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Ultrasound is an essential tool for the critical care physician. It improves diagnostic accuracy. It greatly improves patient care. It can be a game changer in the critically ill enabling correct diagnosis within minutes. Ultrasound has become a skill the critical care physician can no longer go without.
Images Mark Russel, text Genevieve Carbonatto A 35 year old women presents to the Emergency Department for a review of a possible ectopic pregnancy. She is 7 weeks pregnant by dates. An outpatient scan was performed the day before for painless vaginal bleeding . It did not show an intrauterine gestational sac. A complex left Read more about Pitfall: Painless ruptured ectopic pregnancy[…]
Text and images Genevieve Carbonatto Pericardial effusions are commonplace. A pericardial effusion is not synonomous with pericardial tamponade. Pericardial tamponade is a medical emergency characterised by shock and associated with a number of clinical criteria including Becks triad (hypotension, decreased heart sounds, elevated JVP) pulsus paradoxus ( > 12 mmHg drop in BP on inspiration), Read more about Assessment of Pericardial effusion[…]
Images Ying Ying Lee, text Genevieve Carbonatto A 44 year old man presents with acute abdominal pain. His pain is mainly epigastric but you are concerned about the possibility of cholecystitis, cholelithiasis or choledocholithiasis. While scanning the patient in the supine position, you think you can see stones in the GB. They do not appear Read more about Common pitfall – Stones in the gall bladder – Adenomyomatosis[…]
Images Roger Burrell, text Genevieve Carbonatto A 54 year old man presents one week after a fall. He is complaining of severe left lower rib pain especially with respiration. His chest Xray looking for rib fractures does not show any fractures, nor is there a pneumothorax or a pleural effusion. On palpation he is tender Read more about Trauma – fractured ribs undiagnosed on chest Xray[…]
Images and Text Genevieve Carbonatto If we consider that there are different levels of expertise in the acquisition of knowledge of echocardiography for the Critical Care Physician, the recognition of acute cor pulmonale which we see with submassive pulmonary embolus has been described as a Level II skill, level I being the minimal level of Read more about Submassive Pulmonary Embolism – a critical care ECHO skill?[…]
Thankyou Justin Bowra for this post. Ultrasound for interstitial lung disease and pulmonary oedema Key points • US lets you ‘see the crackles’. The US appearance of crepitations / crackles is called ‘B lines’ (formerly rockets, comets) • Just like crackles, B lines are found in pulmonary oedema and also in pulmonary fibrosis • B Read more about B lines – how best to see them[…]
Images Tina Cullen, text Genevieve Carbonatto It is 10.00 pm and you get a BAT call. There has been a fight at the local pub and the ambulance are bringing in a 34 year old who has been stabbed in the chest. He is tachycardic and hypotensive, GCS 14. They will arrive in 10 minutes. Read more about Trauma – Haemopericardium[…]
Images Sarah Vaughan, text Genevieve Carbonatto A 38 year old man presents to the Emergency department with shortness of breath which he has had for 4 weeks. His symptoms have worsened over the past 3 days. He can no longer go up 2 flights of steps to his apartment and he has noticed his ankles Read more about Ice cardiomyopathy, apical thrombus[…]
Images and text Genevieve Carbonatto A 52 year old lady presents to the Emergency Department with chest pain. After an argument with her husband about his spending she developed acute severe central chest pain radiating down her right arm. She is mildly SOB. There is no past history of note, notably no cardiovascular risk factors. Read more about Takotsubo cardiomyopathy[…]
Images and text Genevieve Carbonatto A 73 year old man presents to your department jaundiced. He says he has not been feeling unwell but that over the past 4 days the white of his eyes have turned yellow as well as the skin of his face. His urine turned very yellow 4 days ago and Read more about Biliary Obstruction: Double Barrel sign, Monkey Puzzle sign[…]