Unresolved UTI: The Search For a Prompt Diagnosis

A 14-year-old female presented to the emergency department (ED) with persistent left upper quadrant (LUQ) pain. She was last seen in the ED one week prior for similar symptoms. Initially, she was diagnosed with a urinary tract infection (UTI), treated with IV ceftriaxone, and discharged home on a course of cefdinir. On re-presentation, she complained of persistent LUQ pain, fevers with a Tmax of 103 F, and one episode of emesis overnight. Physical examination revealed abdominal tenderness in the LUQ, without ipsilateral CVA tenderness…

UltrasoundBrian DruryJune 17, 2022Ultrasound, PyelonephritisComment

A Flare in the ED: Using Ultrasound to Diagnose Gout

A 53-year-old male with hypertension presents to the emergency room with painful swelling of the right first toe at the MTP joint. The patient was in good health until a few days ago, where he was attending a college reunion. The swelling and pain increased overnight. The patient is having difficulty walking this morning due to the pain. He tried taking two Advil for the pain, which helped bring the pain from an 8/10 to a 6/10…

Community EM, Orthopedics, Radiology, Rheumatology, UltrasoundShital ShahApril 22, 2022Gout, Ultrasound, Brown SoundComment

$When laughter isn’t the best medicine: The serratus anterior plane block for multiple rib fractures$

When laughter isn’t the best medicine: The serratus anterior plane block for multiple rib fractures

A 67-year-old man presents to the emergency department after a mechanical fall from standing. During his trauma evaluation, he is found to have severe right-sided chest wall tenderness. His imaging demonstrates multiple right-sided rib fractures with an otherwise unremarkable workup. The patient is in significant discomfort and is given acetaminophen and morphine. Despite this, he remains in severe pain and has difficulty taking deep breaths. The patient is given an incentive spirometer and his maximum vital capacity is measured at 500 ml. What complications is this patient at risk of developing? What interventions can be performed in the emergency department to help manage his pain?

Community EM, Sports Medicine, Trauma, UltrasoundBrendan HolmesApril 15, 2022Ultrasound, Nerve BlockComment

Volume Assessment Using POCUS in the Emergency Department

An 83-year-old male with a history of HFrEF (40%), CAD, hypertension, and hyperlipidemia presented to the ED with generalized weakness and fatigue. His vitals were remarkable for hypotension with a MAP of 58. On physical exam, the patient appeared non-toxic and was able to answer questions appropriately. He did not appear frankly fluid overloaded, other than mild, chronic peripheral edema. Additional laboratory studies and chest x-ray were performed. A fluid bolus was given to treat his hypotension, however there was minimal response. Given his heart failure, there was concern that aggressive fluid resuscitation would result in pulmonary edema. Additionally, inserting a central line and starting vasopressors is not without risk. Fortunately, this clinical team knows how to use ultrasound to do a proper volume assessment to manage this patient appropriately…

Ultrasound, ResuscitationJoshua NimsApril 11, 2022POCUS, ShockComment

Geriatrics Going to Ground : Ultrasound-Guided Femoral Nerve Block

“It would be unusual to go too many shifts as an emergency medicine provider without seeing the classic elderly female patient with hip pain after a fall. On exam, the patient would likely be uncomfortable with their hip appearing shortened and externally rotated on exam. Before you even view the X-ray, you know they likely fractured their hip. You ascertain whether it was a mechanical fall, if there were other injuries, if the injury is open or closed and if the patient is neurovascularly intact. You proceed to order your imaging and consider your plan for pain control. Sound familiar…”

Contact

Subscribe