This is 54 yo M who presented for an elective surgery. On POD # 0 he became tachycardic with subjective dyspnea and hypotension progressing into a PEA arrest. ROSC was quickly obtained with typical ACLS and he was placed on life support and transferred to the ICU for further management. A CTPA was negative, and his EKG was unremarkable with no evidence of coronary ischemia. On POD # 1 he remained hemodynamically unstable, and given very poor transthoracic windows, the decision was made to perform a TEE. Have a look at the images and Doppler information below. Is there a finding that may explain the etiology of his arrest? What would your recommendation be to the treating team?
This is a 35 yo M PWID who presented with a right septic AC joint, MRSA bacteremia and hypoxic respiratory failure. He was taken to the OR for washout of his AC joint and subsequently transferred to the ICU for post-op management. A post-operative CXR showed some patchy consolidations but no obvious pleural effusions. The POCUS team was subsequently deployed. Interrogation at the costophrenic angle and PLAPS (posteroalveolar and/or pleural syndrome) point on both sides yielded the following images. What do you see and what should the next steps in management be?
A 47 year-old female is admitted to ICU for respiratory failure and sepsis. She has a history of immune suppression and has had a prolonged stay in ICU. She is requiring pressors and the POCUS team was asked to assess cardiac function. Here are some of her echo images:
The Day Last Friday I had the amazing opportunity to present our work at the Department of Medicine Resident Research Day (take a deep breath before saying this one out loud): Acquisition and Retention of Lung Ultrasound Skills by Respiratory Therapists: a point-of-care ultrasound curriculum for respiratory therapists (and breathe). Although complimentary meals are usually enough to get hungry medical students out to [...]
A 30-year-old female, presents to the emergency department with acute lower abdominal pain. She is 9 weeks pregnant by dates and has had no formal ultrasound prior to presentation. Her initial vitals are; HR 102, BP 116/70, RR 24, T 36.2 and SpO2 98% on RA. A bedside ultrasound is completed and demonstrates:
A 75 year old male presents to the emergency department with delirium and fever. You use your POCUS skills to look for a possible source of infection in his lungs.
Hi POCUS enthusiasts, We set a new record with >65 participants in last week's case voting. Unfortunately this will be our last COTW/COTG until we are back in action in early April. For all those who haven't signed up for automatic distribution do it now by going to westernsono.ca and filling in your name and email address. This will be the last email reminder! Now let's jump into [...]
Hi POCUS enthusiasts,Thanks again to the more than 20 participants in the online voting for last week's case! For those who have yet to sign up, just go to westernsono.ca and insert your name and email into the text box on the right side of the webpage. Then get ready to flex your POCUS muscles and post your answers/votes. Or click here to access the case directly: https://westernsono.ca/category/cases/ The [...]
A 42 year old female is admitted with ARDS and a pleural POCUS is performed. Due to difficulties identifying lung sliding, M-mode was used to evaluate for pneumothorax. Based on this image, does the patient has a pneumothorax? What is the 2D ultrasound image correlate of the vertical areas as shown by the arrows?
A middle aged man presented to the Emergency Department 5 days after a ERCP and stent insertion for obstructive jaundice feeling unwell, feverish, and lightheaded. He rapidly deteriorated with hypotension and was admitted to the ICU with sepsis NYD. What (if anything) is concerning on this patient's RUQ/biliary POCUS? What management steps would you recommend based on these images?