EMsono Challenge

August 2008 Challenge

2008-08-15T11:32:00Z

56-year-old female with metastatic breast CA presents with dyspnea and hypotension. You are concerned that the patient has a pericardial effusion with tamponade physiology and perform a focused echo.

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July 2008 Challenge

2008-07-21T22:26:00Z

54-year-old dialysis patient presents with left arm pain and swelling. His dialysis nurse sends him in because she is afraid to dialyze him from his AV graft in the left arm. The patient states that swelling has been present in the arm for a while but it has gotten worse recently and he is waiting to follow back up with his vascular surgeon. You perform a focused study of the left arm and note the following...

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June 2008 Challenge

2008-06-15T04:00:00Z

64-year-old female presents to the ED three days after undergoing an outpatient diagnostic heart cath. She is complaining of pain and swelling at the catheter insertion site in the right groin. You perform a focused study of the right groin and note the following on the sagittal video...

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May 2008 Challenge

2008-05-13T17:05:00Z

A 22-year-old right-hand dominant male with known retained glass foreign bodies (fb) in his for two months duration. The patient has seen several hand surgeons and told it would be best to leave the fb's alone. The patient presents to the ED stating he can no longer perform his job duties due to pain. You perform a focused ultrasound and note the following...

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April 2008 Challenge

2008-04-20T10:55:00Z

48-year-old Amish female transferred via lifeflight after an auto vs. buggy accident. The patient is intubated at the scene for a GCS 6. Her vitals on arrival are as follows: BP-84/50, HR 142, RR- 20 (bagged) and PO-100%. On examination, she has multiple bruises noted on her torso and extremities. Her pelvis is unstable and she has a closed right femur fracture. After initial stabilization you perform a FAST exam. The pericardial, perisplenic and pelvic windows were negative. On the perihepatic window you note the following...

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March 2008 EMsono Challenge

2008-03-26T03:17:00Z

32-year-old female presents to the ED with RUQ abdominal pain and jaundice. She denies any chronic medical conditions and does not take any medications. She admits to tobacco use but denies other drug use. She appears obviously jaundiced but is otherwise nontoxic and has stable vital signs. Her physical exam is only significant for the jaundice and some RUQ tenderness with guarding. You perform a gallbladder ultrasound and note the following...

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February 2008 EMsono Challenge

2008-02-14T07:34:00Z

A 40-year-old female presents with non-traumatic left hand pain. Patient is right-hand dominant and has no significant PMH. Pt states she is unemployed and did not do anything that could have caused this pain. On examination, her vital signs are stable and she is afebrile. She has swelling on the dorsal aspect of her hand extending toward the wrist. She has good ROM but has pain with extension and flexion of digits. No definitive cellulitis or lymphangitis is noted, although the swollen area feels warmer than the surrounding tissue. Her labs are as follows: WBC 6.8 with normal differential, ESR 14, CRP 0.8. Her hand xray was negative for acute process per radiology. You perform a focused ultrasound of the hand and note the following...

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January 2008 EMsono Challenge

2008-01-09T05:26:00Z

A 43-year-old female presents to the ED with sudden onset of dyspnea and left sided chest pain. The patient tells you she just underwent a TAH for uterine fibroids and was discharged home 5 days ago. The patient denies other past medical history although she relates having a spontaneous pneumothorax when she was a teenager. On examination, the patient is noted to be morbidly obese. Her vitals are: BP 146/88, HR 124, RR 28, T 37.0, and Pulse Ox on Room Air 93%. Her physical exam reveals clear lung fields with no evidence of JVD, edema, or stigmata of a DVT. While waiting for a STAT portable chest radiograph to be performed, you perform a thoracic ultrasound to evaluate for possible pneumothorax.

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December 2007 EMsono Challenge

2007-12-26T23:17:00Z

5 week old male child presents with three days of non-bloody, non-bilous emesis. The mother states she feeds the child only 1 ounce at a time and he has emesis after each feeding which is "projectile". Mother denies fever, irritability, lethargy, and the patient is otherwise well. The mother also reports no blood per stool and no sick contacts.

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November 2007 EMsono Challenge

2007-11-09T19:29:00Z

You are asked by one of your colleagues to scan a 22-year-old women who is 18 weeks pregnant. Her PMH is only significant for ureteral stones. She presented with fever of 103 F and right flank pain. Her urinalysis is consistent with a UTI and your colleague suspects pyelonephritis. He is concerned, however, that this may be a result of an obstructive uropathy due to a ureteral stone based on her PMH. He asks you to evaluate the patient for the presence of hydronephrosis.

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October 2007 EMsono Challenge

2007-10-08T03:31:00Z

54-year-old hispanic male presents with intractable vomiting and upper abdominal pain. He has a history of type 2 DM and hypertension. He was just recently discharged from the medicine service where he was hospitalized for intractable vomiting. He denies history of early satiety or history of fried/fatty food intolerances. On examination, the patient appears uncomfortable. His abdomen is distended and he has midepigastric and right upper quadrant tenderness but no rebound. His vitals signs are stable. You are concerned about possible cholecystitis and you perform a focused GB ultrasound and note the following:

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September 2007 EMsono Challenge

2007-09-30T05:00:00Z

A 64-year-old female visiting from Jordan develops RUQ abdominal pain and jaundice. You are asked to perform a focused ultrasound of the gallbladder to assess for acute gallbladder disease. The patient's vitals are stable and her abdominal exam reveals RUQ tenderness but no organomegaly. You perform a focused GB ultrasound and note the following...

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August 2007 EMsono Challenge

2007-09-01T02:32:00Z

A 64-year-old white male with history of hypertension, diabetes mellitus and ESRF on dialysis presents with cough and dyspnea after having missed two dialysis appointments due to a family crisis.

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July 2007 EMsono Challenge

2007-07-31T04:46:00Z

A 22-year-old white male presents to the ED 2 days after snowboarding accident with significant right flank pain. His vitals are stable and he denies any hemoptysis, dizziness, syncope, anterior abdominal pain, vomiting or hematuria. His exam is only significant for bruising and tenderness in the right flank. You perform a beside ultrasound and note the following...

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June 2007 EMsono Challenge

2007-06-30T16:00:00Z

A 28 year old morbidly obese female presents with five days of dyspnea and chest tightness. She presented via EMS after having a syncopal episode at church. She has no past medical history and the only medication she takes is oral contraceptive pills that she has been on for 8 years. Her vitals signs are: BP 98/54, HR 136, RR 28, T 37.3. Her physical exam reveals her to be in moderate distress. Her pulmonary exam reveals clear lung sounds bilaterally. Her heart is regular without murmurs, rubs or gallops. She has no JVD, ankle edema or stigmata of a deep venous thrombosis. You order an EKG. A chest radiograph reveals no acute process per radiology. You are concerned about the possibility of a PE. You perform a focused bedside echo and note the following...

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