Time- 0100
A 55-year-old man brought in by ambulance with a history of hematemesis.
His initial vitals are-
GCS15, Pulse- 125, BP- 110/70, Sats- 97%, Temp- 36.5
- Outline your assessment of this patient?
Category Archives: EMergucate by Topic
Case of the week 16
Time- 2100 (Cold winter night)
Priority 1 call
A 3-year-old boy, Jack was found face down in the bathtub at home. PEA arrest on scene.
ETA 5 minutes
- How will you prepare for his presentation?
Case of the week 15
In a busy night shift, a 42-year-old man was brought in by police after found in the train station agitated. He is still in the police van and very uncooperative.
The shift coordinator wants you to assess the patient.
- How will you approach the situation?
Lab case 272
A 9 year old boy brought to ED by ambulance after developing a tonic-clonic seizure, it lasted for 8 minutes and was terminated by a single dose of benzos. Background of fever for 4 days and he is on amoxicillin for possible otitis media.
CSF was taken and the results are:
Case of the week 14
Time- 0200
A 51-year-old male with a history of diabetes and hypertension presented to the hospital with left facial droop, slurred speech, and left-sided hemiparesis. His initial CT scan was negative for acute hemorrhage. As he has no contraindication for thrombolysis the stroke team decided to treat him with tPA.
After the infusion finished patient developed left-sided facial swelling.
- How will you approach this situation initially?
Case of the week 13
You are about to see 2 brothers in the pediatric area, one 2 and another one 4-year-old. They were brought in by their mother, who is concerned that they may have had some of her iron tablets 1 hour ago at home. She pulled out at least 4-5 tablets from the younger one’s mouth.
According to the mother, there were 30 tablets in the bottle, with 105mg elemental iron in each tablet.
- What is your risk assessment in this situation?
Ultrasound Post 3 Interpretation
30 year old male presents to ED with onset of right sided chest pain 2 hours ago. pain is pleuritic in nature and is associated with some Shortness of breath. His Vitals are HR 90, BP 130/70, RR 18, Sats 96 RA. He has history of primary spontaneous pneumothorax on right side about a year ago ,was treated with ICC insertion and subsequently resolved . Bedside ultrasound is performed and following images and clips are obtained.
Answer 1. First Clip is of left side of chest ( normal side) . It shows 2 rib shadows, with pleural interface as bright white line. We can appreciate “ant crawling ” effect over pleural interface which is actually lung sliding and indicates absence of pneumothorax. Small vertical flashing lines intermittently are also evident which are called Comet tail artefacts.
Remember lung sliding can be absent in chronic lung conditions e.g severe emphysema, bronchiectasis, intubated patient.
Second clip is of symptomatic right side. It again shows rib shadows with bright line ( pleural interface ) , but it is quite static as compared to other side and we can not appreciate ant crawling effect or lung sliding. Also there are no comet tail artefacts seen. This strongly indicates presence of pneumothorax on right side. There is also small movement coming towards centre like a curtain with breathing , it is called lung point.
Answer 2:
These images are taken with M mode. First image shows sea shore sign , and second image shows bar code sign. Barcode sign indicates pneumothorax but is not very sensitive or specific .
Answer : 3. This clip shows ” lung point” which is highly sensitive for presence of pneumothorax. It appears as a curtain moving towards middle as the patient breaths and represents normal lung sliding coming in contact with abnormal lung.
Summary:
Absence of lung sliding, and comet tail artefacts and presence of lung point strongly suggests presence of pneumothorax.
Case of the week 12
A 5-year-old boy represented to the emergency with his mother at 11 pm after a head injury earlier in the afternoon. He vomited twice so far and bit drowsy as per mom. He was seen in ED 2 hours ago and discharged with head injury advice.
- Outline the indications for CT head in this child.
Ultrasound Post 3
30 year old male presents to ED with onset of right sided chest pain 2 hours ago. pain is pleuritic in nature and is associated with some Shortness of breath. His Vitals are HR 90, BP 130/70, RR 18, Sats 96 RA. He has history of primary spontaneous pneumothorax on right side about a year ago ,was treated with ICC insertion and subsequently resolved . Bedside ultrasound is performed and following images and clips are obtained. Continue reading
Case of the week 11
A 23-year girl was brought in ED by her mother in a wheelchair as she is refusing to walk. She is known to have borderline personality disorder and had multiple presentations before, with behavioral issues. During triage, she refused to talk to the nurse and kept her eyes shut.
- How will you assess the patient in the ED?