Ultrasound is not time-consuming!

27 Jun

In the Netherlands, the majority of Emergency Physicians unfortunately do not use ultrasound frequently at this moment. One of the arguments I often hear is: “I don’t have the time to perform ultrasound at my busy Emergency Department (ED), because there are to many patients to take care of”. Hopefully my case will prove otherwise.

A few months ago, this 40 year old guy from Poland came to our ED. Our secretary called the triage nurse to inform ‘this man doesn’t look good’, maybe you can pick him up. As the nurse went to call for this patient, he indeed didn’t look well and that was not because the use of alcohol. He looked pale and diaphoretic all over, but didn’t speak a word English, German or Dutch. As they walked to a empty room, the nurse shouted for my help as they always do. While I was doing nothing except drinking coffee at my busy ED, she said: Please come over immediately ‘this man doesn’t look good’. I carefully watched the nurse (and the patient as well) and followed them into the room with my ultrasoundmachine, because this man was indeed looking awful. As she put the man on the monitor to get his vital signs, it was my time to shout. I ordered for ECG and regular bloodtest, because he might have STEMI. While I was preparing my device I noticed the man holds his both hands on his belly. Instead of performing an cardiac exam first, I choose to do abdomen (see fig 1 and 2). I diagnosed free fluid in his belly before the needle (for bloodtest) was actually in this specific patient. Later on, we found out that he was using brufen for a week because of backpain and the CT-scan revealed an hole in his stomach, so he went for surgery and did well afterwards.

fig 1 echo

fig 2 echo

I’ll guarantee, everything I just wrote down was for real (except the nurse was checking me out obviously).

I hope this case will stimulate you all to perform ultrasound more rapid and more often in future! Those of you, interested in learning ultrasound, you can always contact me for a four week ultrasound rotation at Sint Franciscus Gasthuis in Rotterdam. Although we are fullly booked until april 2015.

 

All the best,

Arthur Rosendaal

Hyponatriemia!

4 Jun

Today 3 incredible talks about hyponatriemia. Everything you need to know in the ED!

These talks are the top 3 talks about hyponatriemia from the MNSHA Masterclass: Acute Medical Emergencies. They are in the PechaKucha style, which means 20x20sec talks….so about 6 1/2 minutes.

 

Nr. 1 is from Klaartje Caminada. She shows the real art of PechaKucha!

 

Nr 2. is from Jasper Rebel, who makes hyponatriemia really, really  easy….in 10 steps.

 

Nr 3. is from Heleen van der Peijl. She explains hyponatriemia step by step.

 

Hope you will enjoy the talks….and hyponatriemia!

In Dutch: a local guideline anafylactic reactions

14 Apr

Hi all,

Attached the local guideline anaphylactic reactions in Dutch from Elisabeth hospital, Tilburg, with thanks to Pieter van Driel.

A while ago some of us had an email discussion about treatment, especially the role of epinephrine, and when to administer it.

Would you mind sharing your local protocols with us on this website? Please contact us by mail, see homepage.

Cheers, Laura

 

Protocol anafylaxe definitief.2014

Sterile gloves in wound repair

12 Apr

Useful article from Sebastian Aller, EP and M.Been, keuze-coassistent

Sterile gloves do we really need them in wound repair at the Emergency Department

 

 

Videolezing over analgesie

18 Feb

Een videolezing (Nederlandstalig) over analgesie, gegeven door  SEH-arts Gael Smits uit het Catharina Ziekenhuis in Eindhoven.

Screenshot 2014-02-18 14.47.02

Sommige van jullie kennen hem misschien al, hij heeft deze presentatie afgelopen jaar ook op het NVSHA congres in Egmond aan Zee gegeven.
Veel plezier.

NB/ Reakties zijn altijd welkom.
Heb je een andere interessante lezing, presentatie of casus? Stuur hem vooral naar ons toe en we nemen contact met je op.

 

De webmasters van EMDutch.

 

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