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This case was sent by Dr Avinash Krishnamurthy, a fine emergency medicine resident from Australia Cairns base hospital Case : An adolescent male had a mechanical fall and injured his left shoulder and arm. A bedside cardiac ultrasound was normal. His chest was tender. Most physicians, at first glance, get this wrong. What is it?
On arrival, the patient was in shock, was intubated, and had an immediate cardiac ultrasound. What does a heart look like on ultrasound when the EKG looks like that? Here you go: It's not the world's greatest cardiac ultrasound video, but it does appear to show poor function and low volume. They transported to the ED.
Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.
Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. Could the dysrhythmias have been prevented? Severe hypokalemia in the setting of STEMI or dysrhythmias is life-threatening and needs very rapid treatment. He was managed medically with Clopidogrel. Learning Points: 1.
He spent almost 2 months in the hospital, and reportedly made a full neurologic recovery. Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism. Now another, with ultrasound. This patient arrested shortly after hospital arrival. He was prescribed apixaban. This is a quiz.
Echocardiography – We can use ultrasound to visualize the heart and look at how well it pumps. The heart is an electrical organ and occasionally the electrics can choose to malfunction and the patient may develop a heart rhythm disturbance or a dysrhythmia such as AF or SVT or VT. This is termed as diastolic dysfunction.
A bedside POC cardiac ultrasound was done: Findings: Decreased left ventricular systolic function. The patient was given furosemide and admitted to the hospital. A diagnostic NT-proBNP cutoff of 900 pg/mL has been suggested in adults 50-75 years of age in absence of renal failure."
Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to general hospital: the EGSYS score.
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