Videos Archives - The Western Journal of Emergency Medicine

Diagnosis of Pneumoperitoneum with Bedside Ultrasound

Volume 16, Issue 2, March 2015
Alice Chao, MD et al.

An 86-year-old female was brought in by ambulance for severe abdominal and back pain. She was hypotensive en route and appeared to be in distress upon arrival to the emergency department. Her abdomen was tense and distended with diffuse tenderness to palpation present.

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Spontaneous Pneumomediastinum on Bedside Ultrasound: Case Report and Review of the Literature

Volume 16, Issue 2, March 2015
Sybil Zachariah, MD et al.

Spontaneous pneumomediastinum is a rare disease process with no clear etiology, although it is thought to be related to changes in intrathoracic pressure causing chest pain and dyspnea. We present a case of a 17-year-old male with acute chest pain evaluated initially by bedside ultrasound, which showed normal lung sliding but poor visualization of the parasternal and apical cardiac views due to significant air artifact, representing air in the thoracic cavity. The diagnosis was later verified by chest radiograph. We present a case report on ultrasound-diagnosed pneumomediastinum, and we review the diagnostic modalities to date.

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Bedside Ultrasound Identification of Infectious Flexor Tenosynovitis in the Emergency Department

Volume 16, Issue 2, March 2015
Kevin Padrez, MD et al.

Infectious flexor tenosynovitis (FTS) is a serious infection of the hand and wrist that can lead to necrosis and amputation without prompt diagnosis and surgical debridement. Despite the growing use of point-of-care ultrasound (POCUS) by emergency physicians there is only one reported case of the use of POCUS for the diagnosis of infectious FTS in the emergency department setting. We present a case of a 58 year-old man where POCUS identified tissue necrosis and fluid along the flexor tendon sheath of the hand. Subsequent surgical pathology confirmed the diagnosis of infectious FTS.

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Can Emergency Physicians Perform Common Carotid Doppler Flow Measurements to Assess Volume Responsiveness?

Volume 16, Issue 2, March 2015
Lori A. Stolz, MD et al.

Common carotid flow measurements may be clinically useful to determine volume responsiveness. The objective of this study was to assess the ability of emergency physicians (EP) to obtain sonographic images and measurements of the common carotid artery velocity time integral (VTi) for potential use in assessing volume responsiveness in the clinical setting.

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Non-thrombotic Abnormalities on Lower Extremity Venous Duplex Ultrasound Examinations

Volume 16, Issue 2, March 2015
Srikar Adhikari, MD, MS et al.

Emergency physician-performed compression ultrasonography focuses primarily on the evaluation of the proximal veins of the lower extremity in patients with suspected deep venous thrombosis (DVT). A detailed sonographic evaluation of lower extremity is not performed. The objective of this study was to determine the prevalence of non-thrombotic findings on comprehensive lower extremity venous duplex ultrasound (US) examinations performed on emergency department (ED) patients.

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Healthcare Utilization

Low-Cost Alternative External Rotation Shoulder Brace and Review of Treatment in Acute Shoulder Dislocations

Volume 16, Issue 1, January 2015
Kyle Lacy, MD, MS et al.

Traumatic dislocations of the shoulder commonly present to emergency departments (EDs). Immediate closed reduction of both anterior and posterior glenohumeral dislocations is recommended and is frequently performed in the ED.

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Achilles Tendon Rupture

Volume 16, Issue 1, January 2015
Sean P. Stickles, MD et al.

A 60-year-old man presented to the emergency department complaining of acute onset posterior ankle pain. He reported playing tennis earlier in the afternoon when he suddenly stopped and pivoted, noting a “pop” sensation and pain to the right posterior ankle.

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Bedside Echocardiography for Undifferentiated Hypotension: Diagnosis of a Right Heart Thrombus

Volume 16, Issue 1, January 2015
James F. Kenny, MD et al.

A free-floating right heart thrombus is often a harbinger of a massive pulmonary embolism and must be diagnosed and treated rapidly in order to avoid significant adverse sequelae. We present the case of an 84-year-old female who presented with two days of dyspnea and was hypotensive on arrival.

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Half-dose Alteplase for Sub-massive Pulmonary Embolism Directed by Emergency Department Point-of-care Ultrasound

Volume 16, Issue 1, January 2015
Richard Amini, MD et al.

This report describes a patient with sub-massive pulmonary embolism (PE) who was successfully treated with half-dose thrombolytics guided by the use of point-of-care (POC) ultrasound. In this case, POC ultrasound was the only possible imaging since computed tomography was contraindicated.

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Ultrasound-Guided Diagnosis and Aspiration of Subdeltoid Abscess from Heroin Injection

Volume 15, Issue 7, November 2014
Amanda Clauson, MD et al.

A 49-year-old man presented to the emergency department (ED) with shoulder pain after intramuscular injection of heroin into his right deltoid muscle. Point-of-care (POC) ultrasound identified a subdeltoid abscess, and ultrasound-guided aspiration of the fluid collection was performed.

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False Positive Appendicitis on Bedside Ultrasound

Volume 15, Issue 7, November 2014
Caleb P. Canders, MD et al.

A 27-year-old woman presented with sharp, right lower quadrant abdominal pain for six hours. The pain was colicky, non-migratory, and non-radiating.

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Ultrasound Distinguishes Ascites from a Large Ovarian Fluid-Filled Cyst

Volume 15, Issue 7, November 2014
Marissa Camilon, MD et al.

A 51-year-old woman with Hepatitis C was referred to the emergency department (ED) for “massive ascites.” She reported increasing abdominal girth for six months with intermittent abdominal pain. An outpatient ultrasound performed two weeks prior to ED presentation was interpreted by a radiologist as “massive ascites, no masses within the abdomen” on the paper report the patient brought with her. In the ED, the patient was afebrile with normal vital signs. Her abdomen was distended with mild right upper quadrant tenderness.

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Sydenham Chorea: Rare Consequence of Rheumatic Fever

Volume 15, Issue 7, November 2014
Paul J. Myers, DO, et al.

Sydenham Chorea (SC) is an acute rheumatic fever complication. SC is the most common acquired childhood chorea, usually affecting children five to fifteen years of age.1 It occurs following an untreated group A streptococcal infection and a latent period of one to six months.1,2 Despite rheumatic fever diminishing, 18% to 36% of acute rheumatic fever patients develop SC.3 Full recovery often takes several months; some patients suffer permanent neurologic sequelae.1

An 11-year old male presented to the Emergency Department with two days of uncontrolled body twitching. The movements affected his right arm and leg, with occasional lip twitches; he experienced intermittent confusion and hyperactivity. The patient denied recent illness, but recalled a fever with headache and vomiting several months prior. Besides the above findings, his physical examination was normal.

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Hepatic Portal Venous Gas: Findings on Ultrasound and CT

Volume 15, Issue 7, November 2014
Kristin Berona, MD et al.

A 76-year-old female with a history of Parkinson’s, dementia, and hypertension presented to the emergency department with non-bilious, non-bloody vomiting and abdominal pain for 2 days.

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Post Transapical Aortic Valve Replacement (TAVR) Pseudoaneurysm

Volume 15, Issue 7, November 2014
Michael W. Manning, MS et al.

A 63-year-old female presented to the emergency department with complaints of her “heart beating out of my chest,” palpitations, and shortness of breath. She was three months postoperative a #23 Edwards Sapien Transapical Aortic Valve Replacement (TAVR).

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A Woman with Dyspnea and Hemoptysis

Volume 15, Issue 7, November 2014
Steven G. Schauer, DO et al.

A 55-year-old female presented to the emergency department at a small community hospital with cough, fever, dyspnea and blood-streaked sputum. A chest radiograph was ordered.

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Pilot Study of Ultrasound-Guided Corticosteroid Hip Injections by Emergency Physicians

Volume 15, Issue 7, November 2014
Erik S. Anderson, MD et al.

Our objective was to assess the efficacy of ultrasound-guided hip injections performed by emergency physicians (EPs) for the treatment of chronic hip pain in an outpatient clinic setting.

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From the Heart: Interatrial Septal Aneurysm Identified on Bedside Ultrasound

Volume 15, Issue 6, September 2014
Michael Butterfield, MD, MS, MPH et al.

A 61 year-old man presented to the Emergency Department for one day of nonspecific chest pain. Bedside echocardiogram performed by the emergency physician revealed normal systolic cardiac function but also showed a large ( > 10mm) bicornuate interatrial septal aneurysm (IASA) projecting into the right atrium (Figure 1, Video 1). There was no evidence of intraatrial thrombus. A formal echocardiogram performed later that day confirmed the diagnosis and also detected a patent foramen ovale (PFO) with a left-to-right shunt that reversed with Valsalva maneuver.

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Ocular Ultrasound Identifies Early Orbital Cellulitis

Volume 15, Issue 4, July 2014
Tarina L. Kang, MD et al.

A 36 year-old man with a history of a complicated oral surgery from a complex mandibular fracture months prior presented with traumatic right eye swelling, tearing, and redness.

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From the Heart: Interatrial Septal Aneurysm Identified on Bedside Ultrasound

A 61 year-old man presented to the Emergency Department for one day of nonspecific chest pain. Bedside echocardiogram performed by the emergency physician revealed normal systolic cardiac function but also showed a large ( > 10mm) bicornuate interatrial septal aneurysm (IASA) projecting into the right atrium (Figure 1, Video 1). There was no evidence of […]

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The Mirror-Image Artifact Mimicking Heterotropic Pregnancy on Point-of-Care Transvaginal Sonography: A Case Series

Vaginal bleeding in early pregnancy is a common emergency department complaint. Point-of-care ultrasound is a useful tool to evaluate for intrauterine ectopic pregnancy. Emergency physicians performing these studies need to be cognizant of artifacts produced by ultrasound technology, as they can lead to misdiagnosis. We present two cases where mirror-image artifacts initially led to a […]

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Color Doppler Evaluation Prior to Ultrasound-guided Supraclavicular Brachial Plexus Nerve Block to Prevent Vascular Injection

Ultrasound-guided nerve blocks are quickly becoming integrated into emergency medicine practice for pain control and as an alternative to procedural sedation. Common, but potentially catastophic errors have not been reported outside of the anesthesiology literature. Evaluation of the brachial plexus with color Doppler should be standard for clinicians performing a supraclavicular brachial plexus block to […]

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BE-SAFE: Bedside Sonography for the Assessment of the Fetus in Emergencies. Effect of an Educational Intervention on Emergency Physician Ability to Perform a Focused Late Pregnancy Obstetric Ultrasound Video

Introduction: Late obstetric emergencies are time critical presentations in the emergency department (ED). Evaluation to ensure the safety of mother and child includes rapid assessment of fetal viability, fetal heart rate (FHR), fetal lie, and estimated gestational age (EGA). Point-of-care (POC) obstetric ultrasound (OBUS) offers the advantage of being able to provide all these measurements. […]

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USEFUL Ultrasound Exam for Underlying Lesions Incorporated into Physical Exam Video

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Diagnosis of Fournier’s Gangrene on Bedside Ultrasound

Volume 15, Issue 2, March 2014
Christopher Coyne, MD et al.

A previously healthy 48 year-old male presented to the hospital with a 4-week history of “pimples” on his scrotum. This condition had progressively worsened, resulting in increased pain, swelling and redness to the genital region and buttocks.

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Diagnosis of Necrotizing Faciitis with Bedside Ultrasound: the STAFF Exam

Volume XV, Issue 1, February 2014
Erik Castleberg, MD et al.

We propose the STAFF ultrasound exam may be beneficial in the rapid evaluation of unstable patients with consideration of necrotizing fasciitis, in a similar fashion to the current use of a focused assessment with sonography for trauma exam in the setting of trauma.

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