Case and images courtesy of Dr Micky Fiorentino (ultrasound under supervision of Dr James Dent) Triage at 1pm: 46F, representation with recurrent RUQ pain. Known gallstones. Representing with further pain, yellow skin colour and pale stool and dark urine. Further history: Diagnosed with gallstones with 3 weeks prior on outpatient ultrasound showing multiple small stones. Read more about Case 3 Gallstones, dilated CBD[…]
A 72 year old lady presented to the Emergency Department with syncope. A point of care ECHO was performed. What is the structure in the right atrium? This is a Eustachian valve. The differential diagnosis would be a tumour, a thrombus or a vegetation. In the context of syncope the presence of such a Read more about Eustachian valve[…]
Dr Chris Harrington (FACEM) presents 2 cases for this month. Both demonstrate the importance of ECHO in the context of the deteriorating patient with heart failure. Case 1 A 48F is referred to the Emergency department by her cardiologist with exacerbation of right heart failure and rapid AF PHx aortic valve repair (for congenital aortic Read more about Case 2 FELS Right heart failure[…]
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?[…]
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 the emergency 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 Read more about Biliary Obstruction: Double Barrel sign, Monkey Puzzle sign[…]
Images and text Genevieve Carbonatto The most difficult and frustrating ultrasound examination in the Emergency department must be the ECHO exam. What can we do to optimise our images ? Here are some tips and tricks. 1. Positioning the patient Some of our patients in the Emergency Department cannot be moved because of body habitus Read more about ECHO : image optimisation[…]
Images Bashir Antoine Chakar (Emergency registrar) Text Genevieve Carbonatto You get a BAT call. The ambulance are bringing in a 65 year old lady who developed acute onset chest pain radiating to her back. The paramedics tell you that she was found to be diaphoretic with a systolic BP of 130. Thinking this was an Read more about Type A dissection – Full house[…]
Images and text Genevieve Carbonatto A 14 year old boy presents to the Emergency Department with abdominal pain. The pain had started acutely the day before and he had been unable to sleep because of the pain. As you lead the patient to the examination room you note his antalgic gait. He states that while Read more about Appendicitis[…]