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21-40 of 321 results by Haney Mallemat
- Evaluating the systolic function of the RV is an important skill and there are described methods.
- One of the simplest method is using the tricuspid annular plane of systolic excursion (or T.A.P.S.E.)
- This is how far the tricuspid annulus travels from diastole to systole because the RV contracts in a longitudinal fashion from the base (diastole) to the apex (systole)
- A TAPSE of <17mm is consistent with abnormal function and >17mm is normal. An eyeball method of assessment can be done when grossly obvious or M-mode can be used when an accurate assessment is required.
- The clip below demonstrates the technique, which should always be performed from an apical four-chamber view.
- Want more info on the RV, then click here for a whole podcast on it.
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30 year-old male with abdominal pain and diffuse tenderness on exam. Ultrasound is shown, what's the diagnosis?
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35 year-old female presents to the Emergency Room with cough and chest tightness. She was discharged from the hospital yesterday for an asthma exacerbation that was secondary to pneumonia. What's the diagnosis?
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68 year-old man presents with a new-onset seizure. What's the diagnosis and what's in your differential diagnosis?
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Person presents following a fall on an outstretched hand and there is snuffbox tenderness. What's the diagnosis?
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The RV is a low-pressure chamber that doesn’t tolerate acute increases in pulmonary pressures (e.g., ARDS, pulmonary embolism, etc.); acute increases can lead to RV dysfunction / failure
Managing RV dysfunction requires a three-pronged approach:
- Optimize preload – give small fluid boluses (e.g., 250cc) but not too much, because too much can worsen RV function. Use ultrasound to determine volume status
- Optimize RV function – Consider starting inotropes (e.g., dobutamine) for better RV contractility and concurrently start pulmonary vasodilators (e.g., inhaled nitric oxide); also minimize hypoxemia and hypercarbia
- Prevent systemic hypotension – hypotension reduces coronary perfusion that leads to RV ischemia and dysfunction; use norepinephrine to keep blood pressure >65
- Bottom-line: Don't under-estimate the importance of the RV when resuscitating your patients
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You find this interesting view while scanning a patient. Which view is this and why should you care about it?
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55 year-old male presents with chest pain. Echo is shown below (parasternal long-axis on the left and aortic root / ascending aorta on the right), what's the diagnosis?
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64 year-old male with no past medical history presents complaining of chronic weight-loss and diffuse chest pain; CXR is shown. What's the diagnosis and what other disease(s) may present similarly?
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It's July, that means new doctors are learning to do central-lines...here's a quick video with some quick pearls on how to do that. Enjoy!
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81 year-old man was mowing the lawn and then felt a sudden pop, then pain in his left arm. What's the diagnosis and what's this sign called?
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7 year-old male "jammed" 5th finger while playing basketball with pain and swelling over finger. What's the diagnosis?
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15 year-old female field hockey player presents with left shoulder pain. Besides fatigue over several weeks, she has no past medical history and there is nothing remarkable on physical exam. What's the diagnosis?
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25 year-old male falls from 10 feet and lands on his right shoulder, what's the diagnosis?
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30 year-old patient presents with palpitations. A parasternal long-axis clip is shown below along with the rhythm strip. What's the diagnosis and what drug was given during this clip?
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Patient presents with headache and papilledema. What's the diagnosis?
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Intraosseous (IO) placement is a rapid and reliable method for obtaining venous access in critically ill patients; previous studies demonstrated that everything from vasopressors to packed RBCs can be infused through it.
This prospective observational study compared the first-pass success rate and time to successful placement of IO versus landmark-based (i.e., not ultrasound guided) central-line placement (femoral or subclavian access) during medical emergencies (e.g., cardiac arrest) in an inpatient population.
The first pass success rate for IO was found to be significantly higher than the landmark technique (90% vs. 38%) and placement was significantly faster for IOs (1.2 vs. 10.7 minutes).
Despite the fact that this study did not directly compare IO to ultrasound guided line placement, this study demonstrates that IO is a rapid and effective means to obtain central access during patients with emergent medical conditions.
Bottom-line: Consider placing an IO line when rapid central access is necessary.
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The following clip is one of three findings found in Beck’s triad. Name all three findings and how often are all 3 signs present for patients with pericardial tamponade?
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Do you need to get stuff out of the thorax (like fluid or air) and don't want to place a HUGE chest tube? Consider a pigtail catheter; don't know how to place one? Well check out this video and learn how.
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5 year-old with no past medical history, complains of a limp and mild left knee pain. No history of trauma. Physical exam is significant for a low-grade fever and is otherwise normal. What’s the diagnosis?
