What The Heck 1

This patient presented with right upper quadrant abdominal pain. There was RUQ tenderness on exam, but no fever, rebound or Murphy sign. A point-of-care ultrasound was performed to assess for signs of cholecystitis and the following image was obtained. This prompted the operator to ask, “What the heck?” What structures are visible here? How could […]

Pearl 12/28

18 y.o. male h/o asthma presenting with chest pain this AM. Pain was substernal, crushing with intermittent sharpness, and has been waxing and waning all day. CP is pleuritic, not positional. Also reports some malaise, decreased appetite, nausea, and headache for the last 3 days. VS wnl, NAD, no murmurs on exam.   EKG:   […]

AAMC article

The Association of American Medical Colleges (AAMC) has written an article about ultrasound education at the medical school level. In the current edition of their widely distributed publication The Reporter, they describe programs at the University of South Carolina School of Medicine, University of California (Irvine) School of Medicine, and the Mount Sinai School of […]

Pearl 12/27

A 32-year-old man presented, complaining of a painful erection for the last 18 hours. His medical history was significant for sickle cell disease,  insomnia and depression, for which he was taking quetiapine, bupropion, and prazosin. Examination revealed a mildly tender, fully erect penis and a soft glans. He was given 0.25 mg of subcutaneous terbutaline, […]

Ultrasound Zen

To image something which moves, you must remain still. To image something which is still, you must move. If you think on this long enough, the point is self-evident and requires no explanation. Or, just see some examples below. We are pretty well adapted to seeing three dimensions at a time. Thus when imaging a […]

A Clarification and a Correction

SVC Syndrome Clarification Dr. Genes pointed out that while likely still the most common etiology of SVCS is cancer, the emerging etiology is Pacemaker implantation/extraction.   I didn’t find evidence that it is the clear cut most common cause, but it is possible we are heading that way. Herscovici R, Szyper-Kravitz M, Altman A, Eshet […]

Influenza on the Rise

25 year old F with no pmh present with 3 days of fever, chills, body aches, sore throat. She is a school teacher and has had many of her kids out sick this week. Her vitals are stable, and she is in no acute distress. She is triaged to the B side at Sinai.   […]

Heme Questions

Here are some Heme questions for your holiday weekend. Enjoy! 1. A 9-year-old female with mild type I von Willebrand’s disease presents with mild gingival bleeding after her first overly vigorous attempt to use dental floss. She stopped as soon as she noticed bleeding, which is limited to the space between her upper central incisors. […]

Pearl for 12/21

A 25 yo male with no PMH walks into your ED complaining of right neck pain, right shoulder stiffness,  and cough x 1 month, no fevers chills. On exam his vitals are all within normal limits, exam is notable for right sided swelling and asymmetric neck. CXR as below:       What are you […]

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