Case File: Point-of-care ultrasound should end the outdated practice of “marking for a tap”

by Anna Platovsky, MD and Benjamin T. Galen, MD

A 55 year old man with a history of alcoholic cirrhosis decompensated by esophageal varices status post banding presented to the emergency room with abdominal pain.  He also noted increased abdominal girth with associated poor oral intake and early satiety as well as a 10 lb. weight gain over 2 weeks.  On examination, the patient was afebrile with stable vital signs and no respiratory distress.  His abdominal examination revealed tense ascites with mild tenderness to palpation of the left upper quadrant.  There was no jaundice or asterixis. Laboratory testing was significant for mild thrombocytopenia but no leukocytosis or abnormal liver tests. Liver synthetic function was preserved.

Case File: Rapid Diagnosis of Pericardial Effusion

by Jeffrey Wilkinson, MD and Amer M. Johri, MD

Mr. DB was a 95 year old man who presented to the emergency department with dyspnea progressing over the last 3 months. Chest x-ray demonstrated an enlarged cardiac silhouette. He had a past medical history significant for coronary artery disease, hypertension and a lobectomy due to tuberculosis. A point of care cardiac ultrasound was conducted by an internal medicine resident as part of his physical examination in the emergency department. A large pericardial effusion was found. There were no clinical signs of tamponade.

Case Files: Use of hand held ultrasound to guide therapeutic and diagnostic thoracentesis in the pleural space clinic

by Michael Fitzpatrick, MD, FRCPC

Case 1: Mr. P was a 75 year old gentleman with a history of splenic marginal zone lymphoma. His cancer was complicated by development of a pleural effusion and ascites. He was admitted to hospital due to abdominal discomfort but following discharge developed dyspnea. He was referred to the Pleural Space Clinic by his oncologist for worsening dyspnea and consideration of thoracentesis.

Case File: Use of POCUS for assessment of dyspnea in the Emergency Department

by Jennifer Meloche, MD

A 65 year-old man presented to the Emergency Department at Kingston General Hospital with progressive shortness of breath, fatigue, dull chest discomfort that worsened with deep breathing and exertion. The patient was referred to cardiology for congestive heart failure and ordered troponin, chest x-ray (CXR), and electrocardiogram (ECG).

Case File: Cardiac amyloidosis using on routine hand-held ultrasound

by Jeffrey Wilkinson, MD

A 64 year-old man presented to the Kingston General Hospital with cardiac arrest. At the time of EMS arrival, the ECG showed ventricular tachycardia. The patient was intubated and ventilated. Multiple defibrillations were required to convert the patient back to normal sinus rhythm.

Case File: Shocking out with severe hypoxia

by Barry Chan, MD

Clinical Vignette: 36 year old presented in acute respiratory distress, hypotension (BP 70/40 with HR 120), and severe hypoxia (SpO2 80s with partial rebreather). Thoracic auscultation was normal though the heart sounds were masked by her breath sounds. The jugular venous pulse (JVP) was grossly distended with no leg edema.