February 2019

First place

Dr.  Omar Hashmi

Dr. Hashmi had a 26 yo female come in for evaluation for a possible ectopic, sent from an outside facility. She had a previous c-section done.  Dr. Hashmi performed a bedside sono and found a c-section scar ectopic pregnancy.  About 90-95% of ectopics occur in the fallopian tubes.  While this is a rare diagnosis, having a high index of suspicion will keep you thinking about it. Important questions to ask all pregnant patients with no IUP are history of ectopic, IVF, and history of STDs.

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rUNNER UP:

Dr. King Tom

Dr. B. Chang had a 67 yo M with ESRD present with L wrist pain which had started a day prior. The patient's wrist was warm and there was decreased ROM.  Dr. Tom did a wrist ultrasound and found a pocket of fluid which he drained.  The following images show a great wrist arthrocentesis.  The patient's synovial fluid showed an elevated WBC at 197700, with 80% neutrophils. The patient was started on abx for suspected septic arthritis. He ultimately had a washout with ortho and was determined to have gout.

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notable cases:

Dr. Jordan Chanler-Berat

Dr. JCB had a 72 yo F with PMH of HTN, DM II, CKD 4 w/ secondary hyperparathyroidisms, Carcinoid syndrome s/p hemoembolization, hypomagnesemia and Anemia of chronic disease p/w CC of nausea/vomiting x today along with RUQ and epigastric pain. Patient had been seen in January and found to have pneumobilia, per radiology likely 2/2 prior instrumentation or sphincterotomy.  Bedside sono during this visit again showed pneumobilia.  The following image shows the hyperechoic areas of gas causing prominent reverberation and/or shadowing.  It has a classically "striped" appearance.

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Dr. Jacob Franklin (FP)

Dr. M. Chang had a 55 year old male with hx of methadone use, COPD and HTN present to the ED due to shortness of breath. Patient had an O2 sat in the 70s at his clinic and was wheezing.  Dr. Franklin was on his ultrasound rotation and performed a bedside sono showing consolidation in the RLL.  This is a great, classic example of hepatization of the lung as well as air bronchograms.  There has been a lot of research done on lung ultrasound and an algorithm has been developed which shows about 90% accuracy when used on patients presenting with dyspnea in the ED.  You can read more on that herehere and here.  This is also Dr. Valdez's favorite sono topic so get at him for more info. This patient was ultimately treated for COPD and PNA in the ED and discharged.  Dr. Franklin's great images also prove the universality of ultrasound.  POC can be advocated for use outside of the ED, improving patient care in all healthcare settings.

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