Ultrasound in COVID-19 · 2020. 3. 26. · Evidence Atlas Blog (/new-blog) About (/about) Donate...
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2020-03-23, 4(54 PM COVID-19 — TPA Page 1 of 8 http://www.thepocusatlas.com/covid19 Home (/) Contribute (/contribute) Image Atlas COVID-19 (/covid19) (/) Evidence Atlas Blog (/new-blog) About (/about) Donate (/donate) Ultrasound in COVID-19 Written by Michael Macias, MD (mailto:[email protected]) (@emedcurious (https://twitter.com/EMedCurious)), Matthew Riscinti, MD (mailto:[email protected]) Editors: Dr. Rachel Liu (mailto:[email protected]), Dr. John F Kilpatrick (mailto:[email protected] ), Dr. Tessa Damm (mailto:[email protected] ) Last updated: March 22nd, 2020 The data on lung ultrasound in COVID-19 is limited but continues to evolve. The current data suggests that lung ultrasound provides similar results compared to chest CT and is superior to standard chest radiography. Advantages of performing lung ultrasound over CT include: ease of use, repeatability, low cost, and
Transcript of Ultrasound in COVID-19 · 2020. 3. 26. · Evidence Atlas Blog (/new-blog) About (/about) Donate...
2020-03-23, 4(54 PMCOVID-19 — TPA
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Home (/)Contribute(/contribute)Image AtlasCOVID-19 (/covid19)
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Evidence AtlasBlog (/new-blog)
About (/about)Donate (/donate)
Ultrasound in COVID-19Written by Michael Macias, MD (mailto:[email protected]) (@emedcurious
(https://twitter.com/EMedCurious)), Matthew Riscinti, MD
(mailto:[email protected]) Editors: Dr. Rachel Liu (mailto:[email protected]),
Dr. John F Kilpatrick (mailto:[email protected] ), Dr. Tessa Damm
(mailto:[email protected] )
Last updated: March 22nd, 2020
The data on lung ultrasound in COVID-19 is limited but
continues to evolve. The current data suggests that lung
ultrasound provides similar results compared to chest CT
and is superior to standard chest radiography. Advantages
of performing lung ultrasound over CT include: ease of use, repeatability, low cost, and
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of performing lung ultrasound over CT include: ease of use, repeatability, low cost, and
avoidance of having to transport a patient with suspected COVID-19 to radiology
(potentially exposing health care providers and hospital staff to unnecessary risk). The
utility of bedside ultrasound in COVID-19 has not been confirmed by evidence and its role
needs to be further delineated in a way that minimizes infectious risks. However, experts
have proposed its importance in a variety of patient care scenarios: (1) Rapid assessment of
the severity of COVID-19 at presentation (see algorithm (https://assets.website-
files.com/5a0cbe08f1138d000147a9d4/5e7263c656e99f4b26c9a75b_2020-
03_COVID_treatment.pdf) by Dr. Mike Stone) (2) Evolution of disease (3) Monitor lung
recruitment maneuvers (4) Guide response to prone position (5) Management of
extracorporeal membrane therapy (6) Make decisions related to weaning from ventilatory
support (7) Differentiation of shock states (including cardiogenic shock) (8) and assessment
of fluid tolerance.
Two recent publications (Peng et al (https://link.springer.com/article/10.1007%2Fs00134-
020-05996-6) and Huang et al (https://papers.ssrn.com/sol3/papers.cfm?
abstract_id=3544750)) have characterized important lung ultrasound findings in patients
with COVID-19, review of these two publications is highly recommended if you plan on
incorporating bedside ultrasound into your clinical management of suspected COVID-19
patients. Characteristic ultrasound findings compared to CT are described in the provided
table.
A few important points to make:
• Large pleural effusions are rare but
small effusions can be seen around
subpleural consolidations
• Lesions are predominately located in the posterior lower fields of both lungs
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• Lesions are predominately located in the posterior lower fields of both lungs
• Compared to B-lines seen in cardiogenic pulmonary edema, the B-lines seen in COVID-
19 are patchy with areas of normal lung in between and are associated with an
irregular, thickened pleural line with punctate defects.
• The degree of lung findings appears to correlate with severity of lung injury:
○ Mild - Focal scattered B-lines
○ Progressive/Severe - Interstitial syndrome (diffuse B-lines) + lung consolidation
COVID Beyond the Lungs: Reports out of cities seeing large volumes of COVID-19 patients
have reported high rates of cardiac complications including cardiogenic shock, myocarditis,
and arrhythmias (Wang (https://jamanetwork.com/journals/jama/fullarticle/2761044)). It
may be beneficial to approach critically ill patients with suspected or known COVID-19 as
having undifferentiated shock, assessing their fluid tolerance, and evaluating for acute
decompensated heart failure early in their course. There may also be a role for POCUS for
confirming central lines, intubations, and ruling out a pneumothorax after invasive
procedures. This may further decrease x-ray utilization and prevent contamination, staff
exposure, and utilization of PPE.
Timeline of COVID-19 Lung Ultrasound Findings: A Case Study
Dr. Yale Tung Chen is an Emergency Medicine physician currently living with an active
COVID-19 infection. He currently serves as the Director of the Ultrasound Division at
Hospital Universitario La Paz in Madrid, Spain. He has graciously allowed us to share his
#mycoviddiary on our site to help educate and provide a perspective on symptoms in
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comparison to lung ultrasound findings. Follow him on Twitter @yaletung
(https://twitter.com/yaletung)!
Day 1 (/new-gallery/day-1)
Day 2 (/new-gallery/wjrks29kc8vgzv7ybpyfu6euyxj6lu)
Day 3 (/new-gallery/cq5v97ph6xnodxlfcusrvllzsq5zp5)
Day 4 (/new-gallery/4fwr5mtfbzwqcfpb5jfmye8tr8lu2f)
Day 5 (/new-gallery/voi7dcarqejvm2p1ogf6v85vw20i59)
Day 6 gallery/lb100gefgcxvoutc6b6d32ddrey62n)
More Images of Lung Ultrasound
COVID-19 Lung Ultrasound Findings
CommonPleural BasedFindings in
A COVID-19Patient with3 days of
A COVID-19Patient with3 days of
A COVID-19Patient with3 days of
B-lines inCOVID-19Versus CHF
!!
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Findings inCOVID-19(/covid19-1/common-pleural-based-findings-in-covid19)
3 days ofSymptoms[1/3](/covid19-1/ru6w5sgjyu1zn21jraypm2pfm0h6uf)
3 days ofSymptoms[2/3](/covid19-1/m2ra6cg22od32eryxmdr7im3qgw714)
3 days ofSymptoms[3/3](/covid19-1/3ytz1el5hly8cq6jigpy0y4irdmy1v)
Versus CHF(/covid19-1/e0uhjicdqcst7lui8rhknijyuridh9)
Normal Lung Ultrasound Anatomy
A - Lines -Normal Lung(/lung/5l9jgyaszu0othj5tidg0miqxkmvyv)
Improve LungSlidingVisualization(/lung/improve-lung-sliding-visualization)
Lung Curtain(/lung/0qbrvrw4ouvowjw3rqjd49q8ujia34)
Pleural Space(/lung/r0rwfjsuyay58csdb4lriyu6byephy)
Other Lung Ultrasound Pathology
!!
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A - Lines -Normal Lung(/lung/5l9jgyaszu0othj5tidg0miqxkmvyv)
ClassicFindings inPneumonia(/lung/pneumonia)
B-Lines -PulmonaryEdema(/lung/9kalmbf8y6j0nrspwvv876nyem83t5)
Confluent BLines(/lung/tnb16xs0qfeg6lc1rc23edrkrub8rm)
Spine Sign -PleuralEffusion(/lung/2dp7gz2u21bou53jnb0yybokdxq772)
Dove inPleural Fluid(/lung/2017/10/9/dove-in-pleural-fluid)
Infection Control During the COVID-19 Pandemic
EPA List of Disinfectants
for Use Against SARS-
CoV-2
VIEW LIST(HTTPS://WWW.EPA.GOV/PESTICIDE-
REGISTRATION/LIST-N-DISINFECTANTS-USE-AGAINST-SARS-
COV-2)
Denver Health COVID-19 Portable
Ultrasound Workflow
DOWNLOAD(/S/ETU0B4PU0AIRPC.JPEG)
ACEP Ultrasound
Section COVID-19 Cleaning Protocol
DOWNLOAD(/S/ACEP-
US-CLEANING-PROTOCOL-
COVID19.PDF)
Using Probe Cover for
Butterfly iQ + iPhone from Mike Stone
WATCH VIDEO(HTTPS://PLAYER.VIMEO.COM/VIDEO/398949721?
BYLINE=0&PORTRAIT=0&TITLE=0)
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Learn More About POCUS in COVID-19
PODCAST(https://www.ultrasoundgel.org/posts/bcLLYxfR8yN1SmYvwXPW9A)POCUS in COVID-19 via Ultrasound GEL. Michael Pratt sits down with Mike Mallin to discuss the most recent evidence regarding POCUS use in COVID-19 patients.
VIDEOCAST(https://www.coreultrasound.com/usp_covid_1/)POCUS Use in Patients with Suspected COVID-19 via Core Ultrasound. Mike Mallin and Jacob Avila talk with Michael Prats and Mike Stone on how ultrasound can be used to help manage your patients with suspected COVID.
COVID +POCUSRESOURCES(https://www.ultrasoundtraining.com.au/news/covid-19-pocus-resources)A comprehensive list of all things related to COVID-19 + POCUS from Zedu!
MORE COVID19 + POCUSRESOURCES(https://www.butterflynetwork.com/covid-19#stayconnected)Comprehensive resource page on use of bedside ultrasound in suspected COVID-19 patients tailored towards Butterfly iQ use.
References
1. Peng, Q., Wang, X. & Zhang, L. Findings of lung ultrasonography of novel corona virus
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Peng, Q., Wang, X. & Zhang, L. Findings of lung ultrasonography of novel corona virus
pneumonia during the 2019–2020 epidemic. Intensive Care Med (2020). Link
(https://link.springer.com/article/10.1007%2Fs00134-020-05996-6)
2. Huang, Yi and Wang, Sihan and Liu, Yue and Zhang, Yaohui and Zheng, Chuyun and
Zheng, Yu and Zhang, Chaoyang and Min, Weili and Zhou, Huihui and Yu, Ming and Hu,
Mingjun, A Preliminary Study on the Ultrasonic Manifestations of Peripulmonary
Lesions of Non-Critical Novel Coronavirus Pneumonia (COVID-19) (February 26, 2020).
Link (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3544750)
3. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, Tao Q, Sun Z, Xia L. Correlation of Chest CT
and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014
Cases. Radiology 2020. doi: 10.1148/radiol.2020200642 Link
(https://pubs.rsna.org/doi/10.1148/radiol.2020200642)
4. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With
2019 Novel Coronavirus–Infected Pneumonia in Wuhan,
China. JAMA. 2020;323(11):1061–1069. doi:10.1001/jama.2020.1585 Link
(https://jamanetwork.com/journals/jama/fullarticle/2761044)
(https://creativecommons.org/licenses/by-
nc/4.0/)
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