Archives

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.

Case File: Point-of-care ultrasound should end the outdated practice of “marking for a tap”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 Report: Pediatric POCUS: 4 month old infant with a timely diagnosis

by Victor Istasy MD, FRCPC; Tim Lynch MD, FRCPC; Rodrick Lim, MD, FRCPC –

A healthy, four month-old female infant presented to a local emergency department with a 12-hour history of decreased activity, non-bilious vomiting and one episode of dark red blood in the stools. There was no history of fever. Telephone consultation was completed and the patient was transferred to a tertiary, pediatric centre for further evaluation. On arrival, the infant appeared pale and was lethargic during the exam.

Pilot Project: Does formal bedside training of medical students with a FAST exam increase their knowledge and comfort level with ultrasound use in a community family medicine practice setting?

by Rimi Sambi, MD and Heather Sawula, MD; Brent Wolfrom, MD; and Joseph Newbigging, MD –

As point of care ultrasound (PoCUS) becomes increasingly popular and a standard of care in many clinical settings, the interest for integration in medical undergraduate curriculum is also growing. This project aims to assess whether formal bedside Focused Abdominal Scan for Trauma (FAST) exam training of medical students increases their knowledge and comfort with the use of bedside ultrasound in a family medicine setting at Queen’s University.

Case Report: Point of care ultrasound of a broken heart

by Winnie Chan, MD, FRCPC and Joseph Newbigging, CCFP(EM), FCFP –

Mrs. K, a 70 year old lady, presented to the urgent care with severe retrosternal chest pain that started at rest. She described the pain as a constant heaviness and rated it as 9/10 in severity. The pain did not radiate to the neck, arms, or back. The pain had started one hour after she was informed that her son had passed away unexpectedly.

Case Report: A wolf in another wolf’s clothing: point-of-care ultrasound in a patient with an acute exacerbation of chronic obstructive pulmonary disease

by Jordan K. Leitch MD and Nicole A. Rocca MD FRCPC –

Patients often present to hospital, and to the Intensive Care Unit (ICU) in particular, in situations that render them unable to provide an accurate (or any) clinical history to facilitate diagnosis. These patients also typically have multiple, serious medical co-morbidities, which further makes diagnosing and initiating an appropriate treatment difficult. Furthermore, the investigations performed to optimally diagnose acute critical medical conditions are often only possible in remote locations in the hospital or only available during regular daytime work hours, both of which are a concern with critically ill patients.

Research: Does the Addition of Ultrasound Enhance Cardiac Anatomy Learning in Undergraduate Medical Education?

by Joshua Durbin, MD; Amer M. Johri, MD; Anthony Sanfilippo, MD –

With the advent of portable hand-held ultrasound units, the use of point of care ultrasound (POCUS) has become increasingly popular amongst a wide array of medical specialists for both diagnostic and therapeutic interventions. Canada-wide surveys demonstrate a desire for increased utilization of POCUS in primary medical education. In this study, we aim to assess the efficacy of an ultrasound based anatomy tutorial and the perspectives of a cohort of first year medical students at Queen’s University.

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).