Archives

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 Report: FAST Ultrasound Interpretation in Trauma Resuscitation

by Stuart Douglas, MD; Joseph Newbigging, MD; David Robertson, MD –

FAST Background: Focused Assessment with Sonography for Trauma (FAST) is an integral adjunct to primary survey in trauma patients (1-4) and is incorporated into Advanced Trauma Life Support (ATLS) algorithms (4). A collection of four discrete ultrasound probe examinations (pericardial sac, hepatorenal fossa (Morison’s pouch), splenorenal fossa, and pelvis/pouch of Douglas), it has been shown to be highly sensitive for detection of as little as 100cm3 of intraabdominal fluid (4,5), with a sensitivity quoted between 60-98%, specificity of 84-98%, and negative predictive value of 97-99% (3).

Case Report: Incarcerated femoral hernia containing ovary, unusual presentation of uncommon groin hernia

by Priyank Gupta, MD, FRCR; Hadiel Kaiyasah, MRCS Glasgow; Mahra AlSuwaidi, MRCS Glasgow –

Of all groin hernias, femoral hernias account for around 2–8%. They occur four to five times more commonly in females than males and have a peak incidence in those between 30 and 60 years old [1,2]. In adult population, femoral hernias are more commonly found in patients with previous inguinal hernia repair [3].

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 Report: Hemoptysis localization – hearing with your eyes

by Barry Chan, MD –

Clinical Vignette: 45 year old was transferred from a peripheral facility for acute massive hemoptysis though maintained sufficient airway patency with no evidence of hemodynamic instability or respiratory failure. Thoracic auscultation revealed vesicular breathing with no adventitious sound. CXR from the peripheral site was normal.

Case Report: The use of gastric ultrasound to assess risk of pulmonary aspiration

by James Cheng, PGY-4 –

Pulmonary aspiration of gastric contents is a dreaded complication of general anesthesia, as it carries significant patient morbidity and mortality. Subsequent aspiration pneumonia can lead to prolonged mechanical ventilation, and a mortality rate of up to 5%. To minimize the risk of pulmonary aspiration, patients are required – as per the American Society of Anesthesiology’s “Practice Guidelines for Preoperative Fasting” – to fast prior to elective surgery in order to ensure that the stomach is empty prior to induction of general anesthesia.

Welcome to POCUS Journal

by Amer M. Johri, MD –

Welcome to the first issue of the world’s first journal dedicated solely to point-of-care ultrasound. The Point-of-care Ultrasound Journal (POCUS J) is unique in its dedication to showcasing studies performed by any specialty- whether it’s the Emergency Department, Critical Care, Anesthesiology, Cardiology, Primary Care or Allied Health.

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.