Is chest X ray necessary to rule out PNX after thoracic maneuvers?

Clinical Scenario

It’s a busy day in ED this morning. 

The first patient refers dyspnoea, he has an advanced pulmonary neoplasia, ultrasound and chest x-ray confirm that the left zone is occupated by a pleural effusion. The thoracentesis removes about 1.5 liter of fluid, the patient breathes easily.

The second patient is 65 yo, he has pneumonia, he is septic, it’s impossible to find a vein, the right internal jugular vein is identified by ultrasound and the catheterization is performed without any problem.   

Is it necessary in this cases to perform a chest  X-ray to rule out a PNX?

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Can we fight against Pulmonary Embolism using the LR’s arrows?

Clinical Scenario

A 80 y/o woman presented to the ED for dyspnoea.

She underwent a knee replacement 2 weeks ago, RR is 24, O2 saturation is 88%. HR is 90, the knee is edematous.

You are going to hunt a pulmonary embolism (PE)

While you phone the radiologist for a thorax CT scan you have an idea:

Can a compression ultrasonography (CUS) helps to avoid a CT?

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