PEM Pearls: The nonvisualized appendix quandary on ultrasound

A 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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2017-10-26T14:33:47-07:00

May 11th, 2016 | CME, Gastrointestinal, Pediatrics, PEM Pearls, Ultrasound

By: Delphine Huang, MD and Aaron Kornblith, MD

Ultrasound For the Win! Case – 43-year-old Man with Syncope #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 43-year-old man presents to the Emergency Department after a syncopal episode.

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2017-07-19T00:06:51-07:00

April 21st, 2016 | Cardiovascular, Ultrasound, Ultrasound for the Win

By: Peter Reardon, MD and Jeffrey Shih, MD, RDMS

Trick of the Trade: Patient positioning for ultrasound-guided ulnar nerve block

Patients with 5th metacarpal fractures (commonly termed “boxer’s fracture”) are frequently treated in the emergency department (ED) with closed reduction and splinting. Obtaining analgesia and a successful closed reduction can often be challenging without procedural sedation. Severe swelling can make a hematoma block difficult, often resulting in inadequate analgesia. An ultrasound-guided ulnar nerve block provides a simple method to facilitate pain relief and allow for improved fracture site manipulation.

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2018-10-28T21:25:09-07:00

January 20th, 2016 | Tricks of the Trade, Ultrasound

By: Kara Toles, MD and Arun Nagdev, MD

Ultrasound For the Win! Case – 55-year-old man with chest 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 55-year-old man presents with acute-onset chest pain.

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2017-07-19T00:06:58-07:00

December 9th, 2015 | Cardiovascular, Ultrasound, Ultrasound for the Win

By: Jeffrey Shih, MD, RDMS

PV Card: Normal Values for Ultrasound Measurements

As emergency medicine providers become more proficient in using bedside ultrasonography as a diagnostic tool, it can be difficult to remember all of the normal cutoff values. Is it 3 or 5 mm as the cutoff? Thanks to the team at UCSF (Dr. Maria Beylin, Dr. Scott Fischette, and Dr. Nate Teismann) for creating a succinct PV card listing the key numbers to remember. You can download this PV card into your mobile device as a reference guide, or you can even print and attach to each of your ultrasound machines!

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2019-01-28T21:43:45-07:00

October 15th, 2015 | ALiEM Cards, Ultrasound

By: Michelle Lin, MD

Ultrasound For The Win! Case – 76M with Right-Sided Vision Loss #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 76-year-old man presents with sudden-onset right-sided vision loss.

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2017-07-19T00:07:06-07:00

August 18th, 2015 | Ophthalmology, Ultrasound, Ultrasound for the Win

By: Jeffrey Shih, MD, RDMS

Ultrasound For the Win! Case: 38-year-old pregnant woman with acute right-sided 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 38-year-old pregnant woman presents with acute right-sided abdominal pain radiating to her flank.
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2017-07-19T00:07:14-07:00

July 14th, 2015 | Expert Peer Reviewed (Clinical), Ultrasound, Ultrasound for the Win

By: Jeffrey Shih, MD, RDMS