Here is another case from a former fellow. It is a more “classic” application of POCUS.
Case: 50’s male presenting for weakness and shortness of breath. Found to have cool extremities and in shock (clinically).
• What probe is being used?
• What views were obtained?
• How do you interpret these images/findings? What diagnosis do these clips suggest for this patient’s etiology of shock?
Let me know your thoughts and I’ll post my own next week (6/20/20).
Here is a quick, “classic” POCUS finding to share with you all.
Case: 80’s Female with h/o dementia presented for AMS. In ED, found to be septic from UTI and admitted to ICU. In ICU, patient appeared to have right sided abd pain.
Questions for discussion:
What views are being shown in the videos/ pics?
What probe is being used?
How do you interpret the normal/ abnormal findings from them?
Do these findings change your diagnosis/ management/ treatment for this patient? If so, how?
Here is another case from a former fellow. Here is the background:
60’s patient presented with chills and fatigue, diagnosed with septic shock. Patient found to have MRSA bacteremia, thought to be from diabetic foot ulcer. Patient was intubated and had complications of AKI, hypoxic respiratory failure, lactic acidosis, metabolic encephalopathy. Patient was started on CRRT. Patient developed SVTs and then a tachy-brady syndrome. Bedside POCUS echo was performed (clips).
This case comes from Drs. David Huang and Gabe Hoffman.
Patient is a 50’s female, h/o liver transplant, who was admitted for bowel ischemia in the setting of venous thrombosis, s/p right percutaneous transhepatic thrombolysis and stent placement on a heparin gtt. She did well and left ICU. Subsequently returned to the ICU for hypoxemic respiratory failure, and right lung white out. Lung US showed consolidated lung posteriorly without effusion, and she was treated for pneumonia. Later, complete lung US was performed and these images were found.
Happy New Year and welcome to the first CCM POCUS Blog of 2020! This one comes to us from Dr. Tim Kaselitz on one of his Presby RI nights.
Stem: elderly F s/p PEA arrest 15 minutes of ACLS. POCUS done immediately after ROSC.
I’m going to leave the discussion open on this one! What are you seeing? What views are there? What is he trying to measure? Thoughts/ concerns from the findings? How would you proceed?
Post your comments up until Friday, 1/10/20. I will then post the “answers” and results from the case!
This case comes from a recent graduate from our fellowship, Karthik Vadamalai, MD. He is building his own POCUS program at his new institute. He continues to follow our blog- as I hope our current fellows will continue to do after graduation as well- and wanted to share the following case for discussion:
He had a teenage patient with cirrhosis secondary to iron overload. He performed a POCUS exam of the abdomen to look for ascites as the patient had portal hypertension and liver cirrhosis.
Here is another post for our CCM POCUS Blog. This one comes from Zachary Rhinehart, MD.
Time for another CCM POCUS post. For this one, we’ll be looking below the diaphragm for a change! ;)
This one comes from Ben Smith, on his CCM POCUS rotation. He was asked to help scan a patient with end stage liver disease being worked up and awaiting a liver transplant. The patient was admitted to our ICU with altered mental status and appeared to clinically deteriorating with worsening level of alertness, increasing tachycardia and tachypnea. His abdomen was distended and tender throughout. POCUS was performed to look for ascites with concerns for SBP.
Here is our next CCM POCUS. This one comes again comes from our Pediatric side, on behalf of our CCM POCUS fellow (Tim Kaselitz) as well as being diagnosed by Todd Sower (a pediatric cardiologist & intensivist).