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Ultrasonography  Fundamentals in Critical Care Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow University of Illinois Medical Center at Chicago
[object Object],[object Object],Bassel Ericsoussi, MD
Ultrasonography  Fundamentals in Critical Care ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Introduction cont. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Echogenicity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
Modes ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Image Artifacts ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Artifacts cont. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
Artifacts cont.  B lines/Comet-Tail Artifacts  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Explanation Of The Formation Of The B-lines (Comet-tail Artifact).  ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Normal Lung few Comet Tails in the lower lung zone Acute pulmonary edema closely spaced comet-tail artifacts Diffuse interstitial fibrosis comet-tail artifacts are 7 mm apart Bassel Ericsoussi, MD
Artifacts cont. ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Artifact cont. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lichtenstein et al. The comet tail artifact: an ultrasound sign of alveolar-interstitial syndrome.  Am J Respir Crit Care Med 1997;156,1640-1646 Bassel Ericsoussi, MD
Artifacts cont. ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Probes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
7.5-10 MHz Superficial  structures (vessels) 1.0-5.0 MHz Cardiac Lung Abdomen Bassel Ericsoussi, MD
Penetration vs. Resolution ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Knobology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Disadvantages of US ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Ultrasonography  Fundamentals in Critical Care ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Lung Ultrasonography Bassel Ericsoussi, MD
Lung Ultrasonography Compared to Chest Radiography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Lung Ultrasonography Compared to Chest CT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lichtenstein D et al. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004 Jan;100(1):9-15. Bassel Ericsoussi, MD
Advantages of Lung Ultrasonography ,[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Equipment Requirement ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Technique ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Ultrasonographic Findings in Normal Lung ,[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Sliding Lung Sign ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Pleural Line ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
A Lines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
B-lines/Comet-Tail Artifacts Lung Rockets ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Normal Lung few Comet Tails in the lower lung zone Acute pulmonary edema closely spaced comet-tail artifacts Diffuse interstitial fibrosis comet-tail artifacts are 7 mm apart Bassel Ericsoussi, MD
E-lines ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Ultrasound Assessment for Extravascular Lung Water in Patients Undergoing Hemodialysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Noble et al. Ultrasound Assessment for Extravascular Lung Water in Patients Undergoing Hemodialysis. Time Course for Resolution. CHEST June 2009 vol. 135 no. 6 1433-1439 . Bassel Ericsoussi, MD
[object Object],[object Object],p value < 0.001 Noble et al. Ultrasound Assessment for Extravascular Lung Water in Patients Undergoing Hemodialysis. Time Course for Resolution. CHEST June 2009 vol. 135 no. 6 1433-1439 . Bassel Ericsoussi, MD
[object Object],[object Object],Noble et al. Ultrasound Assessment for Extravascular Lung Water in Patients Undergoing Hemodialysis. Time Course for Resolution. CHEST June 2009 vol. 135 no. 6 1433-1439 . Bassel Ericsoussi, MD
Lung Ultrasound in Lung Contusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Soldati et al. Chest Ultrasonography in Lung Contusion. CHEST August 2006 vol. 130 no. 2 533-538  Bassel Ericsoussi, MD
Lung Ultrasound in Lung Contusion ,[object Object],[object Object],[object Object],[object Object],[object Object],Soldati et al. Chest Ultrasonography in Lung Contusion. CHEST August 2006 vol. 130 no. 2 533-538  Bassel Ericsoussi, MD
[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Peripheral parenchymal lesion ,[object Object],[object Object],Bassel Ericsoussi, MD
Lung Ultrasound in Lung Contusion Soldati et al. Chest Ultrasonography in Lung Contusion. CHEST August 2006 vol. 130 no. 2 533-538  Bassel Ericsoussi, MD ISS: Injury Severity Score ,[object Object],[object Object]
Lung Ultrasound in Lung Contusion Soldati et al. Chest Ultrasonography in Lung Contusion. CHEST August 2006 vol. 130 no. 2 533-538  Bassel Ericsoussi, MD ,[object Object],[object Object],[object Object],[object Object],Tests CT Lung Contusion Sensitivity Specificity N=88 YES (37) NO (51) Ultrasound AIS + 35 2 94.6% 96% - 2 49 Ultrasound PPL + 7 0 18.9% 100% - 30 51
Using Ultrasound to Evaluate for a Pneumothorax ,[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Using Ultrasound to Evaluate for a Pneumothorax ,[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
Using Ultrasound to Evaluate for a Pneumothorax ,[object Object],[object Object],Bassel Ericsoussi, MD
Using Ultrasound to Evaluate for a Pneumothorax ,[object Object],Bassel Ericsoussi, MD
Using Ultrasound to Evaluate for a Pneumothorax ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Using Ultrasound to Evaluate for a Pneumothorax B-mode vs. M-mode Normal Lung ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
SEASHORE SIGN Bassel Ericsoussi, MD
Using Ultrasound to Evaluate for a Pneumothorax B-mode vs. M-mode PTX ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
STRATOSPHERE SIGN Bassel Ericsoussi, MD
Using Ultrasound to Evaluate for a Pneumothorax B-mode vs. M-mode Lung Point ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Using Ultrasound to Evaluate for a Pneumothorax ,[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Using Ultrasound to Evaluate for a Pneumothorax ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Using Ultrasound to Evaluate for a Pneumothorax American Academy of Emergency Medicine :  Chan SSW et al Acad Emerg Med Jan 2003 Vol.10 1. Bassel Ericsoussi, MD Ultrasound Feature Patient Population  Sensitivity  Specificity No Lung Sliding 328 Surgical And Trauma 95.5% 100% No Lung Sliding 111 Medical ICU 95.3% 91.1% No B Lines  “ Comet Tails” 114 Med-surgical Unit 100% 60% Combined 617  100% 96.5% Lung Point 233 Med-surgical Unit  66%  100%
Using Ultrasound to Evaluate for a Pneumothorax ,[object Object],Bassel Ericsoussi, MD
Alveolar Consolidation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Probe Position for Right Sided Pleural Fluid Evaluation Bassel Ericsoussi, MD
Normal View Right Pleura and Lung Bassel Ericsoussi, MD
Sonographic Hepatization AIR BRONCHOGRAMS  LIVER Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
Probe Position for Left Sided Pleural Fluid Evaluation Bassel Ericsoussi, MD
Pleural Effusion Next to Left Diaphragm and Spleen PLEURAL EFFUSION LUNG SPLEEN DIPHRAGM Bassel Ericsoussi, MD
The Shred Line/The Transition Zone ,[object Object],Bassel Ericsoussi, MD
THE SHRED LINE Bassel Ericsoussi, MD
Lung Ultrasound in the Diagnosis of Acute Respiratory Failure The BLUE Protocol ,[object Object],[object Object],[object Object],[object Object],Lichtenstein et al. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. CHEST July 2008 vol. 134 no. 1 117-125 Bassel Ericsoussi, MD
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lichtenstein et al. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. CHEST July 2008 vol. 134 no. 1 117-125 Lung Ultrasound in the Diagnosis of Acute Respiratory Failure The BLUE Protocol Bassel Ericsoussi, MD
Lung Ultrasound in the Diagnosis of Acute Respiratory Failure The BLUE Protocol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lichtenstein et al. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. CHEST July 2008 vol. 134 no. 1 117-125 Bassel Ericsoussi, MD
[object Object],[object Object],[object Object],[object Object],[object Object],Lichtenstein et al. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. CHEST July 2008 vol. 134 no. 1 117-125 Bassel Ericsoussi, MD
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lichtenstein et al. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. CHEST July 2008 vol. 134 no. 1 117-125 Bassel Ericsoussi, MD
[object Object],[object Object],[object Object],[object Object],Lichtenstein et al. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. CHEST July 2008 vol. 134 no. 1 117-125 Bassel Ericsoussi, MD
Lichtenstein et al. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. CHEST July 2008 vol. 134 no. 1 117-125 Anterior predominant bilateral B lines  with  lung sliding Anterior predominant bilateral A lines associated with lung sliding Scan zone 3 posterolateral chest wall looking for PLAPS posterolateral alveolar and/or pleural syndrome A/B: Anterior predominant B  lines on one side, predominant A lines on the other C: Anterior alveolar consolidation Predominant bilateral B lines  without  lung sliding ??? Bassel Ericsoussi, MD
Ultrasonography  Fundamentals in Critical Care ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
[object Object],[object Object],Normal Pleura Bassel Ericsoussi, MD
Normal Pleura: The Bat Sign ,[object Object],Bassel Ericsoussi, MD
Anatomic Boundaries of the Pleural Effusion ,[object Object],[object Object],[object Object],PLEURAL EFFUSION LUNG SPLEEN DIPHRAGM Important to identify the inside of chest wall to determine depth of needle penetration  Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
Lung Movement: Curtain Sign ,[object Object],[object Object],Bassel Ericsoussi, MD
Lung Movement Lung Flapping Sign or Jelly Fish Sign Bassel Ericsoussi, MD
Pleural Effusion: Sinusoid Sign ,[object Object],[object Object],Bassel Ericsoussi, MD
Pleural Effusion with Alveolar Consolidation Bassel Ericsoussi, MD
Pleural Effusion with Atelectasis Bassel Ericsoussi, MD
Transudative Pleural Effusion ,[object Object],Bassel Ericsoussi, MD
Exudative Pleural Effusion ,[object Object],Bassel Ericsoussi, MD
Plankton Sign ,[object Object],[object Object],Bassel Ericsoussi, MD
Parapneumonic effusion with consolidation ,[object Object],Bassel Ericsoussi, MD
Pleural Effusion Associated with Nodules ,[object Object],Bassel Ericsoussi, MD
Parapneumonic effusion with Thick Septations Bassel Ericsoussi, MD
Complex Pleural Effusion with Septations caused by a Malignant Mesothelioma. Bassel Ericsoussi, MD
The Role of Ultrasound in the Assessment of Pleural Effusion Bassel Ericsoussi, MD
The Role of Ultrasound in the Assessment of Pleural Effusion Bassel Ericsoussi, MD
The Role of Ultrasound in the Assessment of Pleural Effusion Bassel Ericsoussi, MD
The Role of Ultrasound in the Assessment of Pleural Effusion Bassel Ericsoussi, MD
[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Ultrasound-guided Thoracentesis ,[object Object],[object Object],[object Object],[object Object],[object Object],Feller-Kopman. Ultrasound-Guided Thoracentesis. CHEST June 2006 vol. 129 no. 6 1709-1714  Bassel Ericsoussi, MD
 
 
Ultrasonography  Fundamentals in Critical Care ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Diaphragm Movement and Contractility Evaluation by Thoracic Ultrasound  Ultrasonography Determination of Diaphragmatic Excursion ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
HEPATORENAL  RECESS Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
Boussuges et al. Diaphragmatic Motion Studied by M-Mode Ultrasonography Methods, Reproducibility, and Normal Values. CHEST February 2009 vol. 135 no. 2 391-400  Diaphragm Movement and Contractility Evaluation by Thoracic Ultrasound  Ultrasonography Determination of Diaphragmatic Excursion Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
Diaphragm inspiratory time  Diaphragm expiratory time  Diaphragm inspiratory amplitude Boussuges et al. Diaphragmatic Motion Studied by M-Mode Ultrasonography Methods, Reproducibility, and Normal Values. CHEST February 2009 vol. 135 no. 2 391-400  Bassel Ericsoussi, MD
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD CHEST February 2009 vol. 135 no. 2 391-400
Diaphragmatic Paralysis: The Use of M Mode Ultrasound for Diagnosis in Adults ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Spinal Cord. 2006 Aug;44(8):505-8. Epub 2005 Dec 6. Bassel Ericsoussi, MD
Ultrasonographic Diagnostic Criterion for Severe Diaphragmatic Dysfunction After CABG ,[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Thoracic Ultrasound for Diagnosing Pulmonary Embolism (TUSPE):  A Prospective Multicenter Study of 352 Patients ,[object Object],[object Object],[object Object],[object Object],Mathis at al. Thoracic Ultrasound for Diagnosing Pulmonary Embolism. Chest 2005;128;1531-1538 Bassel Ericsoussi, MD
Thoracic Ultrasound for Diagnosing Pulmonary Embolism (TUSPE):  A Prospective Multicenter Study of 352 Patients ,[object Object],[object Object],[object Object],Mathis at al. Thoracic Ultrasound for Diagnosing Pulmonary Embolism. Chest 2005;128;1531-1538 Bassel Ericsoussi, MD
Bassel Ericsoussi, MD
The majority (66%) of lesions were seen in the posterior basal segments of the lung. Bassel Ericsoussi, MD
2 or more typical lesions  1 typical lesion + pleural effusion Small subpleural lesions (< 5 mm)  or a single pleural effusion Bassel Ericsoussi, MD
Results Thoracic ultrasound for diagnosing pulmonary embolism.   Chest. 2005 Sep;128(3):1531-8 Bassel Ericsoussi, MD
[object Object],Bassel Ericsoussi, MD
ETT Position Assessment with Ultrasound ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Transverse view showing ETT Bassel Ericsoussi, MD
Longitudinal view showing ETT Bassel Ericsoussi, MD
ETT Position Tube position OK Confirm with auscultation, ETCO2 Translaryngeal Ultrasound Tip visible Intratracheal Remove and reintubate May be too high, measure distance below VC Pleural Ultrasound Bilateral sliding pleura Unilateral sliding pleura Mainstem intubation Pull tube back 1-2 cm Yes Yes No No Bassel Ericsoussi, MD
Laryngeal Ultrasound: A Useful Method in Predicting Post-extubation Stridor  ,[object Object],[object Object],[object Object],Ding LW, Wang HC, Wu HD, et al. Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study.  Eur resp J 2006; 27-384-389 Bassel Ericsoussi, MD
[object Object],[object Object],[object Object],Ding LW, Wang HC, Wu HD, et al. Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study.  Eur resp J 2006; 27-384-389 Bassel Ericsoussi, MD
[object Object],[object Object],[object Object],Bassel Ericsoussi, MD
Laryngeal Ultrasound: A Useful Method in Predicting Post-extubation Stridor  ,[object Object],Ding LW, Wang HC, Wu HD, et al. Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study.  Eur resp J 2006; 27-384-389 Bassel Ericsoussi, MD
Lung/Pleural Ultrasound Take Home Points ,[object Object],[object Object],[object Object],[object Object],Bassel Ericsoussi, MD

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Ultrasonography Fundamentals In Critical Care: Lung Ultrasound, Pleural Ultrasound, Other Potetial Utilities of Ultrasound

  • 1. Ultrasonography Fundamentals in Critical Care Bassel Ericsoussi, MD Pulmonary and Critical Care Fellow University of Illinois Medical Center at Chicago
  • 2.
  • 3.
  • 4.
  • 5.
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  • 9.
  • 10.
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  • 13.
  • 14. Normal Lung few Comet Tails in the lower lung zone Acute pulmonary edema closely spaced comet-tail artifacts Diffuse interstitial fibrosis comet-tail artifacts are 7 mm apart Bassel Ericsoussi, MD
  • 15.
  • 16.
  • 17.
  • 18.
  • 19. 7.5-10 MHz Superficial structures (vessels) 1.0-5.0 MHz Cardiac Lung Abdomen Bassel Ericsoussi, MD
  • 20.
  • 21.
  • 22.
  • 23.
  • 24. Lung Ultrasonography Bassel Ericsoussi, MD
  • 25.
  • 26.
  • 27.
  • 28.
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  • 30.
  • 31.
  • 32.
  • 33.
  • 36.
  • 37. Normal Lung few Comet Tails in the lower lung zone Acute pulmonary edema closely spaced comet-tail artifacts Diffuse interstitial fibrosis comet-tail artifacts are 7 mm apart Bassel Ericsoussi, MD
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
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  • 45.
  • 46.
  • 47.
  • 48.
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  • 51.
  • 52.
  • 53.
  • 54.
  • 56. SEASHORE SIGN Bassel Ericsoussi, MD
  • 57.
  • 59. STRATOSPHERE SIGN Bassel Ericsoussi, MD
  • 60.
  • 61.
  • 62.
  • 63. Using Ultrasound to Evaluate for a Pneumothorax American Academy of Emergency Medicine : Chan SSW et al Acad Emerg Med Jan 2003 Vol.10 1. Bassel Ericsoussi, MD Ultrasound Feature Patient Population Sensitivity Specificity No Lung Sliding 328 Surgical And Trauma 95.5% 100% No Lung Sliding 111 Medical ICU 95.3% 91.1% No B Lines “ Comet Tails” 114 Med-surgical Unit 100% 60% Combined 617 100% 96.5% Lung Point 233 Med-surgical Unit 66% 100%
  • 64.
  • 65.
  • 66. Probe Position for Right Sided Pleural Fluid Evaluation Bassel Ericsoussi, MD
  • 67. Normal View Right Pleura and Lung Bassel Ericsoussi, MD
  • 68. Sonographic Hepatization AIR BRONCHOGRAMS LIVER Bassel Ericsoussi, MD
  • 71. Probe Position for Left Sided Pleural Fluid Evaluation Bassel Ericsoussi, MD
  • 72. Pleural Effusion Next to Left Diaphragm and Spleen PLEURAL EFFUSION LUNG SPLEEN DIPHRAGM Bassel Ericsoussi, MD
  • 73.
  • 74. THE SHRED LINE Bassel Ericsoussi, MD
  • 75.
  • 76.
  • 77.
  • 78.
  • 79.
  • 80.
  • 81. Lichtenstein et al. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. CHEST July 2008 vol. 134 no. 1 117-125 Anterior predominant bilateral B lines with lung sliding Anterior predominant bilateral A lines associated with lung sliding Scan zone 3 posterolateral chest wall looking for PLAPS posterolateral alveolar and/or pleural syndrome A/B: Anterior predominant B lines on one side, predominant A lines on the other C: Anterior alveolar consolidation Predominant bilateral B lines without lung sliding ??? Bassel Ericsoussi, MD
  • 82.
  • 83.
  • 84.
  • 85.
  • 87.
  • 88. Lung Movement Lung Flapping Sign or Jelly Fish Sign Bassel Ericsoussi, MD
  • 89.
  • 90. Pleural Effusion with Alveolar Consolidation Bassel Ericsoussi, MD
  • 91. Pleural Effusion with Atelectasis Bassel Ericsoussi, MD
  • 92.
  • 93.
  • 94.
  • 95.
  • 96.
  • 97. Parapneumonic effusion with Thick Septations Bassel Ericsoussi, MD
  • 98. Complex Pleural Effusion with Septations caused by a Malignant Mesothelioma. Bassel Ericsoussi, MD
  • 99. The Role of Ultrasound in the Assessment of Pleural Effusion Bassel Ericsoussi, MD
  • 100. The Role of Ultrasound in the Assessment of Pleural Effusion Bassel Ericsoussi, MD
  • 101. The Role of Ultrasound in the Assessment of Pleural Effusion Bassel Ericsoussi, MD
  • 102. The Role of Ultrasound in the Assessment of Pleural Effusion Bassel Ericsoussi, MD
  • 103.
  • 104.
  • 105.  
  • 106.  
  • 107.
  • 108.
  • 109. HEPATORENAL RECESS Bassel Ericsoussi, MD
  • 111. Boussuges et al. Diaphragmatic Motion Studied by M-Mode Ultrasonography Methods, Reproducibility, and Normal Values. CHEST February 2009 vol. 135 no. 2 391-400 Diaphragm Movement and Contractility Evaluation by Thoracic Ultrasound Ultrasonography Determination of Diaphragmatic Excursion Bassel Ericsoussi, MD
  • 114. Diaphragm inspiratory time Diaphragm expiratory time Diaphragm inspiratory amplitude Boussuges et al. Diaphragmatic Motion Studied by M-Mode Ultrasonography Methods, Reproducibility, and Normal Values. CHEST February 2009 vol. 135 no. 2 391-400 Bassel Ericsoussi, MD
  • 115.
  • 116.
  • 117.
  • 118.
  • 119.
  • 121. The majority (66%) of lesions were seen in the posterior basal segments of the lung. Bassel Ericsoussi, MD
  • 122. 2 or more typical lesions 1 typical lesion + pleural effusion Small subpleural lesions (< 5 mm) or a single pleural effusion Bassel Ericsoussi, MD
  • 123. Results Thoracic ultrasound for diagnosing pulmonary embolism. Chest. 2005 Sep;128(3):1531-8 Bassel Ericsoussi, MD
  • 124.
  • 125.
  • 126. Transverse view showing ETT Bassel Ericsoussi, MD
  • 127. Longitudinal view showing ETT Bassel Ericsoussi, MD
  • 128. ETT Position Tube position OK Confirm with auscultation, ETCO2 Translaryngeal Ultrasound Tip visible Intratracheal Remove and reintubate May be too high, measure distance below VC Pleural Ultrasound Bilateral sliding pleura Unilateral sliding pleura Mainstem intubation Pull tube back 1-2 cm Yes Yes No No Bassel Ericsoussi, MD
  • 129.
  • 130.
  • 131.
  • 132.
  • 133.