COVID-19 POCUS HUB

Medstudent POCUS has created a quick-look page for emergency providers using POCUS in the COVID-19 pandemic.

Last update: 5/23/20Please e-mail urquha19@msu.edu if you have something you'd like us to add, edit, or review!
Transcripts from global webinars:ACEP / CUAP / AEUS / AAEM / SCUF national town hall on implementation of POCUS in COVID19 COVID-19 Ultrasound Town Hall 3/18/20 transcript COVID-19 Ultrasound Town Hall Video123sonography Webinar123sonography Webinar 3/19/20 Transcript notesButterfly WebinarButterfly Inc COVID19 POCUS Webinar 3/19/20 Transcript

4 TAKE-HOME POINTS

We are combing the blogs, twitter feeds, published research, conversation forums, podcasts, webinars, and post-it notes. Here are our 4 top points for ED clinicians using POCUS for COVID-19.

COVID-19 lung ultrasound findings

are not specific for the virus and similar to the interstitial syndrome pattern that is seen with other viral illnesses.

Findings include:

  • B lines
  • confluent B lines
  • pleural thickening with irregularity
  • consolidated lesions in a skip pattern.
  • *Pleural effusions are rare.

Lung ultrasound (LUS) is an alternative to time-consuming CT scans, improving throughput and transmission risk. Thoroughness with a lawn-mower scanning motion increases sensitivity. LUS is more sensitive than CXR and as sensitive as CT for viral pneumonia *when lesions extend to pleura.

Preferentially use handheld devices, lung preset, and use same cleaning procedure as with endocavitary probes. Clean both before and after. Consider probe cover.

Disinfecting protocols

Scan the heart! COVID-19 can progress to myocarditis and heart failure.

And don't forget other uses: IV access, central line placement, intubation confirmation

COVID-19 PNA Example videos

courtesy of butterfly, inc. Find tons more on the searchable www.grepmed.com
COVID Lung 2.mp4

Pleural thickening and B lines

COVID Lung 1.mp4

Skip Lesions

COVID Consolidation.mp4

Lung Consolidation

COVID-19 POCUS Publications

Huang Wang Liu Zhang preliminary.pdf

Not peer reviewed, but has a lot of images

Poggiali Can lung US help crit care.pdf
1234004.pdf
Buonsenso. Point-of-Care Lung Ultrasound findings in novel coronavirus disease-19 pnemoniae: a case report and potential applications during COVID-19 outbreak. Private copy-do not distribute.
Peng2020_Article_FindingsOfLungUltrasonographyO.pdf
PIIS221326002030120X.pdf

Learn Lung US Now!

Lung ultrasound is relatively easy to learn. There have been suggestions to teach any untrained staff, including nurses. Some suggested applications: triage, screening, monitor progression

HOW-TO DO LUS (45 seconds)

VIRAL Pneumonia (5 minutes)

Suggested References

Avila, J, Mallin, M, Prats, M, and Stone, M. How ultrasound can be used to help manage your patients with suspected COVID. CORE Ultrasound. Video interview published on March 17, 2020. Accessed March 27, 2020. Available at: https://www.coreultrasound.com/usp_covid_1/
Buonsenso D, Piano A, Raffaelli F, Bonadia N, de Gaetano Donati K, Franceschi F. Point-of-Care Lung Ultrasound findings in novel coronavirus disease-19 pnemoniae: a case report and potential applications during COVID-19 outbreak. Eur Rev Med Pharmacol Sci. 2020;24(5):2776–2780. doi:10.26355/eurrev_202003_20549
Buonsenso, D., Pata, D. COVID-19 outbreak: less stethoscope, more ultrasound. The Lancet. March 20, 2020. https://doi.org/10.1016/S2213-2600(20)30120-X
Butterfly IQ. Fighting COVID-19 Together. Accessed on March 17, 2020. Available at: https://www.butterflynetwork.com/covid-19
Buonsenso, D et al. Point-of-Care Lung Ultrasound findings in novel coronavirus disease-19 pnemoniae: a case report and potential applications during COVID-19 outbreak. Eur Rev Med Pharmacol Sci. Mar 2020. 24(5): 2776-2780. Available at: https://www.europeanreview.org/wp/wp-content/uploads/2776-2780.pdf
Dinh, Vi. Complete Guide to Lung Ultrasound In COVID-29 Patients. Blog post. Published April 1, 2020. Accessed April 1, 2020. Available at: https://www.pocus101.com/complete-guide-to-lung-ultrasound-in-covid-19-coronavirus-patients/
Duncan, Chris. COVID-19 Lung Ultrasound. Ultrasound at the front door Blog. Published on March 16, 2020. Accessed on March 17, 2020. Available at http://www.ultrasoundatthefrontdoor.com/covid-19-lus/
Huang, Y. et al. A Preliminary Study on the Ultrasonic Manifestations of Peripulmonary Lesions of Non-Critical Novel Coronavirus Pneumonia (COVID-19). SSRN (2020)
GREPMED POCUS Example Database. The largest collection online, searchable by organ system and pathology. https://www.grepmed.com/?q=COVID19+POCUS
Farkas, J. COVID-19. Internet Book of Critical Care (IBCC). Published on March 2, 2020. Accessed on March 17, 2020. Available at: https://emcrit.org/ibcc/covid19/#lung_ultrasonography
FUSIC--Focused Ultrasound for Intensive Care. Guidelines for COVID-19. Released March 20, 2020.
Massimo, Gianni. Synopsis from the GiViTI COVID19 Meeting. Available at this link.
Miller, A. Practical Guide to Lung Ultrasound. British Journal of Anaesthesia Education (2016)
Peng, Q., Wang, X. & Zhang, L. Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic.Intensive Care Med (2020).
Poggiali, E. et al. Can Lung US Help Critical Care Clinicians in the Early Diagnosis of Novel Coronavirus (COVID-19) Pneumonia? Radiology. Letter to the editor. In press. https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020200847
Prats, Michael. POCUS in COVID-19. Ultrasound G.E.L. Podcast Blog. Published on March 17, 2020. Accessed on March 17, 2020. Available at https://www.ultrasoundgel.org/89.
Rezaie, Salim. COVID-19: The novel coronavirus 2019. REBEL EM Blog. Published on: March 1, 2020. Accessed on: March 17, 2020. Available at: https://rebelem.com/covid-19-the-novel-coronavirus-2019/
Stempniak, M. Radiologists ‘strongly recommend’ bedside ultrasound for COVID-19 pneumonia diagnosis. Radiology Business. Published on March 16, 2020. Accessed on 3/18, 2020. Available at: https://www.radiologybusiness.com/topics/care-delivery/radiologists-ultrasound-covid-19-chest-x-ray-coronavirus