Assessment of Pericardial effusion

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[…]

Common pitfall – Stones in the gall bladder – Adenomyomatosis

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[…]

Trauma – fractured ribs undiagnosed on chest Xray

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[…]

Submassive Pulmonary Embolism – a critical care ECHO skill?

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?[…]

Takotsubo cardiomyopathy

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[…]

Type A dissection – Full house

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[…]