Ebook Lung ultrasound in the critically Ill: Part 2
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Ebook Lung ultrasound in the critically Ill: Part 2
Part IIThe BLUE-Protocol in Clinical UseThe Ultrasound Approach of an Acute Respiratory Failure: The BLUE-Protocol20Severe dyspnea is one of the most Ebook Lung ultrasound in the critically Ill: Part 2 distressing situations for a patient. Aiming at a therapy based on immediate diagnosis is a legitimate target.The acute incapacity to breathe is one of the most distressing situations one can live 111. The BLUE-protocol concentrates 18 years of efforts (mainly repeated submissions) aiming at prompt Ebook Lung ultrasound in the critically Ill: Part 2ly relieving these patients.The idea of performing an ultrasound examination in time-dependent patients was not far from a blaspheme in 1985. definiteEbook Lung ultrasound in the critically Ill: Part 2
ly not envisageable according to the rules. Our approach possibly intrigued some doctors and nurses in the ERs of our institutions. During the managemPart IIThe BLUE-Protocol in Clinical UseThe Ultrasound Approach of an Acute Respiratory Failure: The BLUE-Protocol20Severe dyspnea is one of the most Ebook Lung ultrasound in the critically Ill: Part 2ded ER and eventually rushed after duty for a deserved nap, end of the story) did not fully see was that, after a few minutes, we were able to give to the nurse therapeutic options, while organizing the transfer to the ICU. And w hat they did not see at all (occupied by I,(MX) other tasks, medical, Ebook Lung ultrasound in the critically Ill: Part 2administrative, familial, etc.: this was not lime for international guidelines on lung ultrasound) was that these options were in accordance with theEbook Lung ultrasound in the critically Ill: Part 2
tinal diagnosis.In the emergency setting, we use familiar tools since decades and centuries, mainly physicalexamination [2| and radiography |3|, two bPart IIThe BLUE-Protocol in Clinical UseThe Ultrasound Approach of an Acute Respiratory Failure: The BLUE-Protocol20Severe dyspnea is one of the most Ebook Lung ultrasound in the critically Ill: Part 2sue [4-8]. One-quarter of the patients of the BLUE-protocol in the first hour of management received erroneous or uncertain initial diagnoses, and many more received inappropriate therapy. The online document of Chest 134:117-125 details these 26 % of wrong diagnoses. CT seems a solution, but Chap. Ebook Lung ultrasound in the critically Ill: Part 229 will demonstrate its heavy drawbacks. One day. the community w ill maybe find this tool definitely too much irradiating [9].We initiated this longEbook Lung ultrasound in the critically Ill: Part 2
work using an ADR-4000 (from 1982) then shifted for our Hitachi-405 (from 1992. last update 2008). Their 3 MHz sectorial probe and 5 MHz microconvex pPart IIThe BLUE-Protocol in Clinical UseThe Ultrasound Approach of an Acute Respiratory Failure: The BLUE-Protocol20Severe dyspnea is one of the most Ebook Lung ultrasound in the critically Ill: Part 2Some protocols are possibly built for exempting doctors to think, but this one requires to keep on being a doctor. It is permanently "piloted." In some situations. it w ill just confirm an obvious diagnosis. In others, it will confidently invalidate a diagnosis w hich looked the likely one.For being Ebook Lung ultrasound in the critically Ill: Part 2 perfectly understood (and anticipating remarks), the BLUE-protocol should beD.A. Lichtenstein. Lung Ultrasound in the Critically III: The BLUE ProtocEbook Lung ultrasound in the critically Ill: Part 2
ol,157DOI 10.1007/978-3-319-15371-l_20.€> Springer International Publishing Switzerland 201615820 The Ultrasound Approach of an Acute Respiratory FailPart IIThe BLUE-Protocol in Clinical UseThe Ultrasound Approach of an Acute Respiratory Failure: The BLUE-Protocol20Severe dyspnea is one of the most Ebook Lung ultrasound in the critically Ill: Part 2n used alone. Countless articles are now using lung ultrasound. and many propose various algorithms including echocardiography and other items, advocating a "multiorgan approach." This is not the spirit of our protocol: it associates these various items but does not include them (the difference is s Ebook Lung ultrasound in the critically Ill: Part 2ubstantial). Comparing these studies with our approach would therefore make little sense. Regarding, for instance, the heart, see at the end of this cEbook Lung ultrasound in the critically Ill: Part 2
hapter and at the end of Chap. 24 that we did not "forget" it (it is known that searchers may sometimes be absent minded, but up to forgetting the heaPart IIThe BLUE-Protocol in Clinical UseThe Ultrasound Approach of an Acute Respiratory Failure: The BLUE-Protocol20Severe dyspnea is one of the most Ebook Lung ultrasound in the critically Ill: Part 2of this chapter, and we invite the readers to make an opinion.Same remark for all clinical signs. Some academicians reproached to the BLUE-protocol to forget these precious signs 110) (don't miss the discussion at the end of Ref. 110]). The clinical signs are. ironically, in the center of the Extend Ebook Lung ultrasound in the critically Ill: Part 2ed BLUE-protocol. for an improved accuracy (Chap. 35). The BLUE-profiles are here, available, up to this respected physician to integrate his favoriteEbook Lung ultrasound in the critically Ill: Part 2
clinical data at will in his clinical approach.The Design of the BLUE-ProtocolThe BLƯE-protocol was conceived in an observational study in a ParisianPart IIThe BLUE-Protocol in Clinical UseThe Ultrasound Approach of an Acute Respiratory Failure: The BLUE-Protocol20Severe dyspnea is one of the most Ebook Lung ultrasound in the critically Ill: Part 2ry failure. Acute respiratory failure was defined based on clinical criteria requiring admission to the ICU.The gold standard was the tinal diagnosis considered in the hospitalization report, made by a medical ICU team (expert panel) who did not take into account the lung ultrasound data and used tr Ebook Lung ultrasound in the critically Ill: Part 2aditional approaches. Uncertain diagnoses, multiple diagnoses, and rare causes (frequency <3 %) were excluded (see Chap. 21).After years necessary forEbook Lung ultrasound in the critically Ill: Part 2
the publication of the preliminary background (mostly lung terminology). we were able to propose the analysis of three items at the lung area - with Part IIThe BLUE-Protocol in Clinical UseThe Ultrasound Approach of an Acute Respiratory Failure: The BLUE-Protocol20Severe dyspnea is one of the most Ebook Lung ultrasound in the critically Ill: Part 2ets at the anterior wall (present or absent)3Alveolar and/or pleural syndrome (called PLAPS if posterior or/and lateral) (yes or no) We added an adapted venous analysis (indicated in 54 % of cases). Note that the venous analysis takes the major time (2 min of a 3 min examination), which is nonethele Ebook Lung ultrasound in the critically Ill: Part 2ss short, since we use a simple machine with fast start-up. the same microconvex probe, time-saving maneuvers. only one setting, and a contact productEbook Lung ultrasound in the critically Ill: Part 2
which allows major time savings. This will be repealed again, intentionally.The BLUE-Profiles: How Many in the BLUE-Protocol?A w ork of a "profiler.”Part IIThe BLUE-Protocol in Clinical UseThe Ultrasound Approach of an Acute Respiratory Failure: The BLUE-Protocol20Severe dyspnea is one of the most Ebook Lung ultrasound in the critically Ill: Part 2. 20.1).There are eight profiles. The anterior analysis, which initiates the BLUE-protocol. can describe six situations. Five of them conclude the protocol: the B-, B'-. A/B-. C-. and A'-profile. One of them is the A-profile (Video 10.1). The A-prolile designates an anterior chest wall with predomin Ebook Lung ultrasound in the critically Ill: Part 2ant A-lines and lung sliding. The A-profile opens to three more profiles (A-DVT. A-no-V-PLAPS. and nude profile).Here are the profiles, which were assEbook Lung ultrasound in the critically Ill: Part 2
imilated to specific diseases. The term "profile" assumes an association of signs (two), plus a location (Fig. 20.2).1The A-profile plus DVT was assimPart IIThe BLUE-Protocol in Clinical UseThe Ultrasound Approach of an Acute Respiratory Failure: The BLUE-Protocol20Severe dyspnea is one of the most Ebook Lung ultrasound in the critically Ill: Part 2 A-no-V-PLAPS profile is a temporarylabel which designates an A-profile with noThe BLUE-Profiles: How Many in the BLUE-Protocol?159B-profilePart IIThe BLUE-Protocol in Clinical UseThe Ultrasound Approach of an Acute Respiratory Failure: The BLUE-Protocol20Severe dyspnea is one of the mostGọi ngay
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