Interscalene Block in an Anesthetized Adult with Hypertrophic Obstructive Cardiomyopathy Undergoing Clavicle Fracture Reduction

Anthony M.-H. Ho, MD, FRCPC, FCCP; Joel Parlow, MD, FRCPC; Rene Allard, MD, FRCPC; Michael McMullen, MD, FRCPC; Glenio B. Mizubuti, MD, MSc – Whether regional anesthesia procedures should be performed in heavily sedated/anesthetized adults remains controversial. One of the purported advantages of performing regional nerve blocks in conversant patients is early warning against major nerve injury and, arguably, early detection of local anesthetic systemic toxicity.

Postpartum Hemorrhage Emergency Management Using Focused Assessment With Sonography For Obstetrics (FASO): A Case Report

by C. Rincón ; J. Cubillos; C. Arzola
Postpartum hemorrhage is the leading cause of maternal death around the world according to World Health Organization [1]. While cesarean delivery is a risk factor, uterine atony is the main etiology [2]. Cesarean delivery and concomitant tubal sterilization are a known risk of postoperative intra-abdominal bleeding, which can be insidious and difficult to diagnose in the recovery period. Furthermore, a late diagnosis can lead to a less than optimal management. Point-of-care ultrasonography is an available technique that can contribute to a prompt diagnosis and accurate decision-making [3]. We present a case of a patient in postoperative care after cesarean delivery and tubal sterilization who developed hypovolemic shock symptoms, without any sign of uterine atony or vaginal bleeding. Focused assessment with sonography for obstetrics (FASO) was quickly performed in the recovery room to diagnose intra-abdominal bleeding and decision-making to perform an emergency surgical intervention.

POCUS for pleural assessment and intervention

by Nicholas Grubic, BScH; Barry Chan, MD

The use of point-of-care thoracic (lung) ultrasound is an integral part of clinical practice that has shown diagnostic accuracy to help guide clinical decision making for pleural interventions.

Infected Baker’s cyst, diagnosed in the emergency department using POCUS

by Joaquín Valle Alonso; F Javier Fonseca del Pozo; Eric Van der Bergh; Harriet Kinderman – 

Baker’s cyst is a closed collection of fluid that forms in the posterior aspect of the knee. Usually, it appears as a non-painful inflammation in the popliteal fossa. In adults, its aetiology is secondary to problems that cause distension of the knee joint. It is often associated with rheumatoid arthritis and osteoarthritis. Occasionally, the cyst may become oversized and rupture with the consequent leakage of synovial fluid into adjacent tissues, presenting a clinical course similar to acute thrombophlebitis.

Two cases of aortic emergency presenting with neurologic manifestations, aided by POCUS

by Muhammad Khidir, Mb Bch BAO; Nur Hanisah, Mb Bch BAO; Farah Alwi, Dr EmMed; Al-Hilmi Saim, MMed

Acute aortic dissection and aneurysm are lethal vascular emergencies and may present with various clinical presentations including neurological manifestation. Thus, the diagnosis of aortic dissection and aneurysm can be challenging as it may mimic other disorders whereby misdiagnosis can be fatal. In district general hospitals where advanced radiological modalities are not widely available, Point of Care Ultrasound (POCUS) is a tool to diagnose aortic dissection and aneurysm rapidly and accurately.

Case Report: POCUS to FOCUS

by Maryam Al Ali, MBBS; Abeeha Gardezi, MBBsch; Michael Jalal, MBBS; Shihab Al Sheikh, MB.ChB. CABS. MRCS. PgCert medical ultrasound

Point of care ultrasound (POCUS) plays an important role in the Emergency Department or in any Critical Care Unit. In our case, we present how a POCUS mnemonic guided us in diagnosing two fatal conditions in a single case.

Case Report: A cardiac mass diagnosed using Point-of-care ultrasound in a dyspneic patient. An integrated ultrasound examination of lung-heart-Inferior Vena Cava

by Maria Viviana Carlino MD; Costantino Mancusi MD; Alfonso Sforza MD; Giorgio Bosso MD; Valentina Di Fronzo MD; Gaetana Ferro MD; Giovanni de Simone Prof.; Fiorella Paladino MD

A 74-year-old woman with history of hypertension presented to the Emergency Department (ED) with severe resting dyspnea and swelling in the feet, ankles and legs. She was on treatment with furosemide and a beta blocker. At the time of admission blood pressure was 145/88 mmHg, heart rate (HR) 99 bpm, regular, oxygen saturation was 89% (FiO2 21%) and respiratory rate was 17 breaths/min.

Case Report: Type 1 aortic dissection presenting as acute pericarditis: the roles of POCUS and transthoracic echocardiography

by Bill Ayach MD PhD; Aadil Dhansay MD1, Andrew Morris MD; James W. Tam MD; Davinder S. Jassal MD

A 59 year old male presented with a 1 day history of non-exertional chest pain that was pleuritic in nature and aggravated by lying flat. His chest pain symptoms were preceded by a one week history of “flu-like” symptoms. Physical exam demonstrated a blood pressure of 114/55 mmHg, heart rate of 75 bpm, and a normal oxygen saturation on room air. Cardiac examination revealed a biphasic pericardial rub vs. to-and-fro murmur.

Case Report: Early signs of tamponade may be detected by cardiac point-of-care ultrasound

by Michael Cenkowski, MD; Amer M. Johri, MD; Raveen Pal, MD; Jennifer Hutchison, RDCS

A 35-year-old male with a past medical history of end stage renal disease on hemodialysis and a chronic pericardial effusion secondary to dialysis presented to the Emergency Room (ER) with a 2-week history of a flu-like illness and pleuritic chest pain. He was compliant with dialysis three times per week. His blood pressure was 150/85 mmHg with a heart rate of 85 beats per minute and the remainder of his vital signs were stable. Pulsus paradoxus was not present.