“My 14-year-old has Gallstones!” At least that is what the mother of this teen tells you. He’s had abdominal pain off and on for a year, and it has been getting worse. An ultrasound done at an outside institution last week revealed a “gallstone”. Despite feeling better tonight, this pushy mom wants an admission and surgery. But his history is completely negative for gallstone risk factors. Plus, he’s just not sick. Against your better instincts you do labs. And they are negative as well. He won’t be admitted, not on your shift, but you’d like to see what they are talking about.
It’s the middle of a slow weekend shift in the rural ED where you work when a 72-year-old female patient with a history of hypertension comes in complaining of pain and redness on the dorsum her left foot.
It’s Monday night and you are thankful that you put on your running shoes. After a seemingly calm holiday weekend in the emergency department, you walk in to find every nook and cranny filled with weekend warriors who pushed the envelope just a little too far on their extra day off of work. You smile compassionately as you walk by the poor mom who broke her ankle skydiving for the first time, and quietly shake your head at the gurneys full of college students who are still sweating out alcohol through their sunburned bodies.
“Doctor, I can’t get the blood pressure cuff around her arm.” You aren’t
surprised by your trauma nurse’s comment as you stare at the 450-pound
woman lying on a backboard in front of you. EMS miraculously cut her out
of her tiny two-door sedan with the jaws of life and dropped her off in
your ED, with a 22 gauge IV in her right hand and her left leg extended
This month we’re going to answer some basic ultrasound questions and go
over imaging artifacts. The main benefits of learning how to perform
bedside ultrasounds include efficiency and the ability to obtain repeat
scans. Efficiency, for obvious reasons, is a critical consideration in
the management of the unstable patient.
It’s just been one of those nights. It just took you three attempts to get the CSF on a patient that should have been the easiest LP in the world. Your guidewire headed north instead of south during a subclavian vein cannulation for central venous access. And now your charge nurse is telling you that your 85-year-old patient in the resuscitation bay is becoming more short of breath and his O2 sats are dropping.
A 67-year-old man with a history of heavy ethanol and crack cocaine abuse presented to the emergency department with one day of severe generalized abdominal pain.
The patient (CR) is a 16-year-old Caucasian male with a past medical history significant for asthma (no prior intubations or hospitalizations). CR’s mother called her pediatrician’s office on a Friday morning complaining that her son had mild facial swelling in bilateral cheeks and neck.
Patients with a low risk Wells’s score and a negative
moderately-sensitive D-dimer assay (e.g. whole blood agglutination –
SimpliRed) have less than a 1% chance of deep vein thrombosis (DVT).
Patients with a moderate risk Wells’s score and a negative
highly-sensitive D-dimer assay (e.g. ELISA) have a 1% chance of DVT.