Left Anterior Chest: + B Lines
Right Anterior Chest: + B Lines
A 60-something year old patient presents with acute dyspnea, struggling to breath, diaphoretic, sitting bolt upright on the stretcher, waning mental status. There's a significant past medical history of diabetes, as well as heart and lung disease.
POCUS thoracic shows bilateral B lines, representing increased density in the lungs [PMID: 9372688]. BP 180/140, HR 136, 02 75%, afebrile. This patient was suffering from sympathetic, crashing, acute pulmonary edema (SCAPE). A focused echo revealed a pericardial effusion without ultrasonographic signs of tamponade.
Pearls: Patients with SCAPE and crashing COPD can look similar. A lines versus B lines can help differentiate expeditiously.