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.[...]
Author Archive: Lloyd Gordon
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 […]
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. […]
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 […]
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 […]
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: […]
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 […]
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 […]
Pilonidal Abscess: Hair today, gone tomorrow
This may seem like overkill; POCUS for an obvious abscess. Still it was interesting to see the ingrown hair inside the abcess. Also the point of maximal induration was not where the actual abcess was, strangely enough. So in the end the POCUS showed not only that the abscess was ready to be drained but where […]
Glass FB in Palm
This guy got a glass FB in his hand a couple of weeks earlier. You could sort of imagine a little bump and a little mark. POCUS clearly showed it ~ 1 mm deep. I made an X and (luckily) fished it out. I took a lousy picture with my obsolete Palm Treo showing the […]
Purulent tenosynovitis on POCUS
This is from a fellow with the classic high pressure air/water injected in his hand a few days earlier. You can see the pus next to the tendon.
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