28 11, 2016

Ultrasound For The Win! Case – 40F with Fever, Chest Pain, Shortness of Breath

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clinical case where point-of-care ultrasound changed the management of a patient’s care or aided in the diagnosis. In this case, a 40-year-old woman presents with a fever, chest pain, shortness of breath, cough, and generalized weakness.

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21 09, 2016

PEM Pearls: Perfecting your pediatric lumbar puncture using ultrasound

lp_collect-croppedA lumbar  puncture (LP) is a common procedure that every emergency physician must master. Pediatric LPs can be challenging for even the most experienced clinician due to small anatomy, difficulty with patient cooperation, and lack of frequency performed. A successful procedure is defined by obtaining cerebrospinal fluid and/or performing a non-traumatic lumbar puncture. There are multiple variables that lead to a successful pediatric lumbar puncture including provider experience, use of anesthesia, and patient positioning. Success rates for pediatric lumbar punctures are variable, with a large range from 34%-75%.1

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9 08, 2016

Trick of the Trade: Ocular ultrasound for the swollen traumatic eye

Eye swelling ocular ultrasoundYou are caring for a patient with an incredibly swollen eye – like a scene out of almost any Rocky film. This patient is likely going to the CT scanner, but regardless of the finding (retrobulbar hematoma, orbital wall fracture, etc.) you still need to evaluate for extraocular muscle entrapment and loss of pupillary response. There’s only one problem: you can’t see the eye. The old standards like getting the patient to retract their lid using paperclips or a cotton swab may help; but sometimes there is just too much swelling, and those techniques are just not enough. Without brute force – and potentially causing more trauma – you likely won’t be able to examine this patient’s eye.

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20 06, 2016

Ultrasound For The Win! – 63M with an Erythematous Abdomen #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clinical case where bedside ultrasound changed the management or aided in the diagnosis. In this case, a 63-year-old man presents with a painful, warm, and erythematous area of his abdomen.

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9 06, 2016

Top 5 FOAM Radiology Resources: ALiEM Chief Resident Incubator Recommendations

figure_xray_5391There is no shortage of free open access medical education (FOAM) resources available to the current emergency medicine (EM) learner. It seems that no matter what the concept, FOAM has it covered. And radiology is no different. However, with a specialty as vast as radiology, finding educational material pertinent to the emergency practitioner can be overwhelming. The 2016-2017 ALiEM Chief Resident (CRincubator) class also encountered this when attempting to create an organized FOAM radiology curriculum for EM residents. To tackle this challenge, the chief residents have brought together the best online resources to help EM practitioners gain expertise in the field of radiology.

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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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