Episode 28: US in Dyspnea - Part 1

by Bob Stuntz in , , ,

She's short of breath.  Has a history of CHF, COPD, cancer, and has had a cough today...

Sound familiar?  Undifferentiated dyspnea can be a challenge.  But you know me, I'm a sucker for anything 1,540 m/s, and US is usually the answer.  Fortunately, EM Chief Resident, FOAM US superstar, and resident US guru Jacob Avila (@UltrasoundMD) agrees, and he wanted to teach you all how to use US to solve this concerning clinical conundrum.  The possibilities are endless, but Dr. Avila shows you how to simplify your clinical decision making and make the right call. 

How good is physical exam in this very scenario?  Can you tell the difference between CHF and COPD with US?  What about pneumothorax?  And how to you figure out if that effusion is causing tamponade?  Dr. Avila has got it all covered in Part 1.  And in part 2, coming next week, there will be even more goodness - PE, DVT, pneumonia - we've got it all.  

Make sure to check out Jacob and his great blog, 5 Minute Sono.  While you're at it, Jacob works a bunch with Ben Smith, who has a great US blog himself - give him a look as well.  Also, check out the EM Res Podcast Google Community.  Check out our example videos and Dr. Avila's References below, and then enjoy the podcast!

This episode and part two will be eligible for Asynchronous Learning - look for the quiz after part 2.  After answering the short questions in the quizzes, you can print out a certificate that says you spent time listening to the podcast and doing the quiz.  My hope is, that with approval from your individual US EM Residency program directors, you can count this toward individual interactive instruction time (also known as asynchronous learning) if you are in a US EM residency program.  As stated, make sure your program director approves of this before you go chalking this up as asynchronous time.    

Normal lung.  Note the lung sliding and A lines.  You may notice a date and time and location on the Ultrasound image.  No patient privacy worries - that's my left lung back during my fellowship.  I gave myself permission to use this image of...myself.  

Pulmonary edema, multiple B lines

PTX with lung point.  Notice the lack of lung sliding, until the lung point shows up.  

Tamponade, PSLA view

Check out Dr. Avila's amazing summary of references!