Sonography of the pleura. / Sonografie der Pleura.

The CME review presented here is intended to explain the significance of pleural sonography to the interested reader and to provide information on its application. At the beginning of sonography in the 80 s of the 20th centuries, with the possible resolution of the devices at that time, the pleura could only be perceived as a white line. Due to the high impedance differences, the pleura can be delineated particularly well. With the increasing high-resolution devices of more than 10 MHz, even a normal pleura with a thickness of 0.2 mm can be assessed. This article explains the special features of the examination technique with knowledge of the pre-test probability and describes the indications for pleural sonography. Pleural sonography has a high value in emergency and intensive care medicine, preclinical, outpatient and inpatient, in the general practitioner as well as in the specialist practice of pneumologists. The special features in childhood (pediatrics) as well as in geriatrics are presented. The recognition of a pneumothorax even in difficult situations as well as the assessment of pleural effusion are explained. With the high-resolution technology, both the pleura itself and small subpleural consolidations can be assessed and used diagnostically. Both the direct and indirect sonographic signs and accompanying symptoms are described, and the concrete clinical significance of sonography is presented. The significance and criteria of conventional brightness-encoded B-scan, colour Doppler sonography (CDS) with or without spectral analysis of the Doppler signal (SDS) and contrast medium ultrasound (CEUS) are outlined. Elastography and ultrasound-guided interventions are also mentioned. A related further paper deals with the diseases of the lung parenchyma and another paper with the diseases of the thoracic wall, diaphragm and mediastinum.

[POCUS - Thoracic Sonography in Times of Corona: What Sonographing Family Physicians Should Examine]. / POCUS ­ Thoraxsonografie in der Coronazeit: was sonografierende Hausärztinnen und -ärzte untersuchen sollten.

POCUS - Thoracic Sonography in Times of Corona: What Sonographing Family Physicians Should Examine Abstract. When performing chest sonography of patients with symptoms such as respiratory infection, dyspnea and chest pain, the primary goal is to find or exclude significant diagnoses such as pneumothorax, pleural effusion, pulmonary edema, tumors, pulmonary emboli, etc. as the cause of the symptoms. If infection with SARS-CoV-2 is present, COVID-19 pneumonia can be confirmed or excluded as the cause of the symptoms with a high degree of probability based on the sonographic signs. COVID-19 pneumonia shows typical changes in the lungs, which are easily accessible to ultrasound due to their usually peripheral location. These are ubiquitous signs, such as a thickened, fragmented pleura with subpleural consolidations, multiple comet tail artifacts of varying size and thickness, some of which are coascent, broad bright light beams, and possibly small encapsulated pleural effusions. The more of these sonographic signs are present and the more pronounced they are, the sooner the patient must be hospitalized and possibly intubated. Ultrasound is also useful as a follow-up tool, together with clinical and laboratory findings.

[Medications in Emergency Medicine - an Update]. / Notfallmedikamente - ein Update.

Every doctor, whether responsible for a hospital or a clinic, should have a solid foundation in the care of the emergent patient. Nearly all specialties require some medications to be administered by in section - a reanimation or an anaphylactic shock must be correctly treated and promptly, before further help arrives. Medications are an essential onerstone in the care of emerge nices. Varying medications are in demand based on specialty, ED structure, and location in which care is provided. This must be synchronised with the eventual likely emergencies, as well as with personal knowledge and experience of the ED staff.