Ultrasound in the critically ill : a simple idea for facing the extreme emergency and the daily routine in the I.C.U.
Left: tension pneumothorax on X-ray. Right: the A'-profile of BLUE-protocol, combining A-lines and abolished lung sliding. The lung point allows immediate life-saving chest tube insertion (1)
Substantial pleural effusions are often associated with misleading radiographies Thoracentesis can be performed safely, even in ventilated patients (4)
Immediate on-site diagnosis of hemoperitoneum - in a trauma patient (8)
Acute pulmonary edema. These lung rockets are part of the B-profile of the BLUEprotocol, allowing in a patient with acute respiratory failure, appropriate therapy (2)
The A-profile. In the FALLS-protocol, following a simple decision tree, such a pattern seen at step 3 in a circulatory failure allows for fluid therapy (6)
Pulmonary embolism. Left, A-lines (making, if associated with lung sliding, the A-profile of the BLUE-protocol). Right, venous thrombosis. The 99% specificity of this profile allows to envisage life-saving ultrasound-enhanced fibrinolysis (3)
Sinusogram: this pattern can avoid CT for the sole diagnosis of maxillary sinusitis (7)
Subclavian venous access: immediate and safe approach (5)
Simple Cardiac Sonography. Life-saving diagnoses can be obtained at the heart area (tamponade, RV dilatation, LV poor contractility) using simple modes (9). This analysis is the first step of the FALLS-protocol A textbook updated since 1992 (last update 2016)
Basic notions The training in critical ultrasound adapted to the ICU or ER is rapid Ultrasound provides information superior to that of radiography in ARDS (10) A simple, small machine, only one probe are adequate For etiologic diagnosis of acute respiratory failure, ultrasound provides 90.5% of correct diagnoses - the BLUE-protocol (11) General ultrasound of the heart exists (9) Lung ultrasound works perfectly in the neonate (12) Lung ultrasound allows hemodynamic management of a shocked patient (6)
Holistic ultrasound: A compact unit - One unique probe - No gel
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Some references (1) Intensive Care Med 26:1434-1440 (2) Am J Respir Crit Care Med 156:1640-1646 (3) Chest 123:2154 (4) Intensive Care Med 25:955-958 (5) Crit Care Med 24:2053-2058 (6) Chest 136:1014-1020 (7) Intensive Care Med 24:1057-1061 (8) J Trauma 51:545-550 (9) Lung Ultrasound in the Critically Ill, Springer-Verlag (2016) (10) Anesthesiology 100:9-15 (11) Chest 134:117-125 (12) Pediatr Crit Care Med 10:693-698
Cercle des Echographistes dʼUrgence et de Réanimation Francophones www.ceurf.net Next sessions: March 7, 2014 and July 4, 2014 (english)
