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(BQ) Continued part 1, part 2 of the document The critically ill in lung ultrasound has contents: Extension of lung ultrasound to specific disciplines, wider settings, various considerations; the main products derived from the BLUE-Protocol; the BLUE-Protocol in clinical use. Invite you to refer. | Part II The BLUE-Protocol in Clinical Use The Ultrasound Approach of an Acute Respiratory Failure The BLUE-Protocol 20 Severe dyspnea is one of the most distressing situations for a patient. Aiming at a therapy based on immediate diagnosis is a legitimate target. The acute incapacity to breathe is one of the most distressing situations one can live 1 . The BLUE-protocol concentrates 18 years of efforts mainly repeated submissions aiming at promptly relieving these patients. The idea of performing an ultrasound examination in time-dependent patients was not far from a blaspheme in 1985 definitely not envisageable according to the rules. Our approach possibly intrigued some doctors and nurses in the ERs of our institutions. During the management of these critical situations time was not for quiet explanations. What the emergency doctors who had to rush to the next patient in the overcrowded ER and eventually rushed after duty for a deserved nap end of the story did not fully see was that after a few minutes we were able to give to the nurse therapeutic options while organizing the transfer to the ICU. And what they did not see at all occupied by 1 000 other tasks medical administrative familial etc. this was not time for international guidelines on lung ultrasound was that these options were in accordance with the final diagnosis. In the emergency setting we use familiar tools since decades and centuries mainly physical examination 2 and radiography 3 two basic tools yet increasingly known for having limited precision. The crowded emergency room is not the ideal place for serene work an acknowledged issue 4-8 . One-quarter of the patients of the BLUE-protocol in the first hour of management received erroneous or uncertain initial diagnoses and many more received inappropriate therapy. The online document of Chest 134 117-125 details these 26 of wrong diagnoses. CT seems a solution but Chap. 29 will demonstrate its heavy drawbacks. One day the community will maybe .
