Hi, I'm Dr. Tatiana Hoverlook. I'm an emergency physician and founder of Hello Sono. We help medical practices launch compliant and high quality focus programs. In this video, I'll walk you through how to perform lung ultrasound. Let's go over the indications for lung ultrasound. Those would be patients presenting with shortness of breath, chest pain, leg swelling, fever, cough. And the focus questions you want to answer with focus would be, is there anorex? Is there a pneumonia? Is there a plural eusion? Is there pulmonary edema? You want your patient to be positioned either supine, semi-reumbent, or even sitting up. I am going to scan in three different fields each lung and you should definitely scan in more fields if the suspicion for pulmonary pathology is high. Uh but these are the basic views that you should be obtaining. I am going to start off the scanning the APCs of the lungs and those are the most sensitive for a numoththorax and for those views I'm actually going to use the long shallow application. So my depth is going to be pretty shallow because I want to look specifically at the plura and the presence or absence of pneumthorax. My probe marker is going to be facing patient's head and the probe will be in the sagittal orientation. I am going to place it at the second intercostal space in mid-clavicular line. In the middle here we are seeing the hyperaccoic horizontal line that is the plura. We are also seeing shimmering of the plura and that tells us that there is motion of the plura against each other and there is no pneumthorax. We are also seeing rib shadows on the sides of the plura. To confirm that there is motion of the plura, you can also use the M mode or motion mode. Drop the line in the middle of the screen. Got to hold the probe still to get this image that I'm going to freeze. And here the top of the image is all horizontal lines and that signifies that there's no motion over time. Uh this is where your muscle and soft tissue is and that's normal. The bottom of the screen is grainy and it starts at the plural line in the center and that tells us that there is motion of the plura. So this is called seashore sign or sandy beach sign and that signifies that there's no pneumthorax. If there were a pneumthorax, you would see no motion at the plural line and all of all of the screen would be horizontal lines. That's called barcode sign. I am going to move on to the left apex and doing the same thing. So currently I have the rib in the center of my screen with a shadow. So, I'm going going to move my probe either up or down off that rib. So, I chose to go move the probe upward. And now my plura is centered. I'm seeing shimmering of the plura. That tells me that there's no pneumthorax. And I'm also seeing horizontal lines. I'm going to increase my depth a little bit more for you to visualize. That's a normal artifact in lung ultrasound. Um and that tells me that the lung is air filled and there's no pneumonia or eusion at that part of the lung. Okay. I am next going to look um at the posterior field and the base of the lung. And for that I'm going to change my application to lung deep. I typically like scanning it around 15 cmters to make sure I'm seeing all of lung paranma. My probe is going to be in coronal orientation with a probe marker pointing towards patient's head. I'm going to place the probe in a posterior axillary line at about third or fourth intercostal space. Here I am sliding the probe up and down the thorax uh looking at multiple intercostal spaces. So I am noting here um plural line at the top of the screen that's shimmering. If I want to visualize it more I can look at the motion by decreasing the depth and there's clear shimmering telling me that there's no pneumthorax. I'm also identifying those A lines, the horizontal lines on the screen that tell me that the um lung is air filled in this area and there is no pneumonia or fusion. So I'm then going to drag my probe down towards the base of the lung and identify the diaphragm. Here I'm going to decrease my depth a bit. And here in this view we are seeing the liver, the kidney, the spine at the bottom of the screen and the diaphragm, the diagonal hypercoic line. Um this is called a mirror image artifact and that's when the liver is reflecting over the diaphragm into the thorax. That tells us that the lung is airfilled. This is normal for the lung. And I now know that this patient has no eusion on pneumonia at the right base of the lung. I'm also noting that the spine ends at the diaphragm and that also tells me that this patient has no spine sign. Spine sign being an abnormal finding. I'm going to repeat the same thing on the left side. So if you could yeah just switch arms. Okay. Same thing. Coronal orientation, posterior axillary line go pretty high up on the thorax here. Okay. And I'm already noting so I got my plural line and an A-line after that. There is shimmering on the plura. Um I am seeing the rib shadows on each side and I'm scanning downward on the lung to visualize multiple uh rib spaces and I'm only seeing normal findings. So plural motion and a lines. I'm then going to scan downward towards the diaphragm. Here I'm seeing the spleen, the diaphragm here, the kidney and the spine. the spine is ending. Add the diaphragm which is normal and we are seeing also uh the mirror image artifact which is normal and tells us that the lung is air filled in that area. So if you were to have a plural eusion for example, this area superior to the diaphragm or would appear on the left side of the screen, this area would be black and you would be seeing more of the spine continuing. You can also easily identify pulmonary edema with pocus. you would be seeing vertical instead of horizontal lines emanating from the plura. And if you're seeing them diffusely, uh that tells you the patient has pulmonary edema likely consistent with CHF exacerbation. Um you can also um identify pneumonia very easily with ultrasound. Um and that would look like a consolidated lung. So it might look what's called hepatitized area or look like a liver. uh on ultrasound. Um I think it's important to consider the impact of lung ultrasound uh in primary care setting. You are diagnosing patients uh more efficiently and starting them on more appropriate treatments sooner and hopefully saving them trips to the ER um or adverse outcomes. So, thank you for joining me for this uh video. Please check out helloso.com if you want to learn how we can support you in launching a highquality compliance and profitable focus program. Please check out the rest of these video tutorials.
