11 05, 2016

PEM Pearls: The nonvisualized appendix quandary on ultrasound

appendicitis imageA 10-year old girl presents with progressively worsening right lower quadrant pain for the last 2 days. She reports having chills and feeling warm. Her review of systems is negative for nausea, vomiting, diarrhea, or urinary symptoms. Her abdominal exam is unremarkable except for some diffuse, mild tenderness with deep palpation in bilateral lower quadrants. Labs: WBC 9 x 10^9/L. Because of radiation exposure concerns, you order an abdominal ultrasound as the initial imaging modality to evaluate for appendicitis. The radiologist’s reading was: “Unable to visualize the appendix.” Now, what do you do?

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21 12, 2015

Trick of the Trade: Isopropyl Alcohol Vapor Inhalation for Nausea and Vomiting

vomitingYour triage nurse complains of numerous patients in the waiting room complaining of nausea, retching, and emesis. They ask you “why can’t we have an antiemetic on hand in triage?” Turns out they might have had an effective antiemetic on hand, or rather in their scrub pocket the entire time. They just didn’t know about it yet.
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10 09, 2015

Trick of the Trade: Large volume paracentesis technique using gravity

ParacentesisRecall the last time you were sitting in a room doing a large-volume, therapeutic paracentesis in the ED. Were you stressing out because your other patients were still being actively managed? Large-volume paracentesis is a common and important part of our practice, but often requires your dedicated time at the bedside. Additionally, what do you do if you do not have the fancy paracentesis kit or vacuum collection bottles?

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6 04, 2015

Ultrasound For The Win Case – 46F with Abdominal Pain #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In this case, a 46-year-old woman presents with history of right-sided abdominal pain and vomiting.

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10 09, 2014

Small bowel obstruction: Diagnosis by ultrasonography

SBOuprightA 64 year old man with an extensive history of abdominal surgeries presents to the emergency department with abdominal pain and vomiting. Because you suspect a bowel obstruction, you bring an ultrasound machine to the bedside prior to the completion of any laboratory testing or other imaging. A curvilinear probe in the abdominal mode setting was used to scan in all four quadrants of the abdomen looking in both the sagittal and transverse planes.

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22 05, 2014

Ondansetron: Has it reduced need for IV rehydration in vomiting kids?

vomitingA 3-year-old male presents to the emergency department (ED) complaining of vomiting and diarrhea that has been occurring for 2 days. The mother states that the child has had fewer wet diapers today but has made tears when crying. On physical examination you note no rebound or guarding of the abdomen and determine that the child is moderately dehydrated. Your initial plan is to administer ondansetron and rehydrate the child orally. This is what you have been taught but is it actually efficacious? A just published 2014 JAMA Pediatrics article attempted to answer this question.

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