The BLUE Bedside Lung Ultrasound in Emergency -Protocol and the Diagnosis of

Pneumonia
ROHIT BISWAS GRP 29

of the venous network in appropriate cases, allowing the rapid

etiological diagnosis of an acute respiratory failure. It combines signs with localizations, The approach to acute respiratory failure: the BLUE-protocol
Acute respiratory failure is a life-threatening condition whose cause is sometimes difficult to recognize immediately.
Initial mistakes have deleterious consequences. BLUE-protocol, performed on dyspneic patients who will be admitted to the ICU, is a fast protocol: 3 minutes are required using suitable machines and the standardized points of analysis. Otherwise it can take longer (this time depends on the simplicity and adequacy of their equipment, of the standardization of their training).
Based on pathophysiology, it provides a step-by-step diagnosis of the main causes of acute respiratory failure, i.e., six diseases seen in 97% of patients in the emergency room, offering an overall 90.5% accuracy

the pleura, or like tiny ants marching on a string.

The pleura will seem to slide back and forth as the patient breathes. 

B lines and accompanied by a pleural slip, when it

is visible on the 4 BLUE-points (thus anterior) is called "Profile B". At this point, the main diagnosis is Hemodynamic Pulmonary Acute Edema.
The B-profile suggests acute hemodynamic pulmonary
edema with 97% sensitivity and 95% specificity  

Below the pleural line, a line regular and roughly parallel

to the pleural line can be seen: the lung line, indicating the visceral pleura (arrows). This line, together with the pleural line and the shadow of the ribs, display a kind of quad: the quad sign. Right: M-mode shows a movement of the lung line (white arrows) toward the pleural line (black arrows) on inspiration—the sinusoid sign, indicating also a free pleural effusion, and a viscosity enabling the use of small caliper needle if thoracentesis is envisaged. E, expiration. Quantitative data: this effusion found at the PLAPS-point has an expiratory thickness of roughly 13 mm, i.e., an expectedly small volume (study in progress). A 15-mm distance is our minimum required for safe diagnostic or therapeutic puncture, allowing to simplify the problem of modeling the real volume of an effusion

associated with a fringed and irregular pleural line indicative of

pulmonary fibrosis pattern.

ribs and the bottom of the image. The A-line (lower white

arrows) is the repetition of the pleural line at a standardised distance, the skin–pleural line distance.

subject when the probe is placed longitudinally on the lower

BLUE-point: three points are identified successively. 1. The pleural line, by the sign of the bat (hyperechogenic line slightly lower than the line of the ribs). 2. The pleural slip. 3. Artefacts visible in Merlin's space: exclusive A lines here.

syndrome close to the B profile, with the difference that

pleural slippage is here abolished. This profile is called Profile B'. The priority diagnosis is lung disease Lung Rockets: The Ultrasound Sign of Interstitial Syndrome

slip (with the stratosphere sign on the right, in TM

mode). No B-lines are visible. This profile called A' profile is the characteristic aspect of a pneumothorax, which, if time permits, will need to be confirmed by the detection of a lung point.

point, an all-or-nothing law where an A' profile is replaced

transiently, fleetingly and synchronously with breathing, in here a B profile. In the patient, the lung point was located in the PLAPS-point region, reflecting a significant volume pneumothorax.

PLAPS = Postero Lateral Alveolar &/or Pleural Syndrome.)

number and size) on the anterior wall defines the C

profile (for Consolidation), and prioritizes the diagnosis of pulmonary infection that causes acute respiratory failure.

on one side and profile B on the other, is

a true sign of infectious damage. This is the A/B profile, rare but almost specific.

a profile A (thus anterior) and a PLAPS (so later).

Later consolidation and/or posterior pleural effusion, if not associated with a B-profile (transudative reaction in hemodynamic pulmonary edema), an A' profile (possible hemothorax in pneumothorax), or venous thrombosis (pulmonary infarction or pleural reaction during pulmonary embolism), are correlated in the BLUE-protocol to the diagnosis of pneumopathy.  PLAPS = Posterio Lateral Alveolar &/or Pleural Syndrome.)

nude profile, the appearance of profile A (by definition earlier)

broadcast. The slip may be small, but it is present. Later rockets, possible, are not considered, as long as there is no PLAPS. The nude profile implies that no venous thrombosis has been detected. This is the usual profile of COPD and acute asthma.