77 yoF presented to the ED with left middle finger pain, swelling, and discoloration of ~1 week proximally (image 1).  Image 1: digit swelling and abscess She was tachycardic and febrile on arrival. Physical exam revealed ¾ Kanavel signs (flexion at rest, pain with passive extension, fusiform swelling of the digit). Ultrasound was performed using a water bath (image 2). Image 2: water bath technique POCUS findings concerning for flexor tenosynovitis include a hypoechoic peritendunous effusion and a thickened synovial sheath that may be hyperemic. Video 1/Image 3: shows fluid surrounding ..read more

Case 1: A 69 yoF with a PMHx of osteoarthritis presented to the ED with 1 day of worsening knee pain. The workup revealed a moderate-sized effusion and elevated CRP. These factors, combined with her discomfort, prompted the providers to perform an arthrocentesis. Approach: While there are many approaches you can take to tap a knee effusion, the one I have seen most often is the suprapatellar approach (note: it is best to identify the area with the biggest pocket). Next, gather your equipment for a regular arthrocentesis plus a probe cover. Once you  ..read more

27 yoF presented to the ED with acute onset abdominal pain and distention. An ultrasound was performed that showed intraperitoneal fluid. Free fluid was identified at the liver tip and in the pouch of Douglas (video 1).  As a reminder, the pouch of Douglas is the potential space between the uterus and rectum (seen in the suprapubic view).   Video 1 shows something called the “TIE fighter sign,” where large amounts of free fluid fill the pouch of Douglas, posterior to the uterus. The uterus and ovarian ligamen ..read more

This VOTW is brought to you by Drs. Chiu, Butt, Burns, Wong, and Sanghvi on a scan shift.  A 42 yoM presented to the ED with a left shoulder dislocation. The ultrasound team looked at his dislocated shoulder (Image 1) and gave an Intraarticular lidocaine injection. The providers reduced his shoulder and then looked for confirmation using ultrasound (Image 2). How can I do this? Take your linear or curvilinear probe and place it in transverse orientation on the patient’s back next to the humerus (image 3). The glenoid should articulate directly with the humeral head (image 4). In an ..read more

Imagine it's 1989: the Berlin Wall is coming down, the world is marveling at the first GPS satellites going into orbit, and in the bustling world of emergency medicine, newer monoclonal antibody assays for beta-HCG are coming onto the scene. (It should be noted bHCG testing had been out for over a decade by that point, but continual advances in antibody assays meant more accurate but more expensive tests). In a time when cell phones were the size of bricks, Ramoska et al. published a surprising paper investigating if ordering this costly test to determine pregnancy status of patients of child ..read more

Hi all, This week’s VOTW was a case from several months ago brought to you by future ultrasound fellow Dr. Jennie Xu! A 23 year old female w/ hx of migraines was referred to the ED by an ophthalmologist for 4 weeks of intractable headache and three days of vomiting and vision changes. The patient was told she had a "pinched nerve in her eye". She was seen in another ED 1 week ago with a normal head CT. She had no focal deficits on exam. An ocular POCUS was performed which showed… Clip 1 shows a fan thru of a normal appearing globe. Posterior to the eye, an edematous optic nerve sheat ..read more

This week's VOTW is brought to you by Dr. Sanghvi and the UST! An 80 year old male w/ hx of CVA, non-verbal, PEG dependence, hx urosepsis presented from a nursing home w/ hypotension and “rule out sepsis”. Given the broad differential, the UST performed multiple scans including aorta, echo, chest, FAST, renal and bladder. The left kidney showed hydronephrosis and a POCUS of the bladder was performed which showed... Clip 1 shows a transverse view of the bladder w/ color doppler placed over the L ureterovesicular (UVJ) junction demonstrating “twinkle artifact” ?. This indicates th ..read more

This week’s VOTW is brought to you by… none other than our fantastic ED Medical Director Dr. Nubaha Elahi and Dr. Waters! A 44 year old female G5P3 w/ hx of Essure procedure (a 99.3% effective method of contraception) presented to the ED with bilateral eye swelling x1 week. She also had a positive home pregnancy test and vaginal spotting. Without being mislead by the initial chief complaint on a busy fast-track shift the team performed a POCUS of the pelvis which showed... Clip 1 shows a transabdominal view of the uterus with an empty gestational sac and a thick walled complex R adnexal c ..read more

This week’s VOTW is brought to you by Dr. Ye, Dr. J Yang and Dr. Quinn! A 58 year old male presented to the ED after fall. He was tachycardic to 120s, febrile and diagnosed with Flu A as well as alcohol withdrawal. He had an elevated troponin for which a POCUS was performed which showed… Clip 1 shows a parasternal long axis view of the heart with multiple findings. First there is a pericardial effusion with possible RV collapse during systole concerning for tamponade. There is also a large, ovular, immobile, structure approximately 7cm in diameter where the left atrium should be. Bas ..read more

Hi all, This week’s VOTW is brought to you by Dr. Evans! A 56 year old male presented with dull left shoulder pain for two days. He denied any trauma, swelling, erythema to the area or fevers. He did endorse repetitive lifting motions at work. The exam was unremarkable except for some pain w/ ROM of the shoulder. A POCUS showed… In Clip 1, the long head of the biceps tendon is seen in the bicipital groove (between the greater and lesser tuberosity) in its short-axis surrounded by a rim of hypoechoic fluid.  Clip 2 shows the biceps tendon in its long-axis, aga ..read more