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Recommendations for POCUS Curriculum in Canadian Undergraduate Medical Education: Consensus from the Inaugural Seguin Canadian POCUS Education Conference

Sacha Weill, Daniel Armand Picard, Daniel J. Kim MD, Michael Y. Woo MD – Point of care ultrasound (POCUS) in Canadian undergraduate medical education (UGME) is limited. To address this paucity, the inaugural Seguin Canadian POCUS Education Conference hosted 14 of the 17 Canadian medical schools to develop a list of recommendations for POCUS education in Canadian UGME.

POCUS Confirmation of Intraosseous Line Placement: Visualization of Agitated Saline within the Right Heart in a Critically Ill Infant

Inbar S.Y. Plaut, MD; Zachary W. Binder, MD – Intraosseous (IO) line placement can be a life-saving procedure in the management of critically ill patients.  Confirmation of correct IO line placement can be difficult. Prior studies have examined the use of point of care ultrasound (POCUS) to confirm IO line placement by using power Doppler over bone to detect flow within the intraosseous space. This case illustrates a novel use of POCUS in which agitated saline is visualized within the right heart as a means of confirming correct IO placement.

Thoracic Aortic Aneurysm Presenting as a Subacute Cough

Eduardo Diaz, DO; Hanan Atia, MD; Brian Kohen, MD; Seth Lotterman, MD – The suprasternal aortic notch cardiac point of care ultrasound (POCUS) window is a useful view for evaluating thoracic aortic pathologies. However, it is not routinely included in the standard cardiac POCUS exam despite its ability to capture emergent pathologies such as aortic dissection and thoracic aortic aneurysm (TAA). Ruptured aortic aneurysms can present with sudden, severe chest or back pain, as well as hemodynamic instability, resulting in a high mortality.

Acute Upper Extremity Arterial Occlusion Diagnosed on POCUS in the Emergency Department

Derrick Huang, MD; Jacob Ruzicka, MD; Leoh León, MD; Latha Ganti, MD, MS, MBA, FACEP – Upper extremity acute limb ischemia (ALI) is a limb-threatening and potentially lethal pathology that is most commonly caused by vascular embolization. Outcomes of limb ischemia are time-sensitive due to the correlation between a longer time from symptom onset to intervention with a vastly higher risk of amputation. In this report, point of care ultrasound (POCUS) was utilized to rapidly diagnose a patient with a proximal right brachial artery embolic occlusion, prompting expedited surgical consultation and successful embolectomy.

A Case of Pediatric Sternal Fracture Diagnosed by POCUS

Takaaki Mori, MD, MRCPCH, MSc; Sung Shin Teng, MBBS, MRCPCH, FAMS – A previously healthy, 4-year-old boy visited our emergency department due to chest pain after a fall from a skate scooter. Physical examination revealed tenderness over the sternal body. Point of care ultrasound (POCUS) of the sternum demonstrated a discontinuation of a hyperechoic structure of the sternal cortex, suggesting a sternal fracture.

Use Of POCUS for the Paediatric Patient with an Undifferentiated Upper Limb Injury

David J. McCreary, MBBS MRCPCH PgC US; Alex White, MBBS – A 2-year-old girl presented to the Paediatric Emergency Department following an unwitnessed injury to her left arm while playing at nursery limiting further examination. On assessment she was reluctant to use her left arm and further examination was difficult. In cases of unwitnessed and undifferentiated elbow injuries point of care ultrasound (POCUS) can be used to evaluate for elbow joint effusion, fracture, or radial head subluxation, also known as nursemaid’s elbow.

Delayed Iatrogenic Bladder Rupture Diagnosed by POCUS in the Emergency Department

Helen J. Lu, MD; Edward H. Lee, MD; Stephen Alerhand, MD – Bladder rupture is an uncommon injury that leads to significant morbidity and mortality. Though occurring mostly due to trauma, this life-threatening pathology may also occur spontaneously or after a procedure such as transurethral resection of bladder tumor (TURBT). Computed tomography (CT) cystography is the standard imaging modality for diagnosis. However, this test is unlikely to be ordered in a patient with undifferentiated abdominal pain unless there is specific suspicion for this diagnosis.

Missing Inferior Vena Cava on POCUS: A Case of Left-Sided IVC with Azygos Continuation

Ankit Mehta, MD, FACP, SFHM; Kreegan Reierson, MD; Benji Mathews, MD, MBA, SFHM – The merits of utilizing point of care ultrasound (POCUS) in acutely ill patients is leading to a widespread embrace. Assessment of IVC via POCUS as part of a comprehensive multi-organ approach can help guide volume tolerance. Anatomical/developmental variations of IVC can vary widely in prevalence.

Sonographic Features of a Tuberculous Cold Abscess:A Case Report and Literature Review

Figure 3: Axial view of the plain CT thorax showing low density collection in the pectoralis major muscle of the left hemithorax (a) with underlying costochondral junction showing break in cortex (b). – Tuberculosis (TB) remains a global public health concern; most notably in endemic countries where there is a rise in its incidence. Although primary pulmonary involvement accounts for the majority of TB cases, extrapulmonary tuberculosis (EPTB) is rapidly growing in high income countries.