Thursday, May 7, 2020

Covid-19 Effects on the Lungs + Chest Ultrasound

Written and presented by: Dr. Stephen Chagares
Edited by: Dr. Robert L. Bard & Lennard Gettz (of NYCRA HealthScan News)

 The Coronavirus has been shown to be very lethal to a subset of patients. What happens is that the virus is ingested into the mouth or nose, going down into the back of the throat (called the hypopharynx and the larynx) and then is breathed into the lungs themselves. The lungs are made of millions of little air SACS called alveoli, and the virus gets into these little layer sacks and adheres to the inner lining. That lining is what allows the interface between the blood and the air and the CO2 from the blood is given out. The oxygen from the air is given into the blood. That's how we breathe in oxygen and blow out CO2.

When the virus gets in there and coats that surface, everyone creates some kind of reaction. One is an antibiotic body reaction- which is an immune response. The other thing that happens is a physical inflammatory response where the immune system automatically goes into defense mode and wants to go in and kill the virus. It senses it's there and sends in "defender" cells, and to most people, it can send the proper amount of little soldiers to do the job. But in a small percentage of patients, the body's internal reaction causes too much inflammation causing a large body of fluid to fill up in the alveoli (air sacs) in the lungs. This stops the ability for oxygen to fuse through those air sacks to get oxygen into the entire body, include vital organs like the heart, the brain, the liver etc.  Without oxygen, this could result serious problems like heart and liver failure (and other such symptoms).

To visually identify this problem, existing technologies have to be tuned to track and monitor cardio-pulmonary performance. Chest x-rays or CT/catscans are available and are widely used now- but carry a number of key issues when it comes to regular chest monitoring. Often normal chest X rays are going to miss this because radiation itself will go through the lung tissue and the fluid and it may not show anything too specific. And then a cat scan may show something totally different where you can see how both lungs are all inflamed and have fluid in them.

The newest thought is the "LUNGSCAN" paradigm through the  use of ultrasound technology- as published by Dr. Robert Bard and a number of European experts in this field. The system of checking the lungs for covid-related issues is applied in tandem with (and not instead of) replacing other radiologic testing.  The concept of INTEGRATIVE solutions is about making as many solutions available to the public as you can to support patient treatment. So although chest X rays and cat scans are often used, there's a lot of radiation to them- and that's a major discrepancy to regular testing.

THE COMPLEX PROCESS OF CT IMAGING
If you're in the ICU, taking a "field trip" down to a radiology center is no fun at all.  It's probably the most dangerous part of a patient's day. Just getting switched from everything on the wall to everything portable and then getting them down and transferring them first from their bed to the stretcher, and then another stretcher into the cat scan table- can be quite harrowing. And then everyone has to get out and leave the patient there. And all the tubes still have to work. And as they come through to make sure nothing pops off and then they have to get transferred back onto the stretcher, up into the elevator, back into the ICU, back into their bed, and then hook everything back up again. So yes, cat scans work great, but there's a lot to it.

PORTABLE IS "IN"
Though we still have the high-powered center units the size of a washing machine, today's ultrasound technology design has been streamlined to offer PORTABLE versions to respond to its many field applications and demands. An "all-in-one" touch screen with detachable probes can be used at the bedside or in any kind of radiologic facility. It is also used in triage units, battlefields, ocean liners, helivacs/ambulances and even the space station.

You can expect to see "LUNGSCAN STATIONS" open up everywhere for outpatients to get quick lung scans (about a 5-minute experience) in urgent care centers per se.  The accuracy, speed and low prep combination of ultrasound alongside our new TeleMedicine trend makes for a SAFER alternative to imaging.



Ultrasound for Critical Care and Regular Covid Monitoring of Respiratory Pathogens

Adding to the arsenal of diagnostic solutions for the Covid-19 respiratory pathogen, the LUNG (or CHEST) ULTRASOUND is making great strides in triage facilities and bedside monitoring.  A growing community of European health specialists are joining a procedural movement to "replace" the dependency on stethoscopes with portable ultrasound use to check a patient's immediate cardiopulmonary condition. For Covid-positive patients, today's ultrasound excels in getting immediate answers safely without radiation - allowing for screening and repeated monitoring. Such is the case in this test sample.

According to radiologist Dr. Robert Bard, indication of the presence of Covid-19 will show in the form of B-LINES (or the 2 vertical rays). "B-Lines specifically mean that the lung tissue adjacent to the coating of the lung is abnormal- and that's what generates these lines. Normal lung tissue should never have B-lines. If you don't have B-Lines, you don't have Covid in the lungs..."

ULTRASOUND ACCESS TO THE "NEW WORLD" OF MEDICINE
The evolution of the portable ultrasound is now being viewed by many as a diagnostic game-changer for patient care in the field. From an interview with professional technical instructor Michael Thury of Terason Ultrasound, he states "the industry just exploded from 30 years ago with the ability and the confidence that ultrasound can give you. The technology enables the physician to really do a much better job diagnosing the patient. As a clinical trainer with clients worldwide, the boom of telemedicine adds to the success of teaching clinicians how to get the most out of remote ultrasound, but also to have fast and easy access to the physician to read and diagnose the patient from any location!"

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Seeing your doctor (during the coronavirus pandemic) can be more systematic these days. Just come right to an exam room, get the ultrasound examination, go home, and then review those results with your physician via Video chat.  This third imaging option helps augment radiologic testing for Coronavirus effects in the chest area.

I also see the "bedside ultrasound" in the ICU carry huge benefits use. Being able to bring in a portable unit to a patient's room has a major safety element. Ultrasound can see fluid levels and in densities very nicely and with a small amount of training, you are able to use ultrasound to distinguish the density of the fluid in the areas where there is most fluid. This kind of imaging innovation really helped to support the understanding of A.R.D.S. (Acute Respiratory Distress Syndrome) in association with SIRS (Systemic Inflammatory Response Syndrome) where the lungs are majorly affected by these types of illnesses, filling them with fluid.

For regular monitoring of the lungs, ultrasound is a safe (non radiation) bet.  To identify symptoms in the lungs where the fluid can fill up is priceless data as part of early detection. Failure to breathe happens next, where ventilators come in to increase the oxygen level and be able to push through that fluid all caused by this simple little virus that just goes in and wreaks havoc on a small number of patients.

Percentage wise (not small total number), over 60,000 patients had that high reaction and it loops right back to "how do we keep an eye on that"?  Let's say you had grown a virus and then you're discharged. The lung reaction afterwards can be weeks or months until all the inflammation has gone. Some people less, some people more. And if chest X rays don't really see that type of level of fluid and and infiltration of the lungs with water and if cat scans or a lot of radiation, then these outpatient ultrasound sites could provide a literal progression from the discharge date all the way out until it looks like a normal lung again.

To me, that's a sensible protocol for early detection.


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ABOUT THE AUTHOR


STEPHEN CHAGARES, MD, FACS - CANCER SURGEON
Dr. Chagares is a board certified general, laparoscopic, robotic and breast surgeon in Monmouth County, NJ.  He obtained specialty training in breast surgery at Memorial Sloan Kettering Cancer Center. In addition to breast surgery, Dr. Chagares regularly performs hernia repairs of all types, including open, laparoscopic and robotic repairs. He was the first surgeon in his region to perform a robotic hernia repair and remains on the cutting edge of all advanced surgical techniques.  He routinely performs multiple other abdominal procedures, including laparoscopic gallbladder removal.  Dr. Chagares has received numerous awards for excellence and academic teaching, Top Doctors Awards and Patients’ Choice Awards. His philosophy is to provide quality care with a personal touch. He respects the art of surgery and feels honored to treat patients every day. visit his website- drchagares.com


EDITOR / CO-PUBLISHER


ROBERT L. BARD, MD, PC, DABR, FASLMS  - RADIOLOGIST
Dr. Bard is recognized for his specialized work in advanced cancer diagnostic imaging. He co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital imaging technology and has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered sonograms, Power Doppler Histogram, sonofluoroscopy, 3D/4D image reconstruction and the Power Doppler Histogram  are safe, noninvasive, and do not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.


Special thanks to: Alice Chiang and Michael Thury of Terason Ultrasound (https://www.terason.com/) and LonShine Technologies Inc.

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