POCUS Archives - Page 3 of 3 - Emergency Medicine Cases

Episode 31: LP, Spontaneous Pneumothorax and Ultrasound Guided Fracture Reduction

In this episode, Dr. Jordan Chenkin & Dr. Jamie Blicker discuss positioning, landmarking, and best technique for lumbar puncture, how to minimize post-LP headache and traumatic taps, as well as when CT head is not required prior to LP. They discuss the indications, contraindications, trouble-shooting and pros and cons of needle aspiration, small bore pleural catheter with Heimlich valve and large bore chest tube for the treatment of spontaneous pneumothorax. Dr. Chenkin presents an intriguing argument for why he uses ultrasound-guided fracture reduction routinely in the ED, and we end with a few tips and tricks using skin adhesive for some unorthodox indications.

By Anton Helman|2021-03-31T13:02:17-04:00March 11th, 2013|Categories: EM Cases, Emergency Medicine, Episodes, Neurology, Orthopaedics, Respirology|Tags: fracture managment, Heimlich valve, Jamie Blicker, Jordan Chenkin, lumbar puncture, pigtail cathether, POCUS, post-LP headache, spontaneous pneumothorax, ultrasound|2 Comments

Episode 23: Vaginal Bleeding in Early Pregnancy

In this episode on Vaginal Bleeding in Early Pregnancy Dr. David Dushenski & Dr. Ross Claybo run through the key clinical pearls of the history, the physical, interpretation of the BhCG and the value of serum progesterone in working up these patients. The newest on bedside emergency department ultrasound is discussed in the patient with vaginal bleeding in early pregnancy. The various types of spontaneous abortion including septic abortion are reviewed as well as the management of the unstable patient with massive vaginal hemorrhage. Ectopic pregnancy, in all it's various presentations is reviewed with particular attention to the most common pitfalls and how to avoid them.

By Anton Helman|2021-03-31T13:08:01-04:00May 16th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Obstetrics & Gynecology|Tags: abortion, bedside ultrasound, David Dushenski, ectopic pregnancy, methotrexate, molar pregnancy, POCUS, Rhogam, Ross Claybo|0 Comments

Best Case Ever 9 Vaginal Bleeding in Early Pregnancy

As a bonus to Episode 23 on 'Vaginal Bleeding in Early Pregnancy' with Dr. Ross Claybo and Dr. David Dushenski, we have here, Dr. Claybo's Best Case Ever. While vaginal bleeding in early pregnancy is rarely life threatening, there are a significant percentage of woman who will require emergency resuscitation and surgical intervention. We don't have mountains of RCTs on this topic; still Dr. David Dushenski & Dr. Ross Claybo run through the key clinical pearls of the history, the physical, interpretation of the BhCG and the value of serum progesterone in working up these patients. The newest on point of care ultrasound is discussed in the patient with vaginal bleeding in early pregnancy. The various types of spontaneous abortion including septic abortion are reviewed as well as the management of the unstable patient with massive vaginal hemorrhage. Ectopic pregnancy, in all it’s various presentations is reviewed with particular attention to the most common pitfalls and how to avoid them. [wpfilebase tag=file id=388 tpl=emc-play /] [wpfilebase tag=file id=389 tpl=emc-mp3 /]

By Anton Helman|2016-10-20T13:22:25-04:00May 8th, 2012|Categories: Best Case Ever, EM Cases, Emergency Medicine, Obstetrics & Gynecology|Tags: ectopic pregnancy, POCUS, Ross Claybo, ultrasound|0 Comments

Episode 18 Part 2: More Point of Care Ultrasound

In Part 2 of this Episode on Emergency Ultrasound or Point of Care Ultrasound (POCUS) Dr. Fischer, Dr. Hannam, Dr. Chenkin & Dr. Hall, Canada's EM ultrasound gurus discuss how POCUS can help our decision-making in the pediatric patient with a limp, in the patient with necrotizing fasciitis, in the pregnant patient with vaginal bleeding and in the common and challenging elderly patient with undifferentiated abdominal pain. They cover POCUS indications from urinary retention to appendicitis and debate the utility of these indications. This is followed by a debate on how best to educate ourselves and the EM community in POCUS and how best to designs quality assurance programs so that point of care ultrasound (POCUS) becomes an accepted tool across the entire medical community.

By Anton Helman|2021-03-31T13:20:20-04:00November 8th, 2011|Categories: Clinical Practice, EM Cases, Emergency Medicine, Episodes, Obstetrics & Gynecology|Tags: abdominal pain, cauda equina syndrome, cholycystitis, deep vein thrombosis, emergency procedures, FAST, foreign body, Greg Hall, Jordan Chenkin, necrotizing faciitis, nerve block, POCUS, pulmonary embolism, quality assurance, septic arthritis, ultrasound, urinary retention, vaginal bleeding|1 Comment

Best Case Ever 5 Septic Arthritis

Septic Arthritis is often at the top of our differential for acute monoarthritis. Dr. Joel Yaphe tells his Best Case Ever of a patient with septic arthritis as a bonus to Episode 16: Acute Monoarthritis. In the related episode Dr. Yaphe and Dr. Indy Ghosh discuss such questions as: What are the most important risk factors for septic arthritis? What are the most predictive signs and symptoms of septic arthritis? How does serum WBC, ESR and CRP contribute to the probability of septic arthritis? Should we still be performing arthrocenteses on patient's with overlying cellulitis? with an INR of 6? How can you tell the difference between septic bursitis and septic arthritis and how are they managed differently? What does the literature tell us about how useful the synovial fluid tests are in ruling in or ruling out septic arthritis? What is the role of bedside ultrasound in septic arthritis? Is there a role for steroid therapy in septic arthritis? When would you consider oral NSAIDs vs oral prednisone vs intra-articular methylprednisolone for the treatment of Gout? Is there a role for colchicine in the ED treatment of Gout? What is acute calcific arthritis of hydroxyapatite disease and why is it important for ED docs to know about? What is the most common cause of dermatitis-arthritis? How can one distinguish Reactive Arthritis from Septic Arthritis clinically, and how do their work-ups differ? Is there a role for antibiotics in Reactive Arthritis? How does gonococcal arthritis present compared with nongonococcal septic arthritis? and many more..... [wpfilebase tag=file id=378 tpl=emc-play /] [wpfilebase tag=file id=379 tpl=emc-mp3 /]

By Anton Helman|2016-10-20T13:25:22-04:00July 19th, 2011|Categories: Best Case Ever, EM Cases, Emergency Medicine, Orthopaedics|Tags: arthrocentesis, colchicine, gout, Joel Yaphe, POCUS|0 Comments

Episode 10 Part 2: Trauma Pearls and Pitfalls

In Part 2 of this episode on Trauma Pearls & Pitfalls Dr. Dave MacKinnon and Dr. Mike Brzozowski go through key management strategies and controversies surrounding head, neck, chest, abdominal, pelvic and extremity trauma, followed by a discussion on how best to prepare the trauma patient for transfer to a trauma centre.

By Anton Helman|2023-02-06T12:38:24-05:00January 11th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Trauma|Tags: FAST, pan-scan, pelvic fracture, penetrating trauma, pneumothorax, POCUS|2 Comments

Episode 9: Nontraumatic Eye Emergencies

Nontraumatic Eye Emergencies are seldom very satisfying for the emergency physician to manage. However, with systematic approach and timely management they can save a patient's vision. Dr. George Porfiris and Dr. Simon Kingsley discuss four non-traumatic eye emergency presentations. The painful red eye, the painless red eye, acute painful loss of vision and acute painless loss of vision. Several cases are discussed in which an accurate diagnosis and timely ED management are of critical importance in order to prevent permanent vision loss and significant morbidity. A systematic approach to the eye examination is described with particular attention to important maneuvers such as the swinging flashlight test. The utility of ED ultrasound of the eye is debated, and a discussion around systemic diseases that cause eye problems provides fodder for many clinical pearls.

By Anton Helman|2021-03-31T13:33:31-04:00November 22nd, 2010|Categories: Ears Nose & Throat, EM Cases, Emergency Medicine, Episodes, Ophthalmology|Tags: George Porfiris, glaucoma, iritis, optic neuritis, painful loss of vision, painful red eye, painless loss of vision, painless red eye, POCUS, retinal artery occlusion, Simon Kingsley, subarachnoid hemorrhage, temporal arteritis|1 Comment

Episode 4: Acute Congestive Heart Failure

Dr. Eric Letovsky and Dr. Brian Steinhart describe a practical way to approach patients with undifferentiated SOB and acute congestive heart failure, the utility of various symptoms and signs in the diagnosis of CHF, as well as the controversies surrounding the best use of BNP and Troponin in the ED. A discussion of the use of ultrasound for patients with SOB as well as the indications for formal Echo are reviewed. In the second part of the episode they discuss the management of acute congestive heart failure based on a practical EM model, as well as the difficulties surrounding disposition of patients with CHF.

By Anton Helman|2021-03-31T13:40:35-04:00April 30th, 2010|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Resuscitation|Tags: ACE Inhibitor, biomarkers, BIPAP, BNP, Brian Steinhart, cardiomyopathy, echocardiogram, Eric Letovsky, furosemide, hypertensive emergency, nitroglycerine, POCUS, troponin, vasopressors|3 Comments