/sites/default/files/ultrasound_for_pneumothorax_tn.jpg
The video demonstrates how to use long and short axis configurations, as well as M-mode, to detect and diagnose both a complete and partial pheumothorax.
Subtitles
<p begin="00:00:13.527" end="00:00:15.520" style="s2">- Hello, my name is Phil Perera,</p>
<p begin="00:00:15.520" end="00:00:17.174" style="s2">and I'm the Emergency<br />Ultrasound Coordinator</p>
<p begin="00:00:17.174" end="00:00:20.237" style="s2">at the New York Presbyterian<br />Hospital in New York City.</p>
<p begin="00:00:20.237" end="00:00:22.904" style="s2">And welcome to SoundBytes Cases.</p>
<p begin="00:00:23.793" end="00:00:25.675" style="s2">In this module we're<br />going to look specifically</p>
<p begin="00:00:25.675" end="00:00:29.522" style="s2">at Ultrasound of the Lung to<br />Evaluate for Pneumothorax.</p>
<p begin="00:00:29.522" end="00:00:30.355" style="s2">Interestingly enough,</p>
<p begin="00:00:30.355" end="00:00:33.024" style="s2">a classical belief was that<br />the lung was not optimal</p>
<p begin="00:00:33.024" end="00:00:35.194" style="s2">for ultrasound imaging.</p>
<p begin="00:00:35.194" end="00:00:36.960" style="s2">However newer findings have shown</p>
<p begin="00:00:36.960" end="00:00:39.435" style="s2">that actually ultrasound<br />is an excellent modality</p>
<p begin="00:00:39.435" end="00:00:43.868" style="s2">for viewing the pleura and<br />for detecting pnemothoraces.</p>
<p begin="00:00:43.868" end="00:00:46.707" style="s2">There's been a lot of<br />research looking at this</p>
<p begin="00:00:46.707" end="00:00:49.129" style="s2">and what's interesting is that ultrasound</p>
<p begin="00:00:49.129" end="00:00:52.171" style="s2">has been found now to be more<br />sensitive than chest X-ray</p>
<p begin="00:00:52.171" end="00:00:54.643" style="s2">in the diagnosis of<br />pneumothorax especially</p>
<p begin="00:00:54.643" end="00:00:57.186" style="s2">in the supine trauma patient.</p>
<p begin="00:00:57.186" end="00:00:59.640" style="s2">And now we're going to<br />add on views of the lungs</p>
<p begin="00:00:59.640" end="00:01:01.531" style="s2">looking for pneumothorax as part</p>
<p begin="00:01:01.531" end="00:01:03.250" style="s2">of our Extended FAST Exam,</p>
<p begin="00:01:03.250" end="00:01:05.528" style="s2">or the E-FAST exam that<br />we'll be performing</p>
<p begin="00:01:05.528" end="00:01:07.259" style="s2">in trauma patients.</p>
<p begin="00:01:07.259" end="00:01:09.570" style="s2">We can also detect pneumothoraces as well</p>
<p begin="00:01:09.570" end="00:01:11.570" style="s2">in our medical patients.</p>
<p begin="00:01:12.872" end="00:01:15.340" style="s2">Now let's learn how to perform<br />the ultrasound examination</p>
<p begin="00:01:15.340" end="00:01:17.803" style="s2">for the pneumothorax detection.</p>
<p begin="00:01:17.803" end="00:01:20.056" style="s2">Here we have the high frequency<br />linear type array probe</p>
<p begin="00:01:20.056" end="00:01:21.919" style="s2">positioned on the anterior chest wall</p>
<p begin="00:01:21.919" end="00:01:23.857" style="s2">at about the midclavicular line</p>
<p begin="00:01:23.857" end="00:01:27.054" style="s2">looking in to about<br />intercostal space three.</p>
<p begin="00:01:27.054" end="00:01:29.642" style="s2">Now in most cases of pneumothorax<br />with the patient supine</p>
<p begin="00:01:29.642" end="00:01:32.749" style="s2">the air would be predominantly<br />seen in this area.</p>
<p begin="00:01:32.749" end="00:01:34.808" style="s2">Note we're looking in a<br />long axis configuration</p>
<p begin="00:01:34.808" end="00:01:36.575" style="s2">between the ribs with the marker dot</p>
<p begin="00:01:36.575" end="00:01:39.886" style="s2">oriented superiorly<br />towards the patient's head.</p>
<p begin="00:01:39.886" end="00:01:42.387" style="s2">Once we've identified both<br />the ribs and the pleura</p>
<p begin="00:01:42.387" end="00:01:45.220" style="s2">we can swivel the probe into<br />the short axis configuration</p>
<p begin="00:01:45.220" end="00:01:46.891" style="s2">to further look at the pleura</p>
<p begin="00:01:46.891" end="00:01:49.107" style="s2">and to detect pneumothorax.</p>
<p begin="00:01:49.107" end="00:01:51.187" style="s2">Here we have the probe<br />oriented in a transverse</p>
<p begin="00:01:51.187" end="00:01:53.341" style="s2">or short axis orientation between the ribs</p>
<p begin="00:01:53.341" end="00:01:56.112" style="s2">looking directly down at the pleura.</p>
<p begin="00:01:56.112" end="00:01:58.815" style="s2">Notice in this case the<br />marker dot is located</p>
<p begin="00:01:58.815" end="00:02:01.936" style="s2">towards the lateral aspect of the patient.</p>
<p begin="00:02:01.936" end="00:02:04.427" style="s2">Using both long and<br />short axis configurations</p>
<p begin="00:02:04.427" end="00:02:06.462" style="s2">will allow you to detect a pneumothorax</p>
<p begin="00:02:06.462" end="00:02:08.494" style="s2">with a high degree of accuracy.</p>
<p begin="00:02:08.494" end="00:02:10.557" style="s2">If no lung is seen on<br />the anterior chest wall</p>
<p begin="00:02:10.557" end="00:02:12.353" style="s2">one can size out a pneumothorax</p>
<p begin="00:02:12.353" end="00:02:15.170" style="s2">by looking in the lateral<br />positions as shown here.</p>
<p begin="00:02:15.170" end="00:02:16.797" style="s2">Notice the probe on the lateral chest wall</p>
<p begin="00:02:16.797" end="00:02:20.859" style="s2">in the short axis<br />configuration between the ribs.</p>
<p begin="00:02:20.859" end="00:02:24.046" style="s2">If lung is seen here<br />laterally but not anteriorly,</p>
<p begin="00:02:24.046" end="00:02:27.459" style="s2">this would tell you it was<br />an incomplete pneumothorax.</p>
<p begin="00:02:27.459" end="00:02:28.996" style="s2">We can complement the short axis view</p>
<p begin="00:02:28.996" end="00:02:32.035" style="s2">by locating the probe into<br />the long axis configuration</p>
<p begin="00:02:32.035" end="00:02:34.042" style="s2">with the marker dot towards<br />the patient's axilla</p>
<p begin="00:02:34.042" end="00:02:36.597" style="s2">to further examine into<br />these lateral areas</p>
<p begin="00:02:36.597" end="00:02:38.535" style="s2">of the chest wall.</p>
<p begin="00:02:38.535" end="00:02:39.368" style="s2">Here's a nice pictorial showing</p>
<p begin="00:02:39.368" end="00:02:41.110" style="s2">the normal findings of a lung</p>
<p begin="00:02:41.110" end="00:02:43.573" style="s2">in a long axis type configuration.</p>
<p begin="00:02:43.573" end="00:02:44.787" style="s2">Superior rib to the left,</p>
<p begin="00:02:44.787" end="00:02:46.660" style="s2">inferior rib to the right.</p>
<p begin="00:02:46.660" end="00:02:48.737" style="s2">Notice that the ribs<br />cast shadows posteriorly</p>
<p begin="00:02:48.737" end="00:02:50.524" style="s2">due to the inability of the soundwaves</p>
<p begin="00:02:50.524" end="00:02:53.761" style="s2">to permeate the hard<br />calcifications of the rib.</p>
<p begin="00:02:53.761" end="00:02:55.729" style="s2">We see the chest wall anteriorly,</p>
<p begin="00:02:55.729" end="00:02:58.793" style="s2">and note here the two<br />layers of the pleura.</p>
<p begin="00:02:58.793" end="00:03:01.685" style="s2">And we see here the outer parietal pleura,</p>
<p begin="00:03:01.685" end="00:03:04.255" style="s2">and the inner visceral pleura.</p>
<p begin="00:03:04.255" end="00:03:07.197" style="s2">Now while I've depicted<br />these as two separate layers,</p>
<p begin="00:03:07.197" end="00:03:09.158" style="s2">in reality on ultrasound examination</p>
<p begin="00:03:09.158" end="00:03:12.075" style="s2">they're seen as a single<br />shimmering white line</p>
<p begin="00:03:12.075" end="00:03:15.041" style="s2">that moves back and forth<br />as the patient breathes.</p>
<p begin="00:03:15.041" end="00:03:18.268" style="s2">And as the patient breathes<br />we can see white comet tails,</p>
<p begin="00:03:18.268" end="00:03:20.182" style="s2">or linear lines, vertical lines,</p>
<p begin="00:03:20.182" end="00:03:24.015" style="s2">coming off the pleura<br />down deep into the lung.</p>
<p begin="00:03:25.724" end="00:03:28.164" style="s2">So that will be the<br />normal finding of a lung</p>
<p begin="00:03:28.164" end="00:03:30.181" style="s2">on long axis configuration.</p>
<p begin="00:03:30.181" end="00:03:31.349" style="s2">Here's a nice ultrasound image</p>
<p begin="00:03:31.349" end="00:03:32.613" style="s2">showing a normal lung</p>
<p begin="00:03:32.613" end="00:03:33.637" style="s2">and what we see here,</p>
<p begin="00:03:33.637" end="00:03:35.295" style="s2">we're in the long axis configuration,</p>
<p begin="00:03:35.295" end="00:03:37.081" style="s2">so the superior rib is to the left,</p>
<p begin="00:03:37.081" end="00:03:38.912" style="s2">inferior rib to the right.</p>
<p begin="00:03:38.912" end="00:03:40.244" style="s2">Chest wall anteriorly,</p>
<p begin="00:03:40.244" end="00:03:42.074" style="s2">and we see here the lung sliding</p>
<p begin="00:03:42.074" end="00:03:44.427" style="s2">which is the opposition<br />of the outer parietal</p>
<p begin="00:03:44.427" end="00:03:46.604" style="s2">and the inner visceral pleura.</p>
<p begin="00:03:46.604" end="00:03:48.548" style="s2">And we see the vertical comet tails</p>
<p begin="00:03:48.548" end="00:03:51.477" style="s2">coming off the back of the pleura.</p>
<p begin="00:03:51.477" end="00:03:53.678" style="s2">Thus this is a completely normal exam.</p>
<p begin="00:03:53.678" end="00:03:55.471" style="s2">No pneumothorax.</p>
<p begin="00:03:55.471" end="00:03:58.596" style="s2">But note the location of<br />the pleura deep to the ribs,</p>
<p begin="00:03:58.596" end="00:04:00.747" style="s2">and that classic shimmering<br />line back and forth</p>
<p begin="00:04:00.747" end="00:04:03.247" style="s2">as the patient takes a breath.</p>
<p begin="00:04:05.032" end="00:04:07.051" style="s2">Here we see more dramatic comet tails</p>
<p begin="00:04:07.051" end="00:04:10.838" style="s2">coming off the shimmering<br />parietal and visceral pleura.</p>
<p begin="00:04:10.838" end="00:04:12.769" style="s2">In this patient we see the comet tails</p>
<p begin="00:04:12.769" end="00:04:14.096" style="s2">shooting off the back,</p>
<p begin="00:04:14.096" end="00:04:18.590" style="s2">telling us that this lung is<br />up and there's no pneumothorax.</p>
<p begin="00:04:18.590" end="00:04:20.922" style="s2">So vertical lines coming<br />off the back of the pleura</p>
<p begin="00:04:20.922" end="00:04:24.031" style="s2">always mean that the lung is<br />up and are always a good sign</p>
<p begin="00:04:24.031" end="00:04:26.053" style="s2">on lung ultrasound sonography.</p>
<p begin="00:04:26.053" end="00:04:28.039" style="s2">As we mentioned we should<br />also swivel the probe</p>
<p begin="00:04:28.039" end="00:04:29.742" style="s2">into the short axis configuration</p>
<p begin="00:04:29.742" end="00:04:31.252" style="s2">to further examine the lung,</p>
<p begin="00:04:31.252" end="00:04:33.067" style="s2">and what we see here is a normal lung</p>
<p begin="00:04:33.067" end="00:04:35.242" style="s2">in short axis configuration.</p>
<p begin="00:04:35.242" end="00:04:37.119" style="s2">Note here we're looking<br />in between the ribs</p>
<p begin="00:04:37.119" end="00:04:38.996" style="s2">so all we see is the dome of the lung</p>
<p begin="00:04:38.996" end="00:04:40.984" style="s2">and notice that it slides back and forth</p>
<p begin="00:04:40.984" end="00:04:42.382" style="s2">as the patient breathes,</p>
<p begin="00:04:42.382" end="00:04:43.772" style="s2">and we see the vertical comet tails</p>
<p begin="00:04:43.772" end="00:04:45.744" style="s2">coming off the back.</p>
<p begin="00:04:45.744" end="00:04:50.049" style="s2">So a completely normal examination<br />in the short axis plane.</p>
<p begin="00:04:50.049" end="00:04:51.424" style="s2">Here's another ultrasound image</p>
<p begin="00:04:51.424" end="00:04:53.861" style="s2">taken from the short axis configuration.</p>
<p begin="00:04:53.861" end="00:04:56.247" style="s2">Note here we see very<br />prominent comet tails</p>
<p begin="00:04:56.247" end="00:04:59.775" style="s2">coming off the back of the lung<br />as it slides back and forth.</p>
<p begin="00:04:59.775" end="00:05:01.019" style="s2">Again it's that opposition</p>
<p begin="00:05:01.019" end="00:05:03.729" style="s2">of the parietal and visceral<br />layers of the pleura</p>
<p begin="00:05:03.729" end="00:05:05.783" style="s2">that allow the lung shimmering,</p>
<p begin="00:05:05.783" end="00:05:08.381" style="s2">but notice here all the comet<br />tails coming off the back.</p>
<p begin="00:05:08.381" end="00:05:10.965" style="s2">In this case this patient<br />had some pulmonary edema</p>
<p begin="00:05:10.965" end="00:05:12.291" style="s2">associated with the lung</p>
<p begin="00:05:12.291" end="00:05:14.350" style="s2">and these comet tails are more pronounced</p>
<p begin="00:05:14.350" end="00:05:18.113" style="s2">due to the presence of<br />water within the pleura.</p>
<p begin="00:05:18.113" end="00:05:20.339" style="s2">But notice all these vertical<br />lines coming off the back</p>
<p begin="00:05:20.339" end="00:05:22.596" style="s2">telling us this lung is up.</p>
<p begin="00:05:22.596" end="00:05:24.311" style="s2">A way to document that the lung is up</p>
<p begin="00:05:24.311" end="00:05:27.215" style="s2">to print out for the<br />chart is to put M-Mode,</p>
<p begin="00:05:27.215" end="00:05:30.179" style="s2">and generally what we do is<br />locate it so the M-Mode cursor</p>
<p begin="00:05:30.179" end="00:05:32.177" style="s2">is down right at the pleura.</p>
<p begin="00:05:32.177" end="00:05:34.389" style="s2">And what we see is the<br />classic seashore sign,</p>
<p begin="00:05:34.389" end="00:05:36.291" style="s2">or waves on the beach.</p>
<p begin="00:05:36.291" end="00:05:39.115" style="s2">If we look anteriorly we'll<br />see the classic waves,</p>
<p begin="00:05:39.115" end="00:05:41.122" style="s2">or no motion of the chest wall,</p>
<p begin="00:05:41.122" end="00:05:42.017" style="s2">and below that,</p>
<p begin="00:05:42.017" end="00:05:44.924" style="s2">deep to the pleura we'll see<br />the positive motion of the lung</p>
<p begin="00:05:44.924" end="00:05:46.524" style="s2">making up the beach.</p>
<p begin="00:05:46.524" end="00:05:48.194" style="s2">So waves on the beach,</p>
<p begin="00:05:48.194" end="00:05:49.711" style="s2">or the seashore sign,</p>
<p begin="00:05:49.711" end="00:05:52.401" style="s2">and M-Mode documentation<br />that the lung is up</p>
<p begin="00:05:52.401" end="00:05:55.151" style="s2">and that there's no pneumothorax.</p>
<p begin="00:05:56.258" end="00:05:58.228" style="s2">Now that we understand what<br />a normal lung looks like</p>
<p begin="00:05:58.228" end="00:05:59.697" style="s2">on bedside examination,</p>
<p begin="00:05:59.697" end="00:06:02.061" style="s2">let's take a look at a<br />pictorial showing a pneumothorax</p>
<p begin="00:06:02.061" end="00:06:04.052" style="s2">in a long axis view.</p>
<p begin="00:06:04.052" end="00:06:05.877" style="s2">We see here that the parietal pleura</p>
<p begin="00:06:05.877" end="00:06:08.186" style="s2">is now split from the visceral pleura,</p>
<p begin="00:06:08.186" end="00:06:10.104" style="s2">which is attached to the lung</p>
<p begin="00:06:10.104" end="00:06:12.533" style="s2">by a layer of air shown<br />by the yellow color.</p>
<p begin="00:06:12.533" end="00:06:15.424" style="s2">It's the splitting of the<br />parietal and visceral pleura</p>
<p begin="00:06:15.424" end="00:06:18.646" style="s2">that now causes a lack of lung sliding.</p>
<p begin="00:06:18.646" end="00:06:21.356" style="s2">And instead of the opposed<br />visceral and parietal pleura</p>
<p begin="00:06:21.356" end="00:06:23.521" style="s2">sliding back and forth<br />as the patient breathes,</p>
<p begin="00:06:23.521" end="00:06:25.137" style="s2">all we see is a single line,</p>
<p begin="00:06:25.137" end="00:06:26.294" style="s2">the parietal pleura,</p>
<p begin="00:06:26.294" end="00:06:30.161" style="s2">with a lack of vertical comet<br />tails coming off the back.</p>
<p begin="00:06:30.161" end="00:06:31.837" style="s2">Here's an ultrasound<br />image taken from a patient</p>
<p begin="00:06:31.837" end="00:06:33.705" style="s2">who was stabbed to the left chest</p>
<p begin="00:06:33.705" end="00:06:35.491" style="s2">and who had shortness of breath.</p>
<p begin="00:06:35.491" end="00:06:38.733" style="s2">What we see here is a long<br />axis view of a pneumothorax.</p>
<p begin="00:06:38.733" end="00:06:40.911" style="s2">Let's take a look at the<br />chest wall anteriorly,</p>
<p begin="00:06:40.911" end="00:06:43.690" style="s2">and right below that we<br />see the parietal pleura,</p>
<p begin="00:06:43.690" end="00:06:47.370" style="s2">the single white line located<br />directly inferior to the ribs.</p>
<p begin="00:06:47.370" end="00:06:50.835" style="s2">But notice the classic<br />lack of the lung sliding.</p>
<p begin="00:06:50.835" end="00:06:52.692" style="s2">All we see here is a single white line</p>
<p begin="00:06:52.692" end="00:06:55.924" style="s2">that fails to slide back and<br />forth as the patient breathes.</p>
<p begin="00:06:55.924" end="00:06:59.714" style="s2">Notice also the absence of<br />the vertical comet tails.</p>
<p begin="00:06:59.714" end="00:07:01.279" style="s2">Here's another image of a pneumothorax</p>
<p begin="00:07:01.279" end="00:07:02.973" style="s2">in a long axis configuration,</p>
<p begin="00:07:02.973" end="00:07:05.300" style="s2">and we see here the chest wall anteriorly,</p>
<p begin="00:07:05.300" end="00:07:08.440" style="s2">and the single white line<br />which is the parietal pleura.</p>
<p begin="00:07:08.440" end="00:07:10.350" style="s2">Now this patient was acutely dyspneic,</p>
<p begin="00:07:10.350" end="00:07:12.315" style="s2">so notice that there is some<br />motion of the chest wall</p>
<p begin="00:07:12.315" end="00:07:14.896" style="s2">and that the parietal<br />pleura moves up and down,</p>
<p begin="00:07:14.896" end="00:07:18.231" style="s2">but notice the failure<br />of horizontal sliding.</p>
<p begin="00:07:18.231" end="00:07:21.059" style="s2">Notice also the absence of<br />any vertical comet tails</p>
<p begin="00:07:21.059" end="00:07:23.656" style="s2">coming off the back of the pleura.</p>
<p begin="00:07:23.656" end="00:07:26.656" style="s2">Now let's inspect a pneumothorax<br />from the short axis view.</p>
<p begin="00:07:26.656" end="00:07:28.598" style="s2">We see the chest wall anteriorly,</p>
<p begin="00:07:28.598" end="00:07:30.879" style="s2">the parietal pleura as shown as a single,</p>
<p begin="00:07:30.879" end="00:07:33.695" style="s2">non-mobile white line in<br />the middle of the image.</p>
<p begin="00:07:33.695" end="00:07:36.115" style="s2">Note the failure of<br />movement back and forth,</p>
<p begin="00:07:36.115" end="00:07:38.156" style="s2">the lack of vertical comet tails,</p>
<p begin="00:07:38.156" end="00:07:40.696" style="s2">and what we see here is<br />repeating horizontal air lines</p>
<p begin="00:07:40.696" end="00:07:42.740" style="s2">from the pneumothorax.</p>
<p begin="00:07:42.740" end="00:07:44.423" style="s2">To document the absence of lung sliding</p>
<p begin="00:07:44.423" end="00:07:46.293" style="s2">and the presence of a pneumothorax,</p>
<p begin="00:07:46.293" end="00:07:48.023" style="s2">we'll again turn to M-Mode.</p>
<p begin="00:07:48.023" end="00:07:50.200" style="s2">If we put the M-Mode<br />cursor down on the pleura,</p>
<p begin="00:07:50.200" end="00:07:53.775" style="s2">what we'll see is a set<br />of linear repeating lines.</p>
<p begin="00:07:53.775" end="00:07:56.457" style="s2">This documents no motion<br />of both the chest wall</p>
<p begin="00:07:56.457" end="00:07:57.841" style="s2">and of the lung,</p>
<p begin="00:07:57.841" end="00:08:02.180" style="s2">making up a finding known<br />as the bar code sign.</p>
<p begin="00:08:02.180" end="00:08:04.614" style="s2">Here's a pictorial showing<br />interesting finding.</p>
<p begin="00:08:04.614" end="00:08:06.611" style="s2">The signature of an<br />incomplete pneumothorax,</p>
<p begin="00:08:06.611" end="00:08:08.525" style="s2">known as lead point.</p>
<p begin="00:08:08.525" end="00:08:09.954" style="s2">And what we see is an<br />incomplete pneumothorax</p>
<p begin="00:08:09.954" end="00:08:12.222" style="s2">with air collecting to the superior aspect</p>
<p begin="00:08:12.222" end="00:08:13.055" style="s2">of the image to the left.</p>
<p begin="00:08:13.055" end="00:08:16.192" style="s2">Thus splitting the parietal<br />from the visceral layers</p>
<p begin="00:08:16.192" end="00:08:19.458" style="s2">and causing an absence of<br />lung sliding superiorly.</p>
<p begin="00:08:19.458" end="00:08:21.821" style="s2">However, as the lung is coming<br />up against the chest wall</p>
<p begin="00:08:21.821" end="00:08:23.650" style="s2">to the right or inferiorly,</p>
<p begin="00:08:23.650" end="00:08:25.184" style="s2">that's where we'll see the presence</p>
<p begin="00:08:25.184" end="00:08:26.677" style="s2">of horizontal lung sliding,</p>
<p begin="00:08:26.677" end="00:08:29.905" style="s2">and the presence of the<br />vertical comet tails.</p>
<p begin="00:08:29.905" end="00:08:31.714" style="s2">Here's an ultrasound image<br />showing the lead point,</p>
<p begin="00:08:31.714" end="00:08:34.546" style="s2">and what we see here is the<br />lung sliding to the right,</p>
<p begin="00:08:34.546" end="00:08:37.380" style="s2">the area where the lung touches<br />up against the chest wall,</p>
<p begin="00:08:37.380" end="00:08:40.456" style="s2">and to the left the area<br />of absence of lung sliding</p>
<p begin="00:08:40.456" end="00:08:42.651" style="s2">telling you there that air has collected</p>
<p begin="00:08:42.651" end="00:08:45.303" style="s2">between the visceral and parietal layers.</p>
<p begin="00:08:45.303" end="00:08:47.895" style="s2">So the ultrasound equivalent of the image</p>
<p begin="00:08:47.895" end="00:08:49.444" style="s2">that we just looked at telling you</p>
<p begin="00:08:49.444" end="00:08:51.863" style="s2">that this is an incomplete pneumothorax.</p>
<p begin="00:08:51.863" end="00:08:53.356" style="s2">But here we see that lead point,</p>
<p begin="00:08:53.356" end="00:08:54.508" style="s2">or transition point,</p>
<p begin="00:08:54.508" end="00:08:56.900" style="s2">very well on bedside sonography.</p>
<p begin="00:08:56.900" end="00:08:58.378" style="s2">In conclusion I'm glad<br />I could share with you</p>
<p begin="00:08:58.378" end="00:09:00.701" style="s2">this ultrasound module going<br />over ultrasound of the lung</p>
<p begin="00:09:00.701" end="00:09:02.676" style="s2">to evaluate for pneumothorax.</p>
<p begin="00:09:02.676" end="00:09:04.725" style="s2">This is an excellent tool<br />for viewing the pleura</p>
<p begin="00:09:04.725" end="00:09:06.882" style="s2">and making the diagnosis of pneumothorax,</p>
<p begin="00:09:06.882" end="00:09:08.880" style="s2">and there's been some research<br />showing that it may be</p>
<p begin="00:09:08.880" end="00:09:10.942" style="s2">more sensitive than chest<br />X-ray in the diagnosis</p>
<p begin="00:09:10.942" end="00:09:12.245" style="s2">of pneumothorax,</p>
<p begin="00:09:12.245" end="00:09:14.247" style="s2">allowing rapid diagnosis of pneumo</p>
<p begin="00:09:14.247" end="00:09:16.735" style="s2">in both your trauma and medical patient,</p>
<p begin="00:09:16.735" end="00:09:18.710" style="s2">thus facilitating more timely management</p>
<p begin="00:09:18.710" end="00:09:21.641" style="s2">of these most critical patients.</p>
<p begin="00:09:21.641" end="00:09:25.808" style="s2">So I hope to see you back<br />as SoundBytes continues.</p>
Brightcove ID
5508134309001
https://youtube.com/watch?v=Xxdedx1HtHo