Clinical Cases & Journal Review

  A 77-year old man presented to the emergency department with a complaint of appetite loss over the past 15 days. He reported ongoing symptoms for the past 5 months. However, over the previous 15 days, his appetite had been so poor that he only drank 1-2 nutrition drinks per day. He reported a 10-15 lbs weight loss paired with fatigue and weakness. He denied nausea, vomiting, abdominal pain, fevers, and chills. The patient reported normal bowel movements. He denied any significant medical history and had no records in our EMR. He reported an unremarkable colonoscopy 7-8 years ago.  ...

A 77-year-old patient presented to a rural Emergency Department with a chief complaint of shortness of breath a day prior to presentation. Patient also reported that he fell several weeks ago and hurt his ribs. He was subsequently admitted to the hospital and was ultimately treated for pyelonephritis. He endorsed being more sedentary than usual for the next several weeks. On the day of presentation he was lying in bed when he began to suddenly feel short of breath. He denied feeling any chest pain, lightheadedness, dizziness, nausea, vomiting, diarrhea, diaphoresis, jaw or arm pain. His shortn...

A 53-year-old homeless alcoholic female presented to the emergency department with a chief complaint of localized left lower quadrant abdominal pain secondary to a possible gunshot wound. She was unclear but stated she thinks some boys in a gang fired at her two days prior with a possible BB gun. Pertinent medical history included psychiatric history, morbid obesity (BMI>40), chronic alcohol abuse, sepsis and hypoxemic respiratory failure. The patient was clinically intoxicated upon arrival and therefore history was of limited accuracy.    Upon arrival, patient appeared stabl...

A 37-year-old female presented to the emergency room with severe, radiating bilateral flank pain lasting one week. Pain was constant and pressure-like. Patient had a past medical history significant for constipation, ovarian cysts, diverticulitis, and a colonic polypectomy. She denied fever, vomiting, and denied melena and hematochezia. Patient had no dysuria, frequency or hematuria. She denied vaginal discharge or odor. Patient was seen and treated by her primary care provider with ciprofloxacin and metronidazole for presumed diverticulitis. When pain failed to improve two days later, patient...

A 35 year old male with a history of IV drug use and HIV on ART presents to the emergency department with pain and redness of his left upper extremity for a few days. He denies systemic symptoms or prior history of abscess. Vitals: Temp 98.5, HR 93,  BP 122/75, RR20 Physical Exam: Notable for a large, well circumscribed area of induration, erythema, warmth, and  tenderness on the left upper arm. Distal to the lesion, there is intact cap refill and 2+ radial pulse. A bedside ultrasound was performed. What do you see?   Answer and Learning Points Ans...

Background Ultrasound has been shown to be superior to supine chest x-ray in the diagnosis of pneumothorax, with one recent systematic review demonstrating 91% sensitivity using ultrasound compared to 50% using chest x-ray.1 CT scan remains the gold standard in diagnosis but is often not feasible in unstable trauma patients. Ultrasound is recommended by ATLS guidelines for use in trauma patients as part of the eFAST protocol. There are three main described ultrasound findings in pneumothorax: lung sliding, B-lines, and the lung point. While B-mode (2D mode) is commonly described, many resource...

Background Point-of-care echocardiography can provide a rapid and accurate assessment of left ventricular function, which is valuable in differentiating causes of hypotension and dyspnea at bedside. Visual estimation of LV function by experienced practitioners has been shown to correlate well with quantitative estimates. However, the number of examinations required before a practitioner is qualified to visually estimate LV function accurately is unknown. Although there are various comparable parameters for assessing LV function, mitral valve E-point septal separation (EPSS) is an easy-to-obtai...

A 43 year old female with no past medical history presents to the Emergency Department (ED) with lower abdominal pain for the last three hours. She says she knows she is pregnant from a home pregnancy test, but has not had any appointment with obstetrics and has not had an ultrasound yet. She denies any vaginal bleeding.   Vitals: BP 120/65 mmHg, HR 85, O2 100% on RA. She is comfortable appearing, her abdominal exam shows mild tenderness to palpation diffusely in the lower abdomen with no rebound and her pelvic exam shows a closed os with no bleeding. Her point-of-care urine pregnanc...

Background   The serratus anterior plane block (SAPB) is a field block that provides analgesia from T2 to T9 dermatomes of the hemithorax by anesthetizing the lateral cutaneous branches of the intercostal nerves in that area. It was first described in a 2013 study demonstrating long-lasting thoracic-wall anesthesia with no significant adverse effects (1). It has since been utilized by anesthesia for prophylactic treatment of post-thoracotomy and post-mastectomy pain (2-4) and has demonstrated utility for treatment of rib fracture pain in the acute setting (5).  Th...

Dr. Matt Mason and Dr. Medak discuss how to use the GE Venue ultrasound, both basic functions and more advanced modes. Basics of GE Venue machine - 0:00-2:28 Step-by-step of how to perform an ultrasound exam - 2:28-9:18 Advanced functions - 9:18-end