Resus SinaiEM Blog – Page 80

E M Pearl, May 29

Posted on May 29, 2012 by raashee

An 18 year old female presents to the peds ED after an episode of witnessed syncope. Pt was hiking when had sudden LOC, no preceding symptoms. She now feels well and denies CP and palpitations. No prior episodes. No OCP use or other PE risk factors. Her vitals and exam are normal. Her EKG from […]

E M Pearl, May 25

Posted on May 25, 2012 by raashee

Thank you to Papa Hernandez for this fascinating case. 37F 10 weeks pregnant (by LMP), asthma presents with 1-2 weeks of SOB. Extertional, +orthopnea, + bilateral LE edema. Has yet to initiate prenatal care. Her vitals at triage: 97.7 117 230/140 28 98%. On exam, patient is tachypneic but not in distress. Her […]

E M Pearl, May 24

Posted on May 24, 2012 by raashee

A 32F who is 14 weeks pregnant presents with intermittent shortness of breath x 1 day. She has no h/o DVT/PE. Vitals 98.9 100 105/70 18 99% on RA. Clear lungs, no calf asymmetry on exam. You are concerned about PE. How should you proceed? If she needs imaging, CTA or V/Q?

E M Pearl, May 22

Posted on May 22, 2012 by raashee

Thank you to Dr. Chris “This Ain’t No Simulation” Strother. 3 kids, 3 head injuries. A) 2-month old boy, fell out of baby carriage onto top of head 30 minutes ago. No LOC, seizure, vomiting. Acting normally per mom. Abrasion on superior scalp, no palpable skull fracture, fontanelle flat. B) 18-month old […]

E M Pearl, May 18

Posted on May 18, 2012 by raashee

3yo male h/o RAD presents with a nasal foreign body. After a few conservative efforts to remove the FB, it is apparent the child will not be able to cooperate with further attempts. A line is placed and 1mg/kg ketamine is given IV. While loosening the object with a blunt-tipped probe, you notice the sudden […]

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Jennifer Huang

Posted on May 17, 2012 by sinaiem

We are very pleased to welcome the newest member of the Mount Sinai Emergency Ultrasound Division, Dr. Jennifer Huang! Dr. Huang completed her residency training at Highland Hospital in Oakland, California and an emergency ultrasound fellowship at the SUNY Downstate / Kings County Hospital in Brooklyn, New York. Â She has led emergency ultrasound courses and […]

E M Pearl, May 17

Posted on May 17, 2012 by raashee

Shout out to Ben Slovis for providing this case. 22F s/p thyroidectomy here with 1 day back pain and generalized weakness. Patient’s thyroidectomy was complicated by inadvertent parathyroidectomy, and never followed-up to manage this complication. On exam, no concerning signs for cord compression, but significant paralumbar muscle spasms. Her EKG demonstrates a QTc of […]

Sonogames 2012

Posted on May 16, 2012 by sinaiem

The inaugural SonoGames were held at the SAEM Scientific Assembly in Chicago this week. Thirty-eight residency programs were represented at the event, organized by Resa Lewiss and SAEM’s Academy of Emergency Ultrasound. Three rounds separated the dabblers from the master sonographers. In order to win, teams had to demonstrate ultrasound knowledge on tests and then […]

E M Pearl, May 15

Posted on May 15, 2012 by raashee

Courtesy of Dr. Elikashvili. 20 month old female is BIBEMS after seizure at home just prior to presentation. Mother describes “10 minutes” of what sounds like generalized tonic-clonic movements. No h/o seizures. Child was born full term and 18 month vaccines UTD. She reports 2 days preceding fever, no URI, cough, diarrhea, rash, but […]

E M Pearl, May 14

Posted on May 14, 2012 by raashee

23F h/o asthma is brought in from home s/p seizure. She is currently altered, but her grandparents (whom she lives with and witnessed the seizure) are at the bedside. They deny a history of seizures and report no preceding fever. An agile ER tech produces for you the following EKG: What are the important […]

Arcuate Vessels

Posted on May 13, 2012 by sinaiem

Arcuate vessels are commonly seen on ultrasound evaluation of the uterus. Occasionally they can be confused with subchorionic hemorrhage, ovaries, and other structures so it’s worth looking at their characteristic appearance. Once again, thanks to Dr. Gray for his lovely, copyright-free images: Here we see the Uterine venous plexus giving rise to the helicine branches, […]

E M Pearl, May 11

Posted on May 11, 2012 by raashee

Case courtesy of Joe Scofi. 65M history of CAD (on ASA/Plavix), HTN presents with 3 days of epigastric pain and “dark” stools. Denies history of GI bleed. He drinks and smokes. Says that he had a AAA repair in Russia three years ago. His vitals are: 101.3 (rectal) 105 115/65 20 98%. […]

Cavitation

Posted on May 10, 2012 by sinaiem

Rounding out our recent trifecta of biosafety posts is a description of cavitation. Cavitation is the formation of microbubbles in liquid which has been subjected to rapid pressure changes. This can happen from a variety of causes from beating Dolphin tails, propellers, cracking your knuckles, and with ultrasound. The Mechanical Index is used to represent […]

E.m. Pearl, May 10

Posted on May 10, 2012 by raashee

19M brought into pediatric resus looking toxic, diaphoretic with shallow breathing. Temp 38.7, HR 126, BP 146/51, RR 20, 95% on RA. Two weeks ago he had a sore throat which was strep and monospot negative. He’s had a persistent sore throat with fever progressing to trismus, right mandibular numbness, neck stiffness, and now with […]

RUSH in ARREST

Posted on May 9, 2012 by phil

Notes from Grand Rounds on Cardiac Arrest Ultrasound this morning. Screencast (in process) Handout RUSH in Arrest Algorithm Â References: Atkinson, P R T, D J McAuley, R J Kendall, O Abeyakoon, C G Reid, J Connolly, and D Lewis. “Abdominal and Cardiac Evaluation with Sonography in Shock (ACES): An Approach by Emergency Physicians for […]