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.[...]
Cases
Abscesses, hematomas, and cellulitis, oh my!
I used to think that hematomas and abscesses were pretty straightforward to diagnose clinically. But I have had several cases that proved my initial suspicion to be wrong. Certainly the literature suggests we could do better differentiating cellulitis, DVT, and abscesses. I saw a patient who presented after knee surgery with a hot, swollen and […]
Using POCUS for decision-making in CP R/O ACS cases
Can POCUS help you in the management of chest pain rule-out ACS cases? Let’s have a look at a case… A few months ago, a man in his mid-60s presented with a chief complaint of chest pain. Past history included dyslipidemia and a remote lower extremity orthopedic injury. The patient smoked 3/4 ppd. He had […]
Appendicitis: It isn’t all about the size
During a recent EDE 3 course, I was asked about the cutoff size for appendicitis in children. I informed the learner that 6mm was the number I was taught to use for all ages. And this is certainly one of the most accurate measurements to use. But this really doesn’t make sense in very young patients […]
Scan a hernia
Dr.Lloyd Gordon discusses two cases of umbilical lumps that were easily sorted out with POCUS: This patient had a history of a umbilical hernia which had become larger and painful for a few hours. The patient’s habitus made a manual exam difficult. POCUS showed that there was some small bowel at the tender area […]
Ultrasound horror stories
I am looking for tales of patient care gone wrong with POCUS. Please send me your cases, (or cases you “heard happened to someone else”) where the use of ultrasound at the bedside led to less than ideal outcomes. POCUS is just like any other tool in medicine: it has its limitations, it can generate […]
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 […]
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 […]
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 […]
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 […]
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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