This is a case from last week – 21month old boy, one week of cough, had seen another practioner 4 days prior, started on amoxycillin/clavulinic acid, persistent fevers, up all night coughing, drinking, not eating. Child looked unwell. T38.5, HR140, RR40, Sp02RA 93%, slight rib retraction, warm peripheries, well hydrated, nil rash. Red TM, flat tonsils, crepitations right lung base. GPPOCUS with linear probe, lung 6 region, this is region 2 on the right:
Demonstrating shred (breaking up of the visceral pleural line), effusion and increased density in the lung (hepatisation – the lung looks like liver in terms of echogenicity).
These are the lung zones:
They went to the local ED with mother and chest radiograph confirmed right peri-hilar consolidation. POCUS did not definitely change my management here – Sp02 was low, there was persistent fever and they looked unwell. However knowing there was right dependent lung consolidation confirmed that I wasn’t sentencing the family to an ED wait in vain. I called family today and after a change of oral antibiotics the fever is down, eating better and more interactive.
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Varshney T, et al. Point-of-care lung ultrasound in young children with
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