Template:BLUE Protocol
Bedside Lung Ultrasound in Emergency (BLUE) Protocol[1]
- Landmark study by a French intensivist that described various profiles of specific pulmonary disease found on US[2]
- Ultrasound approaches include anterior zones and PLAPS (posterior or lateral alveolar and/or pleural syndrome) point, which is located at the posterior axillary line similar to FAST view
- Predominant A lines anteriorly + lung sliding = Asthma/COPD
- Multiple predominant B lines anteriorly + lung sliding = Pulmonary Edema
- Predominant A lines anteriorly + lung sliding + positive DVT = PE
- Absent anterior lung sliding + anterior A lines + positive lung point = Pneumothorax (PTX)
- PLAPS findings +/- A or B lines +/- abolished lung sliding = Pneumonia
- PLAPS describes changes at the PLAPS point, usually related to consolidations and pleural effusions[3]
- Consolidations may include lung hepatization, shred sign, air bronchograms
- Note that mirroring (normal) may appear similar to hepatization, but mirroring only shows in specific spots due to specific echogenic windows
- Pleural effusions are visualized as anechoic/hypoechoic areas with possible spine sign or floating lung sign (sinusoid sign on M-mode)
- A suggested BLUE protocol guides diagnosis of dyspnea; this should be modified as needed based on clinical presentation
- Check lung sliding in anterior lung fields ---> check for A and B lines ---> check for PLAPS findings
- ↑ http://ccm.anest.ufl.edu/files/2012/08/BLUELung.pdf Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure - The BLUE Protocol
- ↑ Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008 Jul;134(1):117-25. doi: 10.1378/chest.07-2800. Epub 2008 Apr 10. Erratum in: Chest. 2013 Aug;144(2):721. PMID: 18403664; PMCID: PMC3734893.
- ↑ Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014 Jan 9;4(1):1. doi: 10.1186/2110-5820-4-1. PMID: 24401163; PMCID: PMC3895677.