Ultrasound
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You hear Michael Buffer’s voice blaring on the TV in the patient’s room, “Let’s get ready to rumble!” You are thinking how apropos as your charge nurse comes up to you.

“We have 6 traumas coming our way, Doc. ETA is 15 minutes. We’ve mobilized backup. The ultrasound machines are in the rooms, and the residents are gowned and ready to roll. Is there anything else you need help preparing?” You give your favorite charge nurse a thankful smile and start preparing yourself for the organized chaos that is about to ensue.

Thirty minutes and 6 secondary surveys later, you can’t help but marvel at the coordinated efforts of your EM and Trauma teams. The two most critical patients’ from the MVC have been taken up to the OR already, and your crew is carefully resuscitating and reassessing those waiting for CT scans. As your residents are performing their eFAST exams, one comes up to you to verify some of their findings.

“Bed 4 was the front seat passenger in the 2nd car. He is currently hemodynamically stable, and his lung images look fine. But, there is free fluid in his abdomen. He has no other reason to have free fluid other than trauma. I also think I see a liver laceration and a splenic laceration. I know we aren’t supposed to use bedside ultrasound to diagnose solid organ injury, but can you tell me what you think?” Your superstar resident can scan with the best of them, so you’re certain you’re about to see some interesting images saved to the machine.

You begin reviewing the images he has saved.

RUQ1

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RUQ 2

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Left Upper Quad

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Based on these images, do you agree that the patient has free fluid in their abdomen? Does the patient have a liver or splenic laceration?
Conclusion on next page.

 

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