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Emergency Ultrasound Case of November 2013

1 Nov

We are back again with another ultrasound case of the month !!

Brought to you by Amber Hoek. Emergency Medicine Resident, HAGA Teaching Hospital, The Hague . 

She came across this case during her Emergency Ultrasound Rotation at the Emergency Department of the Westfriesgasthuis in Hoorn.

A unexpected finding during a routine EFAST….with a brilliant clip….Enjoy !!

a 27-year-old male visited the ED with chest pain and respiratory distress.

3 weeks ago he was involved in a high speed motor vehicle crash, and fell from a dyke into the water. He refused to go to the hospital, however the day after he went to the ED because of chest pain on the left side. The Emergency Physician did a full physical exam and made a chest X-ray and shoulder X-ray. Only a left clavicle fracture was found.

Chest X-ray 3 weeks ago:

CHEST x ray ultrasound case of the month

Today the patient comes back with progressive chest pain on the left side and dyspnea since one week. He also has a fever of 39.0 °C

Vital signs: blood pressure 134/95 mmHg, heart rate 112/min, Sat. 100%, temperature is 37.8 °C. Auscultation: decreased breath sounds on the left with rales.

-What is your most likely diagnosis?

-What would you do next?

While the patient gets some fluids and waits for the chest X-ray, we do an EFAST:

https://vimeo.com/77497756

-What’s your diagnosis now and what would you do now?

To see the answer and the outcome of this case of the month , check out EMDutch in 2 weeks ….

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U/S after patella luxation

18 Oct

An interesting ultrasound case;

Recently, 2 patients have visited our ED after a patella luxation, which was replaced by EMS personnel. Besides physical examination and plain radiography an ultrasound was performed with a lineair probe to determine and confirm a ligament rupture.

Picture 1: a normal patella ligament of a healthy well built emergency physician (myself).

controle patellapees

Picture 2: a 50 year old man with a knee injury during a field hockey match.

patellapeesruptuur1

Picture 3: a 37 year old man with a knee injury on both sides during exercise after revalidation from his myocardial infarction. He denied use of steroids.

patellapeesruptuur2

Both patients received surgical repair later on.

I really love my ultrasound machine!!!

Arthur Rosendaal
Emergency Physician
Sint Franciscus Gasthuis, Rotterdam

Emergency Ultrasound : answer to case of the month september 2013

22 Sep

ANSWER to the ultrasound case of the month september 2013:

This case is brought to you by Nasim Azizi, emergency physician and hardcore ultrasound fanatic. Enjoy !

50 yr male brought to my ED in the UMCG Groningen by ambulance. He woke up with a crushing chest pain radiating to left arm en neck.
Cardiovascular risk factors ; hypercholesterolaemia, obesitas , smoking. No other past medical history.

According to protocol the ambulance personnel already had given him ASA

Vitals coming in to the ED  : 85/50 mmHg  , 78/min ,  97 % on room air

He is sweating ,clammy and anxious.

His EKG shows SR 78/min no signs of ischaemia

1) What is your most likely diagnosis ?

2) What would you do next ?

– Send him for PCI

– Wait for the troponine ….

-…..

While the patient gets some fluids  I did an emergency cardiac ultrasound .

Whats your diagnosis now ? ( this not the textbook quality images you are used to , but this is the real stuff ;-))

US00006Swatch clip

ANSWER :

Ultrasound : Clip, subcostal view: Pericardial fluid with tamponade physiology , Image, parasternal long axis :widened aortic root measuring 4.5 cm.

Diagnosis :    Type A dissection with tamponade , later to be confirmed with CTA

Patient was brougth to the OR, treated succesfully and discharged from hospital after one week.

Emergency Ultrasound : Case of the month

8 Sep

Here it is ….the first ultrasound case of the month on EMdutch !!  It’s about time !!

This case is brought to you by Nasim Azizi, emergency physician and hardcore ultrasound fanatic. Enjoy !

50 yr male brought to my ED in the UMCG Groningen by ambulance. He woke up with a crushing chest pain radiating to left arm en neck.
Cardiovascular risk factors ; hypercholesterolaemia, obesitas , smoking. No other past medical history.

According to protocol the ambulance personnel already had given him ASA

Vitals coming in to the ED  : 85/50 mmHg  , 78/min ,  97 % on room air

He is sweating ,clammy and anxious.

His EKG shows SR 78/min no signs of ischaemia

1) What is your most likely diagnosis ?

2) What would you do next ?

– Send him for PCI

– Wait for the troponine ….

-…..

While the patient gets some fluids  I did an emergency cardiac ultrasound .

Whats your diagnosis now ? ( this not the textbook quality images you are used to , but this is the real stuff ;-))

US00006Swatch clip

To see the answer and the outcome of this case of the month , check out EMDutch in 2 weeks …

Regional anesthesia

5 Jul
From our DEMC 2013: Mike Stone’s video’s
Laura