ABCDE of prehospital ultrasonography: a narrative review

Ketelaars, Rein; Reijnders, Gabby; van Geffen, Geert-Jan; Scheffer, Gert Jan; Hoogerwerf, Nico

doi:10.1186/s13089-018-0099-y

The Ultrasound Journal

Table 1 BLUE protocol profiles.

From: ABCDE of prehospital ultrasonography: a narrative review

P#	Profile name	Location	Appearance	Implication/diagnosis
1	A-profile	Anterior chest wall	Lung sliding—visualization of the movement of the visceral pleura against the parietal pleura with respiration A-lines—an indication of the presence of air below the parietal pleura^a	Normal lung surface
2	B-profile		Lung sliding Lung rockets—a pattern of three vertical B-lines caused by edema in the interlobular septa^b	Pulmonary edema
3	B’-profile		No lung sliding—in the B’ profile lung sliding is abolished by the deposition of fibrin caused by pneumonia Lung rockets	Pneumonia
4	A/B-profile		Unilateral lung rockets—indicative for a (unilateral) pneumonia and does not correspond with generalized pulmonary edema	Pneumonia
5	C-profile	Anterior chest wall	Anterior lung consolidation—anteriorly located, therefore unlike to be caused by hemodynamic pulmonary edema or embolism	Pneumonia
6	A-profile without DVT^c		Lung sliding A-lines^a No DVT	Normal
	A-no-V-PLAPS profile	Posterolateral chest wall	Lung sliding A-lines^a No DVT PLAPS^e—posterolateral alveolar and/or pleural syndrome—pulmonary consolidation and pleural effusion	Pneumonia
7	A-profile with DVT^c		Lung sliding A-lines^a DVT	Pulmonary embolism
8	A’-profile	Anterior chest wall	No lung sliding—lung sliding abolished by separation of the visceral pleura from the parietal pleura A-lines—an indication of the presence of air below the parietal pleura^a	Pneumothorax when the mandatory ‘lung point’^d is visualized
9	A-profile without DVT and no PLAPS (nude profile)		Lung sliding A-lines^a No DVT No PLAPS	Asthma or COPD

The bedside lung ultrasound in emergency (BLUE) protocol defines nine profiles. They are defined by their sonographic appearance and are associated with the different diagnoses as described in the right-most column
^aA-lines = Horizontal repetition of the pleural line appearing below the pleural line at multiples of the skin–pleural line distance. Their appearance is an indication of air below the parietal pleura, either in or outside of the lung. They are particularly apparent in the absence of B-lines potentially obscuring the A-lines
^bB-lines = A long, well-defined, hyperechoic comet tail artifact arising from the pleural line that obliterates the A-lines
^cDVT= Deep venous thrombosis. Has to be separately found or excluded at the lower extremities
^dLung point = The location where the visceral pleura is only partially in contact with the parietal pleura. With respirations, the A’ profile (without lung rockets) is intermittently replaced with the A-profile (lung rockets are possible). The lung point is a pathognomonic sign for the diagnosis of pneumothorax! See Additional file 1: Video 1
^ePLAPS= Posterolateral alveolar and/or pleural syndrome (posterolateral consolidations or pleural effusions)

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