The Bottom Line on Point-of-Care Lung Ultrasound

 

intro-pocus-lungWhy Learn?

Lung ultrasonography has developed into an incredibly potent tool for the management of the breathless patient. Using a mix of analysis of actual images (effusions, consolidation, lung sliding) and the analysis of artefacts (A-lines, B-lines), in the right hands lung ultrasonography has sensitivity and specificity approaching CT scanning. And all done within 5-10 minutes at the bedside.

Limitations/Challenges

  • Access to training/trainers and maintaining competencies.
  • Debate remains around precise technique. Which probe- linear (for pleura), phased array, micro convex, or curvilinear? How many zones to scan- 6, 8, 12, 24?
  • Potential for overdiagnosis and overtreatment- arguably lung ultrasonography picks up clinically insignificant pneumonias and pneumothoraces.
  • To be performed properly it requires an ultrasound machine with all post processing (e.g. tissue harmonics) disabled. Not every unit has a machine that can do this.
  • It remains an integrative skill involving history and examination, as opposed to an imaging tool that provides all the answers. True mastery involves a careful analytical approach, and potentially multi-organ ultrasonography skills (especially cardiac).

Resources

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