“Ugh, what a waste of time and resources…” you hear your intern mutter under his breath. You decide not to let a good mentoring and teaching moment slip past you, so you reply, “What’s going on? What can I do to help you?” Your intern looks so exasperated with the patient that he just saw that he doesn’t even register your look of consternation.
You are midway through a busy shift when you pick up a chart of a young man with flank pain and vomiting. He was actually seen yesterday in your ED by one of your colleagues who diagnosed renal colic by bedside ultrasound, thus obviating the need for any radiation exposure or even the delays associated with a comprehensive ultrasound by radiology. Unfortunately, now the patient is back with increasing right flank pain...
A disturbing vital sign can often be worked up quickly with ultrasound… but not always
Use ultrasound to diagnose – and quickly remedy – this acute urinary retention
Thoracic ultrasound can be life saving, but it shouldn’t be taken out of context
You’ve got a seemingly straightforward complaint. Should you reach for your Foley or your ultrasound probe?
New patient is a 5-year-old male with a history of a circumcision three months ago for recurrent UTIs. His mom states he has been having intermittent generalized abdominal pain associated with dysuria and urinary urgency. Despite being potty trained since he was 3, he is now having urinary incontinence as well. There has been no fever or flank or back pain and he is otherwise healthy and not on any medications regularly. Mom states he sometimes starts crying from the pain.
A 25-year-old female presents to the ED with her boyfriend after she developed sudden onset pelvic pain during sexual intercourse at around 10 pm. The pain gradually worsened and spread to her ribs and she felt bloated and had the urge to defecate, so she got up from bed and went to the bathroom. Unfortunately she fainted on the way there, though she landed on carpet without injury.
It’s a busy Monday morning, and you watch as a new patient awkwardly limps onto your only open bed. You immediately wonder what is causing him to walk with such a strange gait. After Glancing at the EMR, you find a helpful hint in the nurse’s note about his chief complaint — testicular pain.
They 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.