ultrasound-90They say that things come in threes, and at least for today, you agree. You just finished sending home three young women with first trimester vaginal bleeding and reassuring bedside ultrasounds. Prior to that you actually had three cardiac arrests, one that you remarkably brought back with tPA after your bedside echo showed a severely dilated right ventricle but normal left ventricle from a presumed acute PE.

sound-90-2“Technology has become so disruptive!” your veteran charge nurse exclaims. “Every time I have to answer one of these mass emails to our department, our organization loses money. My time is very valuable!” she bemoans. “How am I supposed to concentrate on patient care when my work email account dings every 2 minutes with an ‘Urgent’ message?”

sound-90A 54-year-old male is in the ED for a paracentesis because he states he is uninsured and has nowhere else to go. He states his last “tap” was about 4 weeks ago and he is starting to feel short of breath even at rest because of all the fluid. He states these are the same symptoms he always gets and denies any issues that are atypical for him. Just to be sure, you run down a list of pertinent negatives and he politely denies fever, pain, melena, confusion, vomiting, and chest pain.

sound-90An 84-year-old woman is brought to the emergency department by ambulance for evaluation of altered mental status and syncope. Per family, the patient had complaints of abdominal pain for two days, tactile fevers, decreased PO intake and one episode of non-bloody, non-bilious vomiting. The patient also fell from her bed to the carpet with loss of consciousness for 10 seconds.

incidental-gallstone-90A 22-year-old G4P2 female is brought to the emergency department by her boyfriend for pleuritic right sided lower chest pain that she has had for approximately 18 hours. The pain is in the low anterior right side of the chest and radiates to the scapula and upper abdomen. It has been constant, but is not associated with nausea, vomiting, fever, chills, diarrhea or shortness of breath.

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