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Respiratory

Creative Commons images

Empyema

Jonathan Patane, MD* and Daniel Ritter, BS^

DOI: https://doi.org/10.21980/J86P9RIssue 3:1 No ratings yet.
The chest X-ray shows a large fluid collection in the right lung demonstrated by the opacification that blunts the costophrenic angle on the right side. There is also a meniscus present, which is generally indicative of fluid.  Chest computed tomography (CT) demonstrated an infiltrate with a mixture of densities within the same collection, consistent with a loculated effusion and concerning for an empyema.
RespiratoryInfectious DiseaseVisual EM
Creative Commons images

Spontaneous Pneumothorax

John Costumbrado, MD, MPH* and Steven Kim, MD*

DOI: https://doi.org/10.21980/J8M33BIssue 2:4 No ratings yet.
Initial chest radiograph showed a 50% right-sided pneumothorax with no mediastinal shift, which can be identified by the sharp line representing the pleural lung edge (see arrows) and lack of peripheral lung markings extending to the chest wall. While difficult to accurately estimate volume from a two-dimensional image, a 2 cm pneumothorax seen on chest radiograph correlates to approximately 50% volume.1 The patient underwent insertion of a pigtail pleural drain on the right and repeat chest radiograph showed resolution of previously seen pneumothorax. Ultimately the pigtail drain was removed and chest radiograph showed clear lung fields without evidence of residual pneumothorax or pleural effusion.
RespiratoryVisual EM
Creative Commons images

Realistic Chest Tube Simulator Using Pork Belly with Skin

Donald Patrick Mebust, MD* and Jonathan Kei, MD*

DOI: https://doi.org/10.21980/J8R03J Issue 2:3 No ratings yet.
By the end of this instructional session learners will be able to: 1) discuss the indications, contraindications, and complications associated with chest tube thoracostomy, 2) competently perform chest tube insertion on a simulator, and 3) properly secure chest tube.
ProceduresInnovationsRespiratoryTrauma
Creative Commons images

Pneumonia Diagnosed by Point-of-Care Ultrasound

Akash Patel, BA*, Steven Bunch, MD^, Maili Alvarado, MD^, Shadi Lahham, MD^ and J. Christian Fox, MD^

DOI: https://doi.org/10.21980/J8XP64 Issue 2:3 No ratings yet.
Point-of-care ultrasound of the left lower lobe demonstrates lung hepatization, a classic finding for pneumonia. In addition, a shred sign is present with both air bronchograms and focal B-lines—all suggestive of poorly aerated, consolidated lung. The patient was started on antibiotics and admitted to the hospital with a diagnosis of community-acquired pneumonia.
UltrasoundRespiratoryVisual EM
Creative Commons images

Re-expansion Pulmonary Edema

Kathryn Bennett, BS, BA* and Benjamin Feldman, MD*

DOI: https://doi.org/10.21980/J8WS6V Issue 2:3 No ratings yet.
Initial chest X-ray (chest X-ray 1) showed a right-sided pleural effusion with compressive atelectasis of the mid to lower right lung. Repeat chest X-ray immediately after evacuation (chest X-ray 2) shows improvement of the pleural effusion and a new trace apical right pneumothorax measuring 6.7 mm. When the patient became tachypneic, a third X-ray (chest X-ray 3) showed persistent trace apical right pneumothorax measuring 6.7 mm.
RespiratoryVisual EM
Creative Commons images

Open Pneumothorax

Bart Paull, MD*, Zachary Jarou, MD* and David Richards, MD*

DOI: https://doi.org/10.21980/J88036 Issue 2:3 No ratings yet.
A large chest wound was clinically obvious. A chest radiograph performed after intubation showed subcutaneous emphysema, an anterior rib fracture, and a right-sided pneumothorax. He was then taken to the operating room for further management.
TraumaRespiratoryVisual EM
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Acute, massive pulmonary embolism with right heart strain and hypoxia requiring emergent tissue plasminogen activator (TPA) infusion

Jonathan Patane, MD* and Wirachin Hoonpongsimanont, MD*

DOI: https://doi.org/10.21980/J84K5K Issue 2:2 No ratings yet.
CT angiogram showed multiple large acute pulmonary emboli, most significantly in the distal right main pulmonary artery (image 1 and 2). Additional pulmonary emboli were noted in the bilateral lobar, segmental, and subsegmental levels of all lobes. There was a peripheral, wedge-shaped consolidation surrounded by groundglass changes in the posterolateral basal right lower lobe that was consistent with a small lung infarction (image 3).
Cardiology/VascularRespiratoryVisual EM

Ventilator TBL

Alisa Wray, MD* and Shannon Toohey, MD, MAEd*

DOI: https://doi.org/10.21980/J8H01MIssue 2:1 No ratings yet.
At completion of this TBL the learner should be able to: 1. Choose appropriate ventilator settings and adjustments for a patient with lung injury or obstructive lung pattern 2. Troubleshoot an alarming ventilator 3. Set up the most common ventilator in their ED 4. Set up the equipment needed for transtracheal jet ventilation.
RespiratoryTeam Based Learning (TBL)
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An Elderly Female with Dyspnea and Abdominal Pain

Jon Van Heukelom, MD*

DOI: https://doi.org/10.21980/J83S3KIssue 2:1 No ratings yet.
Radiography shows a dilated, gas-filled structure that fills nearly the entire left hemi-thorax. Lung markings are visible in the uppermost portion of the left hemi-thorax. There is mediastinal shift to the right. In the visualized portion of the abdomen, dilated loops of bowel are also visualized. This constellation of findings is consistent with a tension gastrothorax.
RespiratoryVisual EM
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Pulmonary Embolism: Diagnosis by Computerized Tomography without Intravenous Contrast

James Roy Waymack, MD*

DOI: https://doi.org/10.21980/J8001ZIssue 2:1 No ratings yet.
Non-contrast CT of the chest demonstrates hyper-densities within both central and sub-segmental pulmonary arteries bilaterally (see yellow arrows). The right ventricle is dilated.
RespiratoryVisual EM
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