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Gallbladder wall thickening

The normal gallbladder wall should measure less than 3-4mm. It is recommended that this measurement be taken through the anterior wall of the gallbladder, since posterior acoustic enhancement will often make posterior measurements inaccurate. The image above was taken in a patient with cirrhosis, chronic ascites, and no acute complaints of upper abdominal pain. WhileRead more

Clinical Pearl

38 yo M pmh brain ca currently under treatment p/w sob, tachpnea, and diaphoresis. You get an initial lactate 6.0 with a FS of 680. What is your diagnosis?Read more

Effusion

Ultrasound is quite sensitive in detecting even very small pleural effusions; it has been demonstrated to perform better than chest x-ray and nearly as well as CT scan. In order to assess for pleural fluid, the transducer should be directed through the liver (Right side) or spleen (Left side) and diaphragm. In a normal thorax,Read more

Clinical Pearl

30 yo M pmh ESRD 2/2 to lupus nephritis on HD p/w sob, tachypnea, and hypertensive not responding to Nitro gtt, lasix, or bipap. what emergent procedure will most likely help this patient?Read more

Clinical Pearl

63 yo F  p/w AMS noted as AAOx2 w/o focal deficits. Pt appeared cachetic, thin, dry with following VS BP 148/70, HR 142, T 96.4, rr 20, o2 98%. EKG showed sinus tachy with noted persistent lactate 4-5 despite aggressive IVF and remained AMS. Pt was afebrile with negative sepsis workup, with neg CTH/CXR/labwork exceptRead more

Clinical Pearl

46 yo F pmh right carpal tunnel release 6 months ago presents with intermittent swelling, pain as in burning, feelings of warmth and cold, and hypersensitivity to right hand worsening over past 6 month. What is the diagnosis ? treatment?Read more

Clinical Pearl

3 month old infant that was born full term, NSVD w/o complications presents with seizure like activity to your ED. Pt is afebrile with normal vitals however lethargic and not actively seizing. Off the blood gas you note a Na of 113. What must you consider and ask mom?   A: how is she mixing theRead more

Clinical Pearl

26 M pmh sickle cell disease p/w chest pain, sob, fever, and cough. She is noted to be hypoxic, anemic and has new pulmonary infiltrates on cxr. What diagnosis must be considered?   A: Acute chest syndrome “Acute chest syndrome is a clinical entity marked by hypoxia, fever and pulmonary infiltrates. Many EPs are confusedRead more

Clinical Pearl

  28 yo obese AA F pmh sickle cell disease comes in complaining of b/l leg pain similar to her prior pain crises. She states that she normally takes 8 mg morphine IV to control her pain however your hospital has a morphine shortage. What drug can you use and how much? A: Dilaudid hasRead more