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EMsono Challenge

  • June 2008 Challenge

    64-year-old female presents to the ED three days after undergoing an outpatient diagnostic heart cath.  She is complaining of Emergency Ultrasound Challenging Case - EMsono 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

    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 Emergent Point of Care Hand Ultrasoundpresents 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

    48-year-old Amish female transferred via lifeflight after an auto vs. buggy accident.  The patient is intubated at the scene for a EMsono ChallengeGCS 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

    32-year-old female presents to the ED with RUQ abdominal pain and jaundice. She denies any chronic Emergency Ultrasound Challenge - EMsono 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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    Posted Mar 25 2008, 11:17 PM by Rob with no comments
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  • February 2008 EMsono Challenge

    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 EMsono Ultrasound Challengevital 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

    A 43-year-old female presents to the ED with sudden onset of dyspnea and left sided chest pain.  The patient tells you EMsono Ultrasound Challenge Emergency Medicineshe 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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    Posted Jan 09 2008, 12:26 AM by Rob with no comments
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  • December 2007 EMsono Challenge

    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, EMsono Emergency Ultrasound Challenging Caselethargy, 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

    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 EMsono ultrasound challengefever 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

    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 US Challenge - EMsonowhere 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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    Posted Oct 07 2007, 11:31 PM by Rob with no comments
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  • September 2007 EMsono Challenge

    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 EMsono ultrasound challengeacute 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

    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 August 2007 Emergency Ultrasound Challengeappointments due to a family crisis.

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  • July 2007 EMsono Challenge

    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, Emergency Ultrasound Challengedizziness, 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

    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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    Posted Jun 30 2007, 12:00 PM by Rob with no comments
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  • May 2007 EMsono Challenge

    A 63-year-old obese patient with history of HTN, CVA, and Afib (on coumadin) presents with abdominal pain. She is most tender when you palpate her abdominal wall just below the umbilicus and you feel a mass. You perform an ultrasound to determine the cause of the pain. 
     
  • March 2007 EMsono Challenge

    5 y.o male presents with 2 day history of RLQ abdominal tenderness. He is afebrile with stable vital signs. His exam is EMsono March Ultrasound Challengeonly significant for RLQ with mild guarding but no rebound. You perform an ultrasound to assess for appendicitis.
     
     
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