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• W4386585792 abstract "acute dyspnea, ultrasound: Image 1. The sandy beach sign, with the active lung sliding on the bottom of the screen (the sand) representing movement of the pleura (arrow) and the static musculature/soft tissue at the top of the screen (the waves of the beach).FigureFigureA young man in distress arrives after a high-speed motor vehicle collision. You perform a basic FAST exam as part of your trauma survey. It is negative, and no cause is obvious for the patient's distress and hemodynamic instability. You turn back to the ultrasound machine, grab the linear probe, and place it on the patient's chest, first scanning the patient's right upper chest. Adjusting to just a few centimeters of depth, you see normal lung sliding, parietal and visceral pleura sliding against each during each breathing cycle. Applying M-mode to the area demonstrates the sandy beach sign. (Image 1.) Moving the probe to the patient's left chest, you see something different: no movement, and the pleural layers appear to be motionless. When M-mode is applied, a different pattern emerges: the barcode sign. (Image 2.) The air is trapped between the visceral and parietal pleura due to a pneumothorax, and it is preventing visualization of lung sliding. You slide the probe across the patient's chest wall, and notice an area of lung sliding periodically appearing on the screen with each breath. You recognize this as a lung point, the border of the pneumothorax and normal lung. A chest tube is subsequently placed on the left side with immediate resolution of his symptoms. Using point-of-care ultrasound (POCUS) to rule out pneumothorax has several advantages over x-ray: It's fast and doesn't require calling a tech or bringing in a bulky machine, and most importantly, it's just better at diagnosing pneumothorax.Figure: Image 2. The barcode sign demonstrates no differentiation between the static musculature and soft tissue at the top of the screen and the static pleura (arrow) at the bottom of the screen.Figure: Image 3. The lung point represents the border between normal sliding pleura (sandy beach sign at the left side of the image, arrowhead) and the pneumothorax (barcode sign at b on the right side of the image).The sensitivity and specificity for a supine chest x-ray is poor, ranging in some studies from as low as 28 percent to 75 percent. On the other hand, bedside ultrasound performs well, with sensitivity ranging from 86 percent to 100 percent with a positive likelihood ratio of 121. (Pneumothorax: M-mode: Seashore vs Barcode. The POCUS Atlas. https://bit.ly/3qIeJnt; Acad Emerg Med. 2010;17[1]:11.) And the specificity for pneumothorax approaches 100 percent when a lung point is visualized. (Acad Emerg Med. 2005;12[9]:844.) The take-home point? Consider lung ultrasound, and look for the barcode sign in your next patient with acute dyspnea. Dr. Sethiis a clinical ultrasound fellow at Emory University. Dr. Buttsis the director of the division of emergency ultrasound and a clinical assistant professor of emergency medicine at Louisiana State University at New Orleans. Follow her on Twitter@EMNSpeedofSound, and read her past columns athttp://bit.ly/EMN-SpeedofSound." @default.
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• W4386585792 date "2022-01-01" @default.
• W4386585792 modified "2023-09-29" @default.
• W4386585792 title "The Speed of Sound" @default.
• W4386585792 doi "https://doi.org/10.1097/01.eem.0000815584.12428.b6" @default.
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