Pediatric emergency medicine trisk 4517 4517
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pneumothorax or pleural effusion from normal tissues and it identifies the level of
the diaphragm as it moves with respiration.
Technique
Any probe can be used to interrogate the lung. If identifying a pneumothorax, the
linear probe is appropriate because it provides the best visualization of the pleural
line. However, for the actual thoracentesis procedure a phased array or curvilinear
probe is preferred because it will provide a wider and deeper view of the chest
cavity (Fig. 131.24 ).
For identifying fluid in the chest, the probe should be placed in the midaxillary
line or posteriorly where the intended catheter will be placed. If the static
technique is used, the level of the diaphragm should be marked along with the
deepest pocket of intrathoracic fluid.
Pitfalls
If using the static technique, moving the patient after the area of fluid is marked
could lead to fluid shifts and inappropriate placement of the catheter or needle. It
is also important to identify the level of the diaphragm when diagnosing a pleural
effusion to ensure that the visualized fluid is not confused with intra-abdominal
free fluid.
