Ultrasound
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“Are you sure I don’t need that magic stroke medication that I saw on TV?” you hear a patient ask through the curtains in your acute care area. “I am within the 3-hour window.” You pause to listen to your senior resident reassure the patient that she is not having a stroke and explain to her the risks and benefits of that “magic stroke medication”. Within a few steps, one of your nurses stops you to tell you that your patient in room 19 wants to talk to you about a prescription for Plavix because he read an advertisement in the newspaper telling him that it can prevent him from having a heart attack. “Isn’t room 19 here for a sprained ankle?” you ask. Your nurse simply throws her hands up and shrugs as she gives you the “It’s your problem” look.

You begin to wonder how the practice of medicine is going to change now that all of your patients have become mainstream media mavens. As if he read your mind, one of your chief residents approaches you with another patient request prompted by something he saw on television. You walk into the patient’s room with your chief resident, politely introduce yourself, and ask how you can be of service. The patient explains that he was playing in a pick-up game of basketball today when he was suddenly shoved from behind. He fell forward and landed on his right knee. He hasn’t been able to bear weight on the knee, and he’s concerned about the intense pain and swelling. On exam, you suspect he has an effusion and you note he is unable flex the joint to 90°.

Your patient meets multiple criteria of the Ottowa knee rule, so it’s a no-brainer that he is going to require imaging of his injured knee. As you are explaining to him that you are going to order an X-ray, the patient interjects with “Can’t you do an MRI or an ultrasound of my knee instead? I read someplace that too much radiation can cause cancer and I saw the doctors on Grey’s Anatomy do an ultrasound on someone’s leg once.” You stifle a smile, and tell the patient, “That’s an excellent idea,” as your resident walks out of the room to grab the ultrasound machine.

With your patient lying supine on the gurney, you perform a bedside scan of the patient’s unaffected left knee first so that you can show him and your resident what a normal baseline is. You then proceed to capture the following images of his injured right knee.

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What do you see on his bedside knee ultrasound?
Conclusion on next page

 

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