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Check out this podcast with @giovolpicelli about how he is using Lung PoCUS with Covid-19:



My take-home points follow:
Lung PoCUS for triage: When the hospital gets a flood of patients in the ED who have complaints of cough/SOB you can use Lung PoCUS to rapidly triage patients.
If they are well and have no signs of viral pneumonia (scattered and diffuse B-lines with pleural change or sub-pleural consolidations) then they can go home.
If they have signs of viral pneumonia then they are considered to have Covid-19 even before PCR testing and should be treated as such. Disposition depends on local resources and patient clinical status but these patients all need to be isolated at home or in the hospital.
Severity of lung findings and severity of symptoms: His group has found that there does NOT appear to be a correlation with how good or bad the lungs looks (i.e. number and distribution of B-lines and pleural changes) and how good or bad the patients look.
Some people have terrible looking lungs on PoCUS and do well and some people only have moderate findings (moderate amount of B-lines and no sub-pleural consolidation for example) and need ventilation/die.
Scoring system: They are trying to come up with something that correlates with severity of illness and need for admission (floor vs. ICU) and treatment (intubation) but this may not be possible given the variability of lung PoCUS findings in both the sick & not-sick patients.
CXR: Can be falsely negative. They have seen lots of people with signs of viral pneumonia who have a normal CXR.
Patients in acute respiratory failure: When someone presents in acute respiratory failure, in order for this to be from Covid-19, they MUST have at least moderate findings of viral pneumonia (scattered and diffuse B-lines with pleural change or sub-pleural consolidations).
If they have no or only mild findings (no or only a few B-lines and no pleural changes) then the respiratory failure is from something else. Other tests like cardiac/IVC PoCUS or EKG / bloodwork / CT chest would be helpful. Consider alternative diagnoses like ACS or PE.
Pleural thickening: Lung PoCUS cannot assess the thickness of the pleural. This is a finding that can only be assessed on CT as Lung PoCUS assessment of the pleura looks only at artifacts. The most important finding on Lung PoCUS is the number and distribution of B-lines.
Lobar consolidations: If you see signs of lobar consolidation on PoCUS (i.e. hepatization with dynamic air bronchograms) then this is NOT from Covid-19. Should suspect secondary bacterial pneumonia.
Training: You cannot learn how to do advanced lung PoCUS in 15 minutes. Suggests that beginners still use it but record lots of images and have them reviewed by a local expert.
Posterior findings: Patients who have lots of Lung PoCUS findings when looking posteriorly might do better with proning, intubated or not.
Monitoring: In the ICU Lung PoCUS might have a role in assessing response to treatment (PEEP/proning) by looking for lung recruitment. (END)
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