POCUS Learning Modules

MODULE 8:  Lung Ultrasound & CLUE Protocol for Dyspnea

Curriculum Location: Cardiology / Total Time: 2 hours

For this and all other modules, you are welcome and encouraged to take notes as helpful to you in your Ultrasound/POCUS for Family MedicineEvernote Notebook, found here. 

Learning Module Objectives:

  1. Evaluate the lungs for pleural effusion, recognizing the spine sign vs normal curtain sign and mirror imaging

  2. Evaluate the lungs for pneumothorax, recognizing the absence of lung sliding, lung point, and the barcode sign

  3. Evaluate the lungs for pulmonary edema, recognizing B-lines vs the A-lines of normal aerated lung

  4. Utilize the CLUE Protocol to assess a patient with dyspnea by answering 5 questions integrating cardiac and lung POCUS applicatons

Lung US (Time: 30 minutes)

  1. Background Case: Dyspnea

    1. Introduction: Read this Case Summary and accompanying Case Questions for a brief example of how POCUS applies to family medicine regarding lung ultrasound and the use of the CLUE Protocol.

    2. Case description: A 70 year old woman with PMH HTN, CAD, CHF, and treated breast cancer stage 3 now in surveillance, presents to your rural clinic with dyspnea. She is too short of breath to provide a useful history. Her RR is 40 bpm and she is tachycardic. Her O2 sat is 80%. On auscultation there is poor air movement bilaterally. You quickly call for support in anticipation of transfer to the E.R., start O2, and decide to use POCUS to assess her dyspnea. You are concerned she may have pleural effusion, pneumothorax, or possible a massive pulmonary embolus.

    3. Case Questions: How is POCUS used to evaluate the lungs for pleural effusion, pulmonary edema, and pneumothorax? (Note: In a low resource setting, such as rural with limited access, a 2-zone compression scan for DVT can be used to rule out a PE in a lower risk patient, in lieu of d-dimer testing. This protocol is reviewed in the Emergency Medicine POCUS module.)

  2. Assignments:

    1. First, watch this overview VIDEO on lung US from USC (7:30 min). Follow along with or take notes in your Evernote as helpful.

    2. Next, review this CASE on patient with shortness of breath in the ER (MGH) (4 min). Note the normal appearance of lung sliding (“Ants on a log”) versus the abnormal appearance of absent lung sliding, and use of M-Mode.

    3. Next, watch this instructional VIDEO on pleural effusion (8:30 min).

    4. Finally, if you haven't yet done so, review your Evernote on Lung US found HERE.

    5. OPTIONAL: Ultrasound is an excellent tool for evaluating pneumonia. This VIDEO provides a helpful 12 minute summary of how to use ultrasound to diagnose pneumonia, particularly in kids. You are encouraged to watch this if time allows.

 CLUE Protocol for Dyspnea (TIme:  30 minutes)

  1. Now that you’ve learned the basics on heart, IVC, and lung US in previous POCUS modules, we’ll review the CLUE Protocol that puts some of these applications together to evaluate a patient with dyspnea. “CLUE” stands for Cardiopulmonary Limited Ultrasound Exam and is a validated protocol developed to answer 5 questions: “Does the patient have LV dysfunction? LA enlargement? Pulmonary edema? Pleural effusion? Elevated CVP/volume overload?” The American College of Physicians now recommends POCUS for the evaluation of all patients with dyspnea!—CLUE gets it done.

  2. Start by watching this introductory VIDEO to the CLUE Protocol (Wagner/Sonointernist/USC). As you watch this, you may want to follow along with your Evernote on CLUE found HERE.

  3. (OPTIONAL) Finally, if you would like to see two more cases of US used to assess dyspnea, watch this CASE from MGH. The instructor does not follow the CLUE Protocol but utilizes heart and lung US and provides a nice example of CLUE elements with 2 cases (7:30 min).

  4. (OPTIONAL) Did you know?… In 2021, the ACP published guidelines recommending use of POCUS for evaluation of acute dyspnea when the etiology is unclear in the ER or inpatient setting.

Module QUIZ (I've got this!) (Time: 10 minutes)

  • Congratulations on completing the module. Please click HERE to take your Module Quiz and provide Module feedback.