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POINT OF CARE ULTRASOUND IN CRITICALLY ILL PATIENT WITH ACUTE
DYSPNEAHE CAN’T BREATHE BUT YOU CAN SCAN
Olivier Felix UMUHIRE, MD
Emergency Medicine & Critical Care Resident/UR
OUTLINE
1. Life threatening Conditions
2. Work up
3. Evidence of POCUS in critical care areas: ED & ICU
4. Scanning protocols
5. Cases
6. References
ACUTE DYSPNEA DiagnosisPro, an online medical expert system,
listed 497 distinct causes in October 2010.
ACUTE DYSPNEA DiagnosisPro, an online medical expert system,
listed 497 distinct causes in October 2010.
Most Common &Life
threatening
ACS/MI*
ADHF/CHF
Pneumothorax
PE
COPD
Asthma
Pneumonia
Pulmonary edema
DIAGNOSTIC APPROCH:CHALLENGES
D-Dimer
BNP
DIAGNOSTIC APPROCH:CHALLENGES
D-Dimer
BNP
RESSOURCES
TIME
IRRADIATION
*Hx+Phy Ex.
EVIDENCE OF POCUS IN CRITICALLY SICK
DYSPNEIC PATIENT
PE Signs and symptoms are non
specific
SCANNING ALGORITHMS
1. BLUE PROTOCOL
Daniel A. Lichtenstein Annals of Intensive Care 2014, 4:1
2. THE RADIUS PROTOCOLE
Heart
Lung parenchyma
Lung Pleura
IVC
3. TRIPLE SCAN
4. MULTI ORGAN SCANS
PUTTING TOGETHER
PE
TO CONLUDE
”Speed of sound”
Portable. Issue of CXR or CT for
Critically sick patient in Critically ill
Non radiating, Non invasive
Recordable information vs Auscultation
Cost effective
Repeatable
Much better than CXR (poor quality,
suppine)
Operator dependent-Training
” Radiography is a familiar tool that lacks
sensitivity : 60-70%, all fields considered.
Prof Daniel Lichtenstein
Service de Réanimation Intensive Care Dept,
Ambroise-Paré, Boulogne (Paris-West), France.
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