CONSIDER THE PROBE: CXR? WHY BOTHER? POCUS THAT PNA!

CONSIDER THE PROBE: CXR? WHY BOTHER...POCUS THAT PNA!

(Courtesy Dr. Larissa Unruh)

Now the following topic is extremely close to my heart. Lung US is well studied in both adult and pediatric patients and has excellent test characteristics for the diagnosis of Pneumonia (AND Bronchiolitis!!!).

Dr. Unruh takes us through the following case of a man who clinically had PNA and was actually HYPOXIC, requiring O2. He had a single CXR that was read by the attending radiologist as negative...leaving us with a patient with a new oxygen requirement with a normal CXR.

Thank goodness Dr. Unruh CONSIDERED THE PROBE! She takes us through the following (REAL LIFE) case and some of the basic sonographic findings for PNA. Make sure that you never catch yourself signing a patient out "we ruled out pneumonia with a CXR" (!ESPECIALLY A SINGLE VIEW!). US is more much more sensitive than any single view CXR for detecting a consolidation. Though like all things US, the more places you look, the more sensitive your exam will be...

Enjoy a great case by Dr. Unruh and ALWAYS CONSIDER THE PROBE when evaluating a hypoxemic/dyspneic patient...

Weekly Fix - Lung Ultrasound!

Check out the awesome narrated lecture below by EM US Fellow Dr. Damali Nakitende. Read the Chou article while listening to the podcast . For more lung US FOAMed fun check out the Thoracic page.

Consider the Probe 3: So I've found the effusion, now what?

A 74 y/o F with pmhx of metastatic breast cancer, IDDM, HTN presents after a syncopal episode. The patient notes that for the past 2-3 days she has been experiencing some lightheadedness and shortness of breath with exertion. She is presently undergoing chemotherapy (I'd throw in some random chemo drus here, but lets face it, we wouldn't know them anyways...) and radiation. She notes that she hasn't been eating/drinking very well. She denies fever, cough, hemoptysis, leg pain/swelling. She has mild nausea but no abdominal pain. As you peek up at the monitor, you note that the patient’s HR is ~ 135 and her BP is 88/56 . Her O2 saturation is 99% and the nurse told you that she was afebrile. Taking a look at this patient, she looks ill-appearing and anxious. Her extremities are cool to touch. You quickly decide that Room 33 might not be the best place to manage this patient and that she would be better served in a RESUS station. As you wheel the patient to RE

Consider the Probe Take 2: Coming to Grips with your Fundoscopic Shortcomings....

49 y/o M with hx of HTN, HLD, IDDM presents with non-traumatic L-sided painless visual loss. The patient states that several hours prior to presentation he developed blurry vision in his L eye. On quick examination, there are no signs of trauma. Visual acuity is 20/120 on the L and 20/40 on the R with normal intraocular pressures bilaterally. Pupils are briskly reactive without any photophobia or consensual photophobia. The lids, sclera, conjunctivae are grossly normal and there are no corneal defects with fluorescein staining. Coming out of the room, you are concerned about this sudden-onset blurry vision. You remember a short lecture on visual acuity changes that Dr. Schindlebeck begrudgingly gave you in between his posting about sweater vests on Pinterest. Your differential brings concerning diagnoses including central retinal arterial occlusion (CRAO), central retinal vein occlusion (CRVO), retinal detachment, as well as vitreous hemorrhage. Now, our patien

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