Wavelength Pearls
Lung ultrasound and the airway.
Pneumothorax, consolidation, effusion, the diaphragm and tube position.
Lung ultrasound beats the supine chest X-ray for pneumothorax, pleural effusion and consolidation, and it needs only a few views. These pearls start with the pleural line and lung sliding, then move to fluid above the diaphragm, air bronchograms, diaphragm movement and confirming tube position after intubation.
Each pearl teaches one sign, the pitfall which makes it misleading, and a short test to check what stuck.
5 pearls
One technique at a time.
Lung
Consolidation: watch the air bronchograms move
Bright dots in consolidated lung are air in the airways. If they move outwards as the patient breathes in, the airway is open and pneumonia is likely. If they stay still, think about collapse.
Lung
Diaphragm ultrasound: watch the sniff
A weak or paralysed diaphragm causes unexplained breathlessness and failure to wean. Put the probe below the ribs, ask for a sniff, and watch which way the diaphragm moves. Towards the probe is normal. Away from it is paradoxical.
Airway
Intubation check: spot the double tract
Watch the neck as the tube goes in. One air shadow in the midline means the tube is in the trachea. A second air shadow beside it, where the oesophagus lies, means it is in the wrong place. Pair it with capnography, every time.
Lung
Lung: absent sliding is not enough
No sliding means look harder, not pneumothorax. B-lines or a lung pulse rule it out under the probe, and a lung point rules it in.
Lung
Pleural effusion: find the spine above the diaphragm
In a normal scan the spine stops at the diaphragm, because air-filled lung hides it. When fluid fills the base, the spine carries on above the diaphragm. Add black fluid and you have an effusion.
Practise it with us
One instructor to every four or five delegates, FAMUS-accredited instructors and RCEM-approved ultrasound supervisors, and long, supervised time on the probe.
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