Lung Ultrasound in COVID-19 Webinar

Introduction on the clinical picture of COVID-19 disease.


(F. Piscaglia)
Basic concepts in lung ultrasound - focus on "US interstitial syndrome”


(F. Stefanini)
Characteristics of US pattern of COVID-19 pneumonitis


(F. Stefanini)
Use of US in the Emergency Department during COVID-19 outbreak: experience from Bologna, Italy


(V. Salvatore)
Video demonstration of how to perform US in COVID+ patients
and perspective in the use of US in a Medicine Unit


F. Stefanini & F. Piscaglia


1Would you consider taking images first, then uploading them to your work station for evaluation later?
We think that interpreting a lung ultrasound examination just by evaluating images afterwards could lead to significant errors. Since unequivocal spatial references are few, it's quite difficult to allocate findings to the right area. Moreover, the whole surface of each area of the lungs has to be assessed by real time continuous movements of the probe: still images don't suffice at all and videos might sometimes look "ambiguous". We find it best to make up our mind and report our findings on the spot. Recording videos and images might may still be important to monitor any particularly prominent findings by comparing their changes in appearance over time.
2Why do you think pleural effussion is so rare in covid-19 patients? While subpleural consolidation is so often seen.
This is a very good question. We don't have any evidence to answer that yet. We're currently making efforts in better understanding the mechanisms behind the appearance of supleural consolidations. We argue that these are manifold. Any new findings will be shared with the scientifical community.
3Will M-mode be useful in Lung U/S for COVID-19?
M-mode has limited applications in lung ultrasound. For COVID-19 two potential uses that we could think of are: 1) to help the diagnose of pneumothorax (potential complication of ventilation); 2) to help assess diaphragm mobilty during normal ventilation (a reduced mobility could hint to a progression to diaphragm exhaustion and reduced compliance, as in ARDS).
4Do you use airborn or droplet PPEs while doing the exams?
Since POCUS in general and LUS' thorough examinations in particular require a prolonged direct contact between patient and examiner we always use full body protective equipment against both droplets and airborne particles in suspected/confirmed positive patients. At present we use only PPE protecting from droplets, but not from airbonr transmission, as you can see see in our video tutorial. As far as it is known there is airborne transmission of the Cars-Cov-2 virus, but only though droplets.
5Is there a place for lung ultrasound in general practice?
Yes. We believe LUS and point-of-care in general to be a potentially inestimable tool in the hands of general practitioners. No other imaging modalities have the same advantages in terms of portability, safety, flexibility and power. We suggest you to look-up terms such as "POCUS" and "echoscopy". Several publications have already covered this topic. As for the "COVID-19 era", several regions in Italy are implementing LUS in existing "task forces" of GP that visit patients in their homes, giving them the ability to screen for potential positive cases and to rule-out severe lung involvement by the disease.
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