U/S Case Studies Martha Villalba MDFellow, Emergency UltrasoundResurrection Medical CenterChicago, Illinois

68 yo male sudden urge to defecate followed by dizziness

Afebrile, 84/58, 92, Diaphoretic, Moderate painAbd- palp. pulsatile mass midline

Rectal Pressure

Diagnostics: EKGLabsBedside US

Management: Type & Cross 6u pRBCs

Management: Consult Vascular

Abd. Aortic Aneurysm

78 yo female per EMS responds to pain, hypotensive, hot to touch, tachycardic from NSH. Indwelling Foley.

Sepsis

Management: Central LineNeosyn IV

Ventilator

Diagnostics: Septic Workup

PE: intubated82/58 132, bagged, Temp.102.3 Lungs-clear Cor- tachy Abd- No guarding

DVT

11 y.o female with R-sided abdominal pain and dysuria for 6 days, seen by PMD twice this week for same. UA & Urine C&S. neg

PE: uncomfortable secondary painVSSLungs-clear Cor- RRR Abd- minimal epigastric + RUQ tenderness.

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Diffuse Abdominal Pain

Diagnostics: UA- + dip bloodBedside US

Hydronephrosis/Nephrolithiasis

25 yo male moderate respiratory distress

70/palp, 125, PO 84%

Abd- Wound R-hypogastrium

GSW to Abdomen

Management: ATLS decision -> to OR open abdomen

Diagnostics: CXRFAST

Management: to OR ->open chest

Impending Tamponade

13 yo female with 3 days gradually increasing LLQ pain, Suddenly worse 30 mins ago.

Afebrile, 98/54, 112, moderate distress- painAbd- mildly tender to LLQ. No R/G Pelvic- Ext. exam WNL’s, deferred internal

Left Lower Abdominal Pain

Management: Pain Meds

Diagnostics: UCG - UA -Bedside US- TAS

Management: Foley

Left Lower Abdominal Pain

Ovarian Cyst/Torsion

Management: OR

76 yo male with swelling mouth & neck x 2 daysAfebrile, 156/90, 74, NAD Heent- right peritonsillar massLungs clearCor- Reg, No M/G/R

Swelling in Mouth

Swelling in Mouth

Management: Vascular ConsultPatient Education

Carotid Aneurysm

54 yo male presents by EMS sitting upright in gurney, anxious, single word answers.

PMH: no medical care - lifetimePE: 88/62, 112, PO= 82Lungs: clear Cor: Tachy, distant tones Skin: cyanotic nailbeds

Respiratory Distress

Management: IV, O2, Cardiac MonitorPressor->DopamineDiagnostics:

CXR, EKG, LabsBedside Echo

54 yo male, no healthcare, respiratory distress, em caveat-> unstable vs

Respiratory Distress

Impending Tamponade

Management: Stat Cardiac consultPericardiocentesis trayStat K+

24 yo female with 6 days RLQ pain, suddenly worse today. Seen ED 6 days ago, OB consult

Afebrile, 90/54, 126, Anxious, clammy Abd- tender to deep palp. RLQ No R/GPelvic- tender RAdx

Right Lower Abdominal Pain

Management: Bedside US

Diagnostics: UCG +UA dip -

Right Lower Abdominal Pain

Management: Intubate

Acute Respiratory Arrest 31 yo male severe respiratory distress, answers nodding head. No Trauma, SOB getting up from computer

90/palp, 122, 32, PO= 84%Lungs- clear bilaterallyCor- tachy, No M/G/R

PMH:None

Diagnostics: CXR -EKG - ST, nsST-T

Cardiac Arrest- immediately proceeding intubation

Management: ACLS per PEAReconfirm Airway- Good BSBedside Echo

Acute Respiratory Arrest

Diagnostics: Cardiac monitor- PEARepeat CXR -

RV Hypertrophy

Management: TPA

RV Hypertrophy

RV Hypertrophy

28 yo pregnant passed out at workAfebrile, 83/44, 124, Abdominal pain, Suddenly

worse 11:30am Abd- Tender diffusely

Syncope

Management: Bedside US

Diagnostics: UCG +UA obtained

84 y.o male with severe abdominal pain. Recently dx. Colon Ca. Chemo. Tx.

PE: writhing on cart VS- 78/palp, 136, Temp 103.6 Lungs- clear Cor- RRR Abd- Involuntary guarding.

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Diffuse Abdominal Pain

Management: VasopressorBedside US

Family Council

Diagnostics: Septic Workup

18yo male URI symptoms & SOB 2 days130/84, 116, T=99.8, P.O= 92% RA, NAD

Heent- mild pharyngeal erythema

Lungs clear

Cor- tachy, No M/R

Viral Syndrome

Diagnostics: CXR- wnl’sCT Chest?Bedside US

Management: Med NebAdmit tele

Pericardial Effusion

58 yo female with severe epigastric pain x 1 hr, radiating to midback, vomiting.

Afebrile, 102/76, 112, 26 uncomfortable- painLungs- clearAbd- tender epigastric, RUQ, R CVA

Epigastric Pain

Management: Pain MedsBedside US

Diagnostics: EKG- no acute changesUA - trace blood, UCG-pCXR - neg

19 yo female with lower abd. pain, suddenly worse 11:30 today

Afebrile, 84/45, 117, clammy, moaning in pain Abd- tender diffuselyPelvic- BME- CMT, adx tend

Lower Abdominal Pain

Management:IVFType & Cross 4 uPRBC’s

Diagnostics: UCG +UA obtainedBedside US

Ruptured Ectopic Pregnancy

6 day old male with bluish discoloration to lips while feeding per Mom.

PE: Alert, Tachypneic, NADCor: Tachy, MurmurLungs: ClearAbd: Liver 2cm below RCM

Poor Feeding

Diagnostics: CXR- no acute findingsBedside Echo

PMH,Sx: NSVD @ local hospitalBottle Feeding

Management:Ab’s Prostaglandins,

Shared Ventricle

19 yo female with increasing lower abd. pain, and unable to urinate

Afebrile, 114/79, 107, uncomfortable - abd pain Abd- lower abd. mass, firm, BS+

Lower Abdominal Pain

Management: Bedside USFoley cath

Diagnostics: UCG +UA obtained

Incarcerated Uterus

68 yo male with Right Groin Pain several days.Afebrile, 148/84, 76, 16 Abd- mild tenderness RLQ. No Inguinal hernia

Syncope

Diagnostics: Bedside US

Diagnostics: Contrast CT?

Management: Vascular Consult

Iliac Aneurysm

48yo female Multiple MyelomaAfebrile, 96/54, 112, P.O= 92% RA, Cyanosis above

shoulders Lungs clearCor- tachy, No M/R, pulses 1/4 throughoutExtr- Cyanosis hands/feet

Syncopal

Management: CXR- no acute findingsBedside Echo

PMH,Sx: Non- SmokerThalidomide

Right Ventricular Strain

29 yo male stabbed in chest (left parasternal 8mm vertical wound)

116/84, 108, sitting up in gurney talking with friends

Management: ATLS per protocolbedside echo

Pearing Knife to Chest

PSH: Thoracotomy-

Stab Chest

Pearing Knife to Chest

Management: decision -> to OR for window

possible Thoracotomy

28 yo pregnant female with lower abd. pain, decrease appetite, abdominal distention

Afebrile, 118/76, 86, NADAbd- distended, fundus above umbilicus

Lower Abdominal Pain

Management: Bedside US

Ovarian Cyst

28 yo pregnant female with lower abd. pain for 4 days.

Afebrile, 108/66, 94, NAD, FHT-144Abd- distended, fundus 1cm above pubic symphysis

Lower Abdominal Pain

Management: Bedside US

14.5 wk EUG

17 yo female with vaginal bleeding for 5 hoursAfebrile, 142/86, 92, NADAbd- soft, fundus at level pubic sympysis

Vaginal Bleeding

Management: Bedside US

Molar Pregnancy

21 yo female with lower abd. pain, and vaginal bleeding

Afebrile, 118/76, 86, NAD Abd- soft, no T/R/G Pelvic- unremarkable

Vaginal Bleeding

Management: Bedside US

Interstitial Ectopic