Saving Brainspace with POCUS
February 8th, 2018
Here is a cool case that Lloyd Gordon recently sent us...
"A 60 year-old woman had a fever of 39.[...]
Common Bile Duct: How useful is it for us to image?
This patient initially gave a history of two months of upper abdominal pain. I was looking at his GB, which seemed normal when I came upon this tubular structure with no flow on Doppler. It certainly looked to be a (very dilated) CBD. Once I saw it, it was natural to ask […]
Localized PCE
I tend to think of pericardial effusions (PCE) as being very uniform around the heart. This one was very localized to the area noted on the image. The CT Abd. (I didn’t order it!) showed the same PCE. The history was severe diarrhea and weakness. I was a bit worried about the dilated right ventricle […]
Smith’s Fracture
This patient had a displaced looking wrist. However the POCUS didn’t look particularly displaced at all. I was wondering about the discrepancy but not enough to get the old brain in gear (do U/S waves cause dementia in the operator?). I should have learned from my last POCUS on a Smith’s that they look very […]
Dr. Richard on Armpits, Metal Rods, Pus, and T-shirts
Here’s a neat case from Dr Bernard Richard from Valleyfield in la belle province… A 30 y.o. man fell on a metal rod a week ago. He was seen in the ED and had his 10 cm right axillary wound sutured. I saw him a week later for 4 cm lump that was located 15 […]
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. […]
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. […]
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 […]
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 […]
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 […]
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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