Top 10 Reasons NOT to Order a CT Pan Scan in a Stable Blunt Trauma Patient

The pendulum has swung one way with CT for trauma, but has it gone too far? Liberal use of CT raises concerns over resource utilization, cost, and the consequences of radiation exposure [1,2]. No-one can seem to agree, including trauma surgeons, on guidelines for a more selective use of imaging studies [3-6].

“CT pan scan” is the term, source unclear, which describes the whole body CT (WBCT) imaging strategy used in blunt trauma management. It consists of the following CT studies:

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By Daniel Firestone, MD RDMS|2017-03-05T14:18:47-08:00Oct 6, 2014|Radiology, Trauma|

Diagnose on Sight: “I feel like I am having a heart attack”

Case: A 18-year-old male with no medical history presents to the emergency department (ED) complaining of “feeling like I am having a heart attack” which started suddenly 1 hour ago. The patient ate from a food truck the night before and developed several episodes of forceful vomiting prior to arrival in the ED. What finding in this supine chest radiograph aids in the diagnosis? Click on image for a larger view.

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By Nikita Joshi, MD|2016-12-22T19:15:42-08:00Sep 23, 2014|Diagnose on Sight, Pulmonary, Radiology|

PV Card: FAST Ultrasound

Keeping in line with the recent ultrasound posts this month, Dr. Mike Stone’s star team is releasing a series of Paucis Verbis cards on the basics of bedside ultrasonography. Here is the first in the series on the Focused Assessment with Sonography in Trauma (FAST) by Drs. Wilma Chan, John Eicken, and Mike Stone.

PV Card: FAST Ultrasound

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Go to ALiEM (PV) Cards for more resources.

By Michelle Lin, MD|2021-10-06T10:09:27-07:00Sep 12, 2014|ALiEM Cards, Ultrasound|

US4TW Case: 28F with Shortness of Breath

Welcome to the inaugural post for an exciting new ultrasound-based case series called “Ultrasound For The Win!” (#US4TW). In this peer-reviewed case series, we will focus on real clinical cases where bedside ultrasound changed the management or aided in the diagnosis. In our first case, we present a 28-year-old female with shortness of breath.

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By Jeffrey Shih, MD, RDMS|2017-07-19T00:09:13-07:00Sep 11, 2014|Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical), Pulmonary, Ultrasound, Ultrasound for the Win|

Small bowel obstruction: Diagnosis by ultrasonography

A 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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By Jailyn Avila, MD, RDMS (She/Her)|2016-12-20T12:27:18-08:00Sep 10, 2014|Expert Peer Reviewed (Clinical), Gastrointestinal, Pre Publication Critique (Clinical), Ultrasound|

Diagnose on Sight: Swollen Upper Extremity in a Patient with End Stage Renal Disease

Case: A 45 year old female with end-stage renal disease presents with 2 days of worsening pain, swelling, and color change of her left upper extremity. The symptoms began after her left arm arteriovenous (AV) fistula was accessed for hemodialysis. The skin is tense and a bruit is present. What is your diagnosis for this swollen upper extremity? Click on the image for a larger view.

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By Jeff Riddell, MD|2016-12-22T20:07:29-08:00Sep 2, 2014|Cardiovascular, Diagnose on Sight, Ultrasound|

Trick of the Trade: Making your own homemade ultrasound gel

You are spending a month in rural Kenya, doing an ultrasound teaching course. Your enthusiastic participants have been ultrasounding every chance they get. Unfortunately, this has caused your ultrasound gel supplies to dwindle. It will be a month before a new shipment of gel arrives from Nairobi. This gel will cost about $5 per bottle, which is a considerable expense for the local hospital’s budget.

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By Christine Riguzzi, MD|2018-10-28T21:23:04-07:00Apr 17, 2014|Expert Peer Reviewed (Clinical), Tricks of the Trade, Ultrasound|