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Nobody expects the liver abscess

October 14, 2014 0 Comments
Nobody expects the liver abscess

I reviewed the computer charting, elderly lady with one day history of fever, vomiting, diarrhea and confusion. Sounded like a boring old gastro, give her fluids, take cultures and refer. No need to drag the U/S to the room when I’m already behind and pressed for time. Still, spare the probe and spoil the patient. […]

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Time is testicle!

October 10, 2014 2 Comments
Time is testicle!

Scrotal EDE is one of the topics that Greg presents at EDE 3.  While not a life-threatening entity (try telling that to an 18 y.o. male!), it still carries with it significant morbidity.  Ultrasound is key to the diagnosis and can help assess the success of attempts at de-torsion. I recently saw an 18 y.o. […]

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Weird Symptoms

October 6, 2014 0 Comments
Weird Symptoms

This patient was in his 70s with the usual litany of diseases and medications. He actually looked quite well. He complained of pain from his R neck to his R flank. The physical exam was not helpful. I had no inkling of what was wrong. I POCUS’ed his carotids/jugulars/CVS/Aorta/Kidneys/liver/spleen/bladder and all looked fine. His GB […]

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Supraclavicular vs. infraclavicular: which to use for subclavian lines with POCUS?

September 29, 2014 0 Comments
Supraclavicular vs. infraclavicular: which to use for subclavian lines with POCUS?

Dr Maja Stachura, who is now staff at Vancouver General ED, tried to help answer this question while she was an ultrasound fellow in Sudbury. The results of her project were recently published in the American Journal of Emergency Medicine. Click here for the pub med link. Here’s the lowdown: Methods: Prospective anatomical survey of […]

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S/Q saline injection for pediatric art lines placed with POCUS guidance?

September 21, 2014 1 Comment
S/Q saline injection for pediatric art lines placed with POCUS guidance?

I was catching up on back issues of Anesthesia & Analgesia when I came across this article from the May 2014 issue: Nakayama et al. A novel method for ultrasound-guided radial arterial catheterization in pediatric patient. This was actually 2 studies in 1, or 2 phases as the authors call it. Common features of both […]

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Ruptured Achilles Tendon

September 15, 2014 0 Comments
Ruptured Achilles Tendon

Imaging the Achilles tendon is technically easy and a nice way to rapidly confirm your diagnosis of tear.  Always compare to the unaffected side.  Beware anisotropy which can make sections of any tendonous structure look black and torn.  If the ultrasound beam is interrogating a section of tendon away from 90 degrees it can look […]

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Don’t become Jaundiced about POCUS

September 8, 2014 0 Comments
Don’t become Jaundiced about POCUS

This patient came in with jaundice and the LFTs were elevated. They had had a cholecystectomy in the past. POCUS revealed a large dilated fluid-filled structure in the RUQ. After looking at the kidneys/liver +/- Doppler it became clear it was a very dilated CBD. CT confirmed the biliary dilatation and obstructing mass. [Ed. note: […]

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Gas Gangrene

August 28, 2014 1 Comment
Gas Gangrene

An elderly woman was sent to the ER by her senior’s residence in the middle of the night for bloody stools. The triage nurse found out that there was no blood but there was pus coming from her rectum.  There was a very red and swollen area starting from the anus and extending onto her […]

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Don’t be subtle: Use POCUS for hard to see fractures

August 24, 2014 0 Comments
Don’t be subtle: Use POCUS for hard to see fractures

A young man had clinically a distal radius fracture. The X-ray looked negative to myself and the radiologist. But with a little bit of fiddling I found the # on U/S. Before I would have said this was a Salter fracture through the epiphysis. POCUS clearly showed the # proximal to the epiphysis. Another fellow […]

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POCUS and recurrent abdominal pain in the elderly

August 20, 2014 0 Comments
POCUS and recurrent abdominal pain in the elderly

A 82 yr. old patient came in for chronic recurrent epigastric pain. A CT was done on the previous admission which showed pancreatic calcifications, consistent with chronic pancreatitis. On this visit the patient had a similar presentation. She looked well, with a pretty benign abdomen and normal labs. I was pressed for time and didn’t […]

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