Bedside Ultrasound Has Potential to be the New Gold Standard for Pneumothorax

​Bedside ultrasound can be useful for identifying lung structures and assisting with chest tube placement. It can also be used to identify a pneumothorax and confirm chest tube placement post-procedure. Practice looking for signs, and make sure you can identify them in normal pediatric and adult patients. You may still need additional imaging such as chest x-ray and CT to confirm the diagnosis, but US yields immediate and accurate results.Check first for lung sliding, a simple yet convincing finding on US confirming that the lung is inflated. A thin, white line will be seen, which highlights the lung's pleural lining. It may appear shiny or shimmery, and will move back and forth subtly as the patient breathes. Monitor this for a few breath cycles to confirm. The absence of this feature indicates a pneumothorax. You may also see a comet tail, a special form of reverberation artifact.Lung sliding and comet tail artifact identification are valuable US skills. Dulchavsky, et. al., performed a prospective evaluation of the sensitivity and specificity of thoracic US in detecting pneumothorax by looking for lung sliding and comet tail artifacts against chest x-ray. A total of 382 trauma patients were examined, and US confirmed 37 of 39 pneumothoraces. (J Trauma. 2001;50[2]:201.) This was 95% sensitive. CXR was completed after US and also confirmed all pneumothoraces.The authors noted that two pneumothoraces were missed on US because subcutaneous air did not allow visualization...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs