SAEM PULSE | MAY-JUNE 2020 | SPECIAL COVID-19 ISSUE
SPECIAL COVID-19 ISSUE
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SARS-CoV-2/COVID-19 Lung Ultrasound Recommendations By Timothy Jang MD, Creagh Boulger MD, Jennifer Carnell MD, Kristin Dwyer MD, MPH, Robert Huang MD, Elaine Situ-LaCasse MD, and Lori Stolz MD on behalf of SAEM's Academy of Emergency Ultrasound It is challenging to differentiate between SARS-CoV-2/COVID-19 and other common causes of dyspnea such as congestive heart failure, community acquired pneumonia, or another viral illness in the setting of acute respiratory distress. Furthermore, as more patients present to the emergency department with concern for possible SARS-CoV-2/COVID-19 infection, hospital resources are being rapidly consumed and may soon exceed capacity. Thus, common diagnostic studies such as chest radiographs
(CXR) and computed tomography (CT) may not be readily available. In addition, performing these tests will expose additional health care workers to a patient under investigation (PUI) for SARS-CoV-2/COVID-19 and may also require radiology suite decontamination, thus making the suite unusable for a period of time. Subsequently, this would require additional supplies and personal protective equipment (PPE). Recent reports from China and Italy recommend the use of lung ultrasound to facilitate early identification of
patients who develop acute respiratory distress syndrome (ARDS) associated with SARS-CoV-2/COVID-19 (See references) and suggest that early use of lung ultrasound could improve upon the physical exam, be more helpful than CXR, and avoid the overuse of CT. In the Italian cohort, most patients with ARDS from SARS-CoV-2/COVID-19 had a diffuse B-line pattern with skip/ spared areas. In the Chinese cohort, 87 percent of patients with SARSCoV-2/COVID-19 had peripheral rather than central infiltrates, 82 percent