Sepsis and septic shock are life-threatening emergencies associated with increased morbidity and mortality. Hence, early diagnosis and management of both conditions is of paramount importance. Point-of-care ultrasound (POCUS) is a cost-effective and safe imaging modality performed at the bedside, which has rapidly emerged as an excellent multimodal tool and has been gradually incorporated as an adjunct to physical examination in order to facilitate evaluation, diagnosis and management. In sepsis, POCUS can assist in the evaluation of undifferentiated sepsis, while, in cases of shock, it can contribute to the differential diagnosis of other types of shock, thus facilitating the decision-making process. Other potential benefits of POCUS include prompt identification and control of the source of infection, as well as close haemodynamic and treatment monitoring. The aim of this review is to determine and highlight the role of POCUS in the evaluation, diagnosis, treatment and monitoring of the septic patient. Future research should focus on developing and implementing a well-defined algorithmic approach for the POCUS-guided management of sepsis in the emergency department setting given its unequivocal utility as a multimodal tool for the overall evaluation and management of the septic patient.

/pdf/point-of-care-ultrasound-a-multimodal-tool-for-the-2ezsi6om.pdf

Point-of-Care Ultrasound: A Multimodal Tool for the Management of Sepsis in the Emergency Department

Abstract Point of Care ultrasound (POCUS) of the lungs, also known as lung ultrasound (LUS), has emerged as a technique that allows for the diagnosis of many respiratory pathologies with greater accuracy and speed compared to conventional techniques such as chest x-ray and auscultation. The goal of this narrative review is to provide a simple and practical approach to LUS for critical care, pulmonary, and anesthesia providers, as well as respiratory therapists and other health care providers to be able to implement this technique into their clinical practice. In this review, we will discuss the basic physics of LUS, provide a hands-on scanning technique, describe LUS findings seen in normal and pathological conditions (such as mainstem intubation, pneumothorax, atelectasis, pneumonia, aspiration, COPD exacerbation, cardiogenic pulmonary edema, ARDS, and pleural effusion) and also review the training necessary to achieve competence in LUS. 

Nuts and bolts of lung ultrasound: utility, scanning techniques, protocols, and findings in common pathologies

SonographyEarly View CASE VIDEO A case of pneumonia with dynamic air bronchogram diagnosed by lung ultrasound Issac Cheong, Corresponding Author Issac Cheong [email protected] orcid.org/0000-0002-8231-1528 Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina Correspondence Issac Cheong, Department of Critical Care Medicine, Sanatorio De los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina. Email: [email protected]Search for more papers by this author Issac Cheong, Corresponding Author Issac Cheong [email protected] orcid.org/0000-0002-8231-1528 Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina Correspondence Issac Cheong, Department of Critical Care Medicine, Sanatorio De los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina. Email: [email protected]Search for more papers by this author First published: 16 May 2023 https://doi.org/10.1002/sono.12362Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES 1Akutagawa K. Dynamic air bronchogram and lung hepatization: ultrasound for early diagnosis of pneumonia. Med Ultrason. 2021; 23(2): 238– 9. https://doi.org/10.11152/mu-3136 2Shah A, Oliva C, Stem C, Cummings EQ. Application of dynamic air bronchograms on lung ultrasound to diagnose pneumonia in undifferentiated respiratory distress. Respir Med Case Rep. 2022 Jul; 30(39):101706. https://doi.org/10.1016/j.rmcr.2022.101706 3Unlüer EE, Karagöz A. A dynamic sign of alveolar consolidation in bedside ultrasonography: air bronchogram. Interv Med Appl Sci. 2014; 6(1): 40– 2. https://doi.org/10.1556/IMAS.6.2014.1.6 4Gillman LM, Panebianco N, Alkadi A, Blaivas M, Kirkpatrick AW. The dynamic sonographic air bronchogram: a simple and immediate bedside diagnosis of alveolar consolidation in severe respiratory failure. J Trauma. 2011; 70(3): 760. https://doi.org/10.1097/TA.0b013e3181ac8f82 5Lichtenstein D, Mezière G, Seitz J. The dynamic air bronchogram. A lung ultrasound sign of alveolar consolidation ruling out atelectasis. Chest. 2009; 135(6): 1421– 5. https://doi.org/10.1378/chest.08-2281 Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation 

A case of pneumonia with dynamic air bronchogram diagnosed by lung ultrasound

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345 Creating a Deep Learning Classifier for the Detection of Soft Tissue Infections Using Point-of-Care Ultrasound Images

Patients presenting with undifferentiated respiratory distress remain a diagnostic dilemma. The use of point-of-care ultrasound (POCUS) to evaluate the lungs and pleural cavities can improve diagnostic uncertainty in these patients. When visualizing consolidated lung tissue with POCUS, one may encounter static or dynamic air bronchograms. Static air bronchograms are seen in atelectasis and pneumonia, whereas dynamic air bronchograms are highly specific for pneumonia[1]. We describe a case of a critically ill patient where bedside thoracic ultrasound helped to narrow the differential diagnosis early in the resuscitation, while standard radiographs were non-diagnostic. 

https://doi.org/10.1016/j.rmcr.2022.101706

Application of dynamic air bronchograms on lung ultrasound to diagnose pneumonia in undifferentiated respiratory distress

Diagnosis of branch retinal artery occlusion with point-of-care ultrasound

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345 Creating a Deep Learning Classifier for the Detection of Soft Tissue Infections Using Point-of-Care Ultrasound Images

Application of dynamic air bronchograms on lung ultrasound to diagnose pneumonia in undifferentiated respiratory distress

Diagnosis of branch retinal artery occlusion with point-of-care ultrasound