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
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
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
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
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
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
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
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 -
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 -
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
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
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,
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
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
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
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
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
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
17 yo female with vaginal bleeding for 5 hoursAfebrile, 142/86, 92, NADAbd- soft, fundus at level pubic sympysis
Vaginal Bleeding
Management: Bedside US
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
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