Batman Bat-signal (Mega Mini Kits)

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B-lines are not observed in pneumothorax, as they are seen only at pleura/tissue acoustic interface (for which the apposition of both pleural layers is required, whereas in pneumothorax both layers are separated by air in between them). Occasional B-lines (up to two) can be seen in normal lungs (commonly at the bases). They are considered significant if three or more B-lines are seen in a single image between two ribs. The B-lines tend to extend through the lung field and do not become less bright, unlike A-lines, which tend to become less echogenic with depth. They also erase or cancel out the A-lines, and it is important to note that they move with respiration. One to two B-lines may be seen in some elderly individuals in the lung bases. It is considered an abnormal finding if three or more B-lines are identified in an intercostal space. It has been reported that the positive predictive value of absent lung sliding for the detection of pneumothorax is only 87% in the general population, falls to 56% in the critically ill, and to 27% in patients with respiratory failure ( 3, 5, 17, 18). Brenner DJ, Hall EJ: Computed Tomography - an increasing source of radiation exposure. N Engl J Med 2007, 357(22):2277–2284. 10.1056/NEJMra072149 Lichtenstein D: Diaphragm. In Whole Body Ultrasonography in the Critically Ill. Heidelberg, Berlin, New York: Springer-Verlag; 2010:146–147.

lung ultrasound in emergency (approach) | Radiology Bedside lung ultrasound in emergency (approach) | Radiology

Matamis D, Soilemezi E, Tsagourias M, Akoumianaki E, Dimassi S, Boroli F, Richard JC, Brochard L: Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med 2013, 39(5):801–810. 10.1007/s00134-013-2823-1 The figure below shows the progression of findings from normal A-line profile to a B-profile and eventually consolidation in a patient with COVID-19. Lung ultrasound is not really ultrasound (i.e., this expert, operator-dependent tool) for several reasons. Just two signs are sufficient to define the normality (lung-sliding, A-lines). This potential allows us to reconsider usual priorities. Once the physicians operational for life-saving protocols (BLUE-protocol, FALLS-protocol), they can quietly learn comprehensive echocardiography during as long time as necessary. Solution to the issue of growing irradiation In cases of small pleural effusion, the fluid occupies the costophrenic angle/recess, causing minimal compressive atelectasis of the surrounding lung tissue. In this scenario, the dynamic motion of the lung curtain can still be seen, however the curtain does not overlap the diaphragm as much as in the absence of effusion, and uncovers it at peak expiration (Video 1B). Jardin F, Farcot JC, Boisante L, Curien N, Margairaz A, Bourdarias JP: Influence of positive end-expiratory pressure on left ventricle performance. New Engl J Med 1981, 304(7):387–392. 10.1056/NEJM198102123040703Ultrasound plays a major role when showing reversible causes. The SESAME-protocol, a fast protocol devoted to cardiac arrest, assesses the lung before the heart, because pneumothorax can be discounted in 2 seconds, with in addition, windows usually available. This apparently futile property influences the choice of equipment. The following section is personal and subjective. A valuable combination may be our kind of equipment, coupled with high-level Echo machines used every time needed, as we repeatedly wrote [ 55]. Hayward, S.A., Innes, S.M., Miller, A.S.C., Smith, M.J. (2020). Point-of-care lung ultrasound in patients with COVID-19 – a narrative review. Anaesthesia, 75(8), 1096-1104. https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15082 The Bat-Signal made its first on-screen appearance in the Batman and Robin serial by Columbia. In its first incarnation, it was simply a high-powered projector that was kept in Commissioner Gordon's office. When needed, he would simply wheel the Bat-Signal over to his office window and shine it directly to the sky. Though small, it was powerful enough to cast an image of the Bat symbol against the clouds. Acute respiratory failure is a life-threatening condition whose cause is sometimes difficult to recognize immediately. Initial mistakes have deleterious consequences [ 41]. The extreme patient’s suffering legitimizes the use of any tool that expedites relief. Reducing the time needed to provide this relief is the aim of the BLUE-protocol. There are many advantages of using Lung Ultrasound (LUS), namely it is a fast, easily repeatable, widely available, cheap, and portable method. Most importantly, it is safe and does not use harmful ionising radiation, and avoids potentially dangerous transfers within the hospital. The diagnostic accuracy of LUS is superior to that of physical examination and chest radiography combined ( 3, 4).

Bat wing opacities (lungs) | Radiology Reference Article

Here are 25 free printable bat templates and outlines that you can use for Halloween crafts and decorations for your house or classroom. You can simply cut them out and let your kids color them, or put googly eyes on them to make some non-spooky bats. How to Make Halloween Bat Decorations The transducer of choice would be a low-frequency curvilinear transducer. Some clinicians also report using a phased array transducer. You may also use a high-frequency linear transducer to assess the chest wall, pleura, or subpleural lesions. The high-frequency transducer is not ideal for imaging deeper structures or evaluating A-lines and B-lines beyond a certain depth from the skin surface. Similarly, a prospective study by Ball et al., noted that up to 76% of all traumatic pneumothoraces were missed by the standard supine AP chest film when interpreted by the trauma team.[ 9] This number was much higher than their prior retrospective study (55%), where image interpretation relied on radiologists. This stressed the poor sensitivity of CXR in a rushed trauma scenario and the utility of performing a rapid bedside ultrasound, to possibly aid in the diagnosis, prior to sending a patient for a CT scan.[ 10] A perspective is holistic when the relevance of each of its multiple element can be understood only if integrated with the others. Lung ultrasound makes ultrasound a holistic discipline, as partially seen in the previous section. Multifaceted tool In Tim Burton's 1989 film Batman, Batman gives the signal to the police as a gift so that they can summon him when he is needed after he defeats The Joker. The Bat-Signal as it appears in the 1989 film BatmanSoldati G, Testa A, Sher S, Pignataro G, La Sala M, Gentiloni Silveri N: Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department. Chest 2008, 133: 204–211. 10.1378/chest.07-1595 Lichtenstein D, Peyrouset O: Lung ultrasound superior to CT? The example of a CToccult necrotizing pneumonia. Intensive Care Med 2006, 32: 334–335. 10.1007/s00134-005-0004-6 In the Elseworlds Batman & Dracula trilogy novel Batman: Crimson Mist, Gordon and Alfred use the Signal to summon the vampire Batman after he has killed Penguin's gang, wanting to establish the situation now that Batman has surrendered to his vampire instincts. Later, Two-Face and Killer Croc use the signal to draw Gordon and Alfred to the roof so that the two sides can discuss a possible alliance against the vampire Batman and his new assault on Gotham's criminals. cortices and posterior acoustic shadowing of the ribs are the wings, the hyperechoic "belly" being the pleural line