissue and what you're going to look at is the artifacts that's created by different pathology states. Lung ultrasound has rapidly

[00:00:30] progressed over the last few years and has now become essential, especially when managing critically ill patients. Let's start with a case. You have an elderly female with a history of CHF and metastatic cancer. She comes in with a fever and a cough. On your physical, you noticed that she's hypotensive and febrile. You get a chest x-ray that really is unremarkable for any obvious pathology. You send off some blood work and you're waiting for those results. Instead of waiting,

[00:01:00] you go ahead and perform a lung ultrasound. Assuming you knew how to do a lung ultrasound, you obtained this image. While you're going to shortly learn how to interpret it, for now, let me tell you. What you're looking at is a complex right pleural effusion. This patient's effusion was later confirmed to be infected. So, why didn't you see it on her chest x-ray? That's because on plain radiology film, you need at least 250 mL of pleural fluid to be detected

[00:01:30] on x-ray versus only 20 mL of fluid to be detected on your ultrasound. So, what else can you diagnose on lung ultrasound? Well, we've talked about pleural effusions, you can also see focal consolidations such as those caused by pneumonia, a pulmonary infarctions, a pneumothorax or interstitial syndrome caused by pulmonary edema or ARDS.