March 2018

First place

Dr. Michael Chang

Prize: $15 Starbucks gift certificate

JCB: "Case: 41 M pressed his foot down accidentally on a large construction screw. 

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The patient originally arrived with the screw going through the sole of his Nike sneaker. We could barely move the sneaker around without severe pain. So we cut as much of the shoe off that he could tolerate. Then ...
Dr. Chang and I set him up for a posterior tibial nerve block.

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Here are stills of our dynamic guidance images. Dr. Chang did an incredible job of hydrodissecting with the anesthetic and completely surrounded the PT nerve. See images below. The patient had fantastic pain control and we subsequently cut off his sneaker sole and pulled out the screw after a good neurovascular exam and X-ray. (he went home on prophylactic Keflex and Cipro - for pseudomonas coverage just like the board questions)

 

rUNNER UP:

Dr. Karen Ambert

Prize: $5 Starbucks Gift Certificate

 

This case at brookdale revealed the sensitivity of POCUS for pneumothorax. Dr. Ambert found a radio-occult PTX missed on Xray. See the XRradiology read, the lack of sliding on the affected side, and the positive sliding on the unaffected side