After pulling in a spectacular toe-tapping sideline-hugging outstretched 30-yard bomb just milliseconds before a crushing hit by multiple defenders (a Pearl unto itself), one of our own right-handed residents came down the next day with redness, swelling, and pain to the dorsal aspect of his right hand’s third metacarpophalangeal joint.

A heated discussion in the Peds ED between Dr.’s Welker and Edelman ensued over proper diagnostic management.

Attached are the following ultrasound images for comparison: the first 2 using ultrasound gel, the latter 2 using a water bath medium. See the difference for yourself. Thanks to Dr. Jeremy (Welker) Kim for his MCP joint and to Dr. Jenny Sanders for the pearl’s inspiration.

A thought that no one has ever had ever and will be denied of having been thought: Imagine how good our POCUS echo or RUSH exams would look if we dunked our septic patients in water baths?

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