Respiratory

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[mrp_rating_result]

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.

Re-expansion Pulmonary Edema

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

DOI: https://doi.org/10.21980/J8WS6V Issue 2:3[mrp_rating_result]

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.

Respiratory Visual EM

Open Pneumothorax

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

DOI: https://doi.org/10.21980/J88036 Issue 2:3[mrp_rating_result]

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.

Trauma Respiratory Visual EM

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[mrp_rating_result]

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/Vascular Respiratory Visual EM

Ventilator TBL

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

DOI: https://doi.org/10.21980/J8H01MIssue 2:1[mrp_rating_result]

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.

Respiratory Team Based Learning (TBL)

An Elderly Female with Dyspnea and Abdominal Pain

Jon Van Heukelom, MD^*

DOI: https://doi.org/10.21980/J83S3KIssue 2:1[mrp_rating_result]

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.

Respiratory Visual EM

Pulmonary Embolism: Diagnosis by Computerized Tomography without Intravenous Contrast

James Roy Waymack, MD^*

DOI: https://doi.org/10.21980/J8001ZIssue 2:1[mrp_rating_result]

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.

Respiratory Visual EM