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Use of point-of-care lung ultrasonography in the critical care setting as an aid to identifying the correct diagnosis in an acutely desaturating patient with COVID-19-related acute respiratory distress syndrome

A 64-year-old man was intubated and ventilated for COVID-19-associated acute respiratory distress syndrome. He had a background history of chronic obstructive pulmonary disease and ischaemic heart disease. His oxygen saturations dropped rapidly to 80% on day 9 of ICU admission. Chest auscultation re...

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Autores principales: Lock, Chris, Nix, Catherine M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970245/
https://www.ncbi.nlm.nih.gov/pubmed/33727298
http://dx.doi.org/10.1136/bcr-2020-240891
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author Lock, Chris
Nix, Catherine M
author_facet Lock, Chris
Nix, Catherine M
author_sort Lock, Chris
collection PubMed
description A 64-year-old man was intubated and ventilated for COVID-19-associated acute respiratory distress syndrome. He had a background history of chronic obstructive pulmonary disease and ischaemic heart disease. His oxygen saturations dropped rapidly to 80% on day 9 of ICU admission. Chest auscultation revealed absent breath sounds over the left upper chest which raised suspicions for pneumothorax, of which a small stable left apical pneumothorax was documented on a recent CT scan of the thorax. Point-of-care ultrasonography was performed prior to attempting chest drain insertion which demonstrated sliding pleura on the left side (GE Healthcare model: Vscan Extend—display: 5 inches, 720×1280 pixels resolution, sector probe—broad bandwidth: 1.7–3.8 MHz, 24 cm penetration and linear probe—broad bandwidth: 3.3–8 MHz, 8 cm penetration). A portable chest X-ray was obtained which demonstrated left upper lobe collapse secondary to mucus plugging. The mucus plug was successfully suctioned from the patient’s airway using bedside bronchoscopy subsequently improving the patient’s oxygen saturation. A follow-up chest X-ray and CT scan of the thorax demonstrated interval resolution of the left upper lobe collapse. While expansion of his existing pneumothorax was first on the list of differential diagnoses, the use of ultrasonography early in the patient’s assessment ensured it was ruled out prior to attempting chest drain insertion, thus prompting the acquisition of the chest X-ray which subsequently demonstrated the left upper lobe collapse as the correct diagnosis.
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spelling pubmed-79702452021-04-01 Use of point-of-care lung ultrasonography in the critical care setting as an aid to identifying the correct diagnosis in an acutely desaturating patient with COVID-19-related acute respiratory distress syndrome Lock, Chris Nix, Catherine M BMJ Case Rep Case Report A 64-year-old man was intubated and ventilated for COVID-19-associated acute respiratory distress syndrome. He had a background history of chronic obstructive pulmonary disease and ischaemic heart disease. His oxygen saturations dropped rapidly to 80% on day 9 of ICU admission. Chest auscultation revealed absent breath sounds over the left upper chest which raised suspicions for pneumothorax, of which a small stable left apical pneumothorax was documented on a recent CT scan of the thorax. Point-of-care ultrasonography was performed prior to attempting chest drain insertion which demonstrated sliding pleura on the left side (GE Healthcare model: Vscan Extend—display: 5 inches, 720×1280 pixels resolution, sector probe—broad bandwidth: 1.7–3.8 MHz, 24 cm penetration and linear probe—broad bandwidth: 3.3–8 MHz, 8 cm penetration). A portable chest X-ray was obtained which demonstrated left upper lobe collapse secondary to mucus plugging. The mucus plug was successfully suctioned from the patient’s airway using bedside bronchoscopy subsequently improving the patient’s oxygen saturation. A follow-up chest X-ray and CT scan of the thorax demonstrated interval resolution of the left upper lobe collapse. While expansion of his existing pneumothorax was first on the list of differential diagnoses, the use of ultrasonography early in the patient’s assessment ensured it was ruled out prior to attempting chest drain insertion, thus prompting the acquisition of the chest X-ray which subsequently demonstrated the left upper lobe collapse as the correct diagnosis. BMJ Publishing Group 2021-03-16 /pmc/articles/PMC7970245/ /pubmed/33727298 http://dx.doi.org/10.1136/bcr-2020-240891 Text en © BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ. This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.https://bmj.com/coronavirus/usage
spellingShingle Case Report
Lock, Chris
Nix, Catherine M
Use of point-of-care lung ultrasonography in the critical care setting as an aid to identifying the correct diagnosis in an acutely desaturating patient with COVID-19-related acute respiratory distress syndrome
title Use of point-of-care lung ultrasonography in the critical care setting as an aid to identifying the correct diagnosis in an acutely desaturating patient with COVID-19-related acute respiratory distress syndrome
title_full Use of point-of-care lung ultrasonography in the critical care setting as an aid to identifying the correct diagnosis in an acutely desaturating patient with COVID-19-related acute respiratory distress syndrome
title_fullStr Use of point-of-care lung ultrasonography in the critical care setting as an aid to identifying the correct diagnosis in an acutely desaturating patient with COVID-19-related acute respiratory distress syndrome
title_full_unstemmed Use of point-of-care lung ultrasonography in the critical care setting as an aid to identifying the correct diagnosis in an acutely desaturating patient with COVID-19-related acute respiratory distress syndrome
title_short Use of point-of-care lung ultrasonography in the critical care setting as an aid to identifying the correct diagnosis in an acutely desaturating patient with COVID-19-related acute respiratory distress syndrome
title_sort use of point-of-care lung ultrasonography in the critical care setting as an aid to identifying the correct diagnosis in an acutely desaturating patient with covid-19-related acute respiratory distress syndrome
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970245/
https://www.ncbi.nlm.nih.gov/pubmed/33727298
http://dx.doi.org/10.1136/bcr-2020-240891
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