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Cases

Two bad things at once

February 7, 2016 1 Comment
Two bad things at once

A female patient in her 60s arrives at the emergency department via EMS with acute CP and SOB.  The history is consistent with cardiac ischemia and the EMS ECG shows clear inferior ST elevation with reciprocal changes.  You call the cath lab and they review the ECG and agree to take the patient immediately.  Vitals […]

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Thrombus in Transit Captured with POCUS

December 23, 2015 0 Comments
Thrombus in Transit Captured with POCUS

Dr. Pete Steinmetz is one of the POCUS leaders at McGill University in Montreal. He runs the POCUS program for the med students. Pete and I go way back. We were in the same med school class at McGill…Class of…never the mind the year…it’s not important 😉 Pete sent us this great case! Take it […]

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My twinkle is better than yours

November 16, 2015 0 Comments
My twinkle is better than yours

Case courtesy of Dr. Joel Turner, Fellowship Director EM Ultrasound, McGill University: 59 year old male with a previous history of renal colic presents with severe LLQ pain, and mild dysuria. He had no fever, no GI symptoms, and was a non-smoker. His urine dipstick was positive for red blood cells. No gross hematuria. While […]

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Troubleshooting Foley catheters

October 20, 2015 1 Comment
Troubleshooting Foley catheters

I firmly believe nurses should be trained to use POCUS to trouble shoot Foley catheters.  It is not that rare for a difficult Foley insertion to result in a small amount of urine return and then no further drainage or the balloon fails to inflate easily.  More often than not, the Foley is still in […]

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Epididymitis

October 14, 2015 0 Comments
Epididymitis

This patient had acute onset of severe L testicular pain and could hardly walk. I thought he was a torsion for sure. However the flow was fine. I moved up to the epididymitis and sure enough it was enlarged and with increased flow. [ed. note]  With any patient that has a high pretest likelihood of […]

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Floaters and Partial Visual Field Loss

October 4, 2015 0 Comments
Floaters and Partial Visual Field Loss

A fairly classical history. The patient had looked it up on the internet and told me he had a retinal detachment. He was right.   [ed. note] The thicker, more echogenic line and tethering near optic disc are classic hallmarks of RD on POCUS.  Don’t forget to always have your patient move their eyes back […]

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How often do you use POCUS?

September 27, 2015 0 Comments
How often do you use POCUS?

Dr. Gordon shares the findings from just three recent ED shifts.  There are many negative and indeterminate scans here but it provides a glimpse into how POCUS is included in the thought process for risk stratification and clinical decision making. This patient complained of R flank pain. POCUS revealed a normal kidney, uterus and pelvis. […]

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Infectious Mononucleosis? Measure that spleen!

September 20, 2015 1 Comment
Infectious Mononucleosis? Measure that spleen!

A reminder that POCUS can improve your sensitivity for diagnosing diseases, even in your low acuity patients.  We all know the Monspot test can be negative for Mono patients depending on when they present to us.  Don’t forget to have a quick look at the spleen if the rest of the clinical presentation points towards […]

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Lung EDE

August 20, 2015 0 Comments
Lung EDE

This patient had fallen on the bathtub and injured his left ribs. CXR 5 days ago showed a slight infiltrate in his LLL. He was sent back with pain and splinting. POCUS showed the diaphragm all around the spleen (you shouldn’t be able to see it above 9 o’clock), with a pleural effusion. It looked […]

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Dislocated? POCUS improves clinical exam

August 12, 2015 0 Comments
Dislocated? POCUS improves clinical exam

The first patient had a shoulder injury and fairly unhelpful X-rays. POCUS revealed both Humeral heads to be in proper postition. The second patient by history had a first dislocation which spontaneously reduced. He was feeling fine when I saw him. POCUS revealed a Hill–Sachs lesion confirming he had dislocated his shoulder and it was […]

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