Recorded: December 2020

Part of the Online Lecture Series on Rapid practical Ultrasound for everyday General & Emergency Medicine

CONTENT DESCRIPTION

Session 2: Beyond Thoracic FAST - Lung & Pleural Space Point-of-Care Ultrasound

Lecture 1 (60min): Point-of-Care Ultrasound in Small Animal Practice Made Easy:  How to ultrasound the Pleural Space & Lung

Ever struggle with determining the cause of dyspnea in a cat that is too unstable to take radiographs or draw blood for ProBNP levels (cardiac, respiratory, pleural effusion)? Ever debate if you should discontinue IV fluids in the patient with mild tachypnea? Have you ever felt frustration at not finding a cause for patients presenting for “ain’t doing right” with no specific clinical signs? Point-of-care ultrasound (POCUS) can help you manage these patients! Using a binary approach to ask the right question at the right time makes learning and applying pleural space and lung ultrasound easy! POCUS techniques are rapid, easy-to-learn and practical ultrasound skills that ANY practitioner can apply in everyday practice. This interactive, banter filled co-lecture (by an internist and a criticalist that rarely agree on anything) will cover the core principles to understand and interpret sonographic findings of the pleural space and lung. Following a binary approach, the key principles of the bat sign, gator sign, glide sign, A lines, B lines, lung pulse, and curtain sign, dry lung and wet lung will be covered: These are all things that can be used by general practitioners in everyday practice. If you own an ultrasound machine, there is no excuse to not apply these principles on a daily basis!

OBJECTIVES:

• Describe the key anatomic structures that are essential to performing pleural space and lung ultrasound
• Identify the pleural line and determine the presence or absence of a glide sign
• Explain the normal findings of the bat sign, gator sign, A lines, B lines, lung pulse and curtain sign
• Discuss the advantages of using a binary approach to identifying pathology with point-of-care ultrasound
• Explain the limitations of pleural space and lung point-of-care ultrasound

Lecture 2 (60min): Point-of-Care Ultrasound in Small Animal Practice Made Easy:  Paradigm shifts in diagnosing Pneumothorax, Pleural Effusion & Lung Pathology.

Recent studies have demonstrated very poor to moderate agreement between Thoracic Focused Assessment with Sonography for Trauma (Thoracic FAST) protocols and CT scans when it comes to diagnosis pleural effusion and pneumothorax, and to some extent, lung pathology. This should not be the case! Using a binary approach, assessing the patient and asking the right clinical question based on clinical findings increases diagnostic accuracy, and makes point-of-care ultrasound rapid and easy to learn! This lecture, which will again be a banter filled co-lecture by a small animal internist (always has 100 diagnoses for every problem) and a small animal criticalist (rarely believes the internist is correct), will focus on a practical approach to point-of-care ultrasound that considers clinical findings and challenges current protocols by asking the question; “where will pathology accumulate” and subsequently, “what should we be sonographically looking for to answer binary, relevant, rapid, clinical, and often lifesaving questions”. Don’t simply put the probe on the patient or expect a “one protocol fits all” approach to be applicable to all situations; ask the right question and know how to modify protocols to increase the chance of success with pleural space and lung pathology!

OBJECTIVES:

• Explain why ultrasound protocols should be modified based on patient positioning and the pathology suspected
• Explain recent modifications to point-of-care pleural space ultrasound techniques designed to maximize diagnostic accuracy of pneumothorax
• Describe newer approaches to pleural space ultrasound designed to maximize diagnostic sensitivity for pleural effusion
• Explain the advantage of turning the probe parallel to the ribs vs. keeping it perpendicular to the ribs
• Explain the sail sign and ski slope sign in relation to positive and negative findings of pleural effusion
• Describe how to find lung borders to maximize the chances of finding pleural space pathology based on patient positioning
• Explain the difference and be able to identify wet lung vs. dry lung using ultrasound