Posts by JETem

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Intraocular Foreign Body: Ultrasound and CT Findings

Maja Feldman, MPP*, Kristi Shigyo, MD^ and Amy Kaji, MD^

DOI: https://doi.org/10.21980/J8JS3MIssue 2:1[mrp_rating_result]
Point of care ultrasound revealed a mobile, radiolucent hyperechoic structure (see red arrow) with reverberation within the posterior chamber (see blue arrow), likely a metallic foreign body. Linear areas of mobile hyperechoic material revealed possible vitreous hemorrhage (see purple circular area). Orbital non-contrast CT confirmed a 3 mm metallic focus within the dependent portion of the left globe, lodged in the posterior sclera, with some vitreous hemorrhage but no evidence of globe rupture. Ophthalmology was consulted and the patient was taken to surgery later that night.
OphthalmologyVisual EM
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Computed Tomography Diagnosis of Appendicitis

Christopher Libby, MPH* and Shannon Toohey, MD, MAEd^

DOI: https://doi.org/10.21980/J8F30NIssue 2:1[mrp_rating_result]
The CT abdomen/pelvis with IV contrast shows a dilated appendix (see red outline) with thickened, hyperenhancing wall (see blue outline) best visualized in the axial and coronal planes.
Abdominal/GastroenterologyVisual EM
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Intracranial Hemorrhage Following a 3-week Headache

John Jiao, MHS* and Alisa Wray, MD*

DOI: https://doi.org/10.21980/J89885 Issue 2:1[mrp_rating_result]
The patient’s head CT showed a significant area of hyperdensity consistent with an intracranial hemorrhage located within the left frontal parietal lobe (red arrow). Additionally, there is rightward midline shift up to 1.1cm (green arrow) and entrapment of the right lateral ventricle (blue arrow).
NeurologyVisual EM
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Gastric Bezoar

Samer Assaf MD*

DOI: https://doi.org/10.21980/J85K5WIssue 2:1[mrp_rating_result]
In the abdominal radiograph, a nonspecific and non-obstructive bowel gas pattern with no air-fluid level was noted, however the stomach was distended with soft tissue. The CT abdomen/pelvis revealed a distended stomach with undigested heterogeneous contents (presumed bezoar).
Abdominal/GastroenterologyVisual EM
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Monteggia Fracture in an Assault Patient

John Jiao, MHS* and Shannon Toohey, MD, MAEd*

DOI: https://doi.org/10.21980/J81S3ZIssue 2:1[mrp_rating_result]
On the axial elbow x-ray, the radial head (red arrow) is dislocated anteriorly from the humerus; the humeroulnar articulation is intact. On the AP forearm x-ray, there is a closed, displaced, comminuted fracture of the ulna (blue arrow).
OrthopedicsVisual EM
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Cholelithiasis: WES Sign

Hamid Ehsani-Nia, MS* and Shannon Toohey, MD, MAEd^

DOI: https://doi.org/10.21980/J8X300Issue 2:1[mrp_rating_result]
Abdominal ultrasound showed the classic presentation of the Wall-Echo-Shadow (WES) sign. The superficial aspect of the gallbladder wall is represented by a hyperechogenic curve. Below this, bile fluid is represented by hypoechogenicity. Underneath the bile fluid is the echo of the dense border created by the collection of gallstones, represented by a hyperechogenic curve. Due to the high density of the gallstones, nothing deeper can be visualized (including other gallstones or the far end of the gallbladder); this is the shadow.
Abdominal/GastroenterologyUltrasoundVisual EM

A Formalized Three-Year Emergency Medicine Residency Ultrasound Education Curriculum

Andrew King, MD*, Alyssa Tyransky*, Alexa Coffman*, Sarah Greenberger, MD*, Ashish Panchal, MD, PhD, RDMS*, David P. Bahner, MD, RDMS*, Sorabh Khandelwal, MD* and Creagh Boulger, MD, RDMS*

DOI: https://doi.org/10.21980/J8RG6HIssue 1:2[mrp_rating_result]
Learners will 1) know the indications for each the 11 ACEP point-of-care ultrasound (POCUS) applications; 2) perform each of the 11 ACEP POCUS applications; 3) integrate POCUS into medical decision-making.
UltrasoundCurricula

Neutropenic Fever

Shannon Toohey, MD, MA*

DOI: https://doi.org/10.21980/J8KW2KIssue 1:2[mrp_rating_result]
Neutropenia is a common oncologic emergency, and it frequently develops as a result of myelosuppression from chemotherapy. Neutropenia is defined as absolute neutrophil count (ANC) <1000/mm3, with severe neutropenia being defined as ANC<500/mm3. Patients with fever and neutropenia should be presumed to have infectious etiology and started on antibiotics immediately. The 48-hour mortality associated with an untreated infection is 20%-50%.
Infectious DiseaseCertifying Exam Cases