Brown Emergency Medicine Blog — BROWN EMERGENCY MEDICINE BLOG

Volume Assessment Using POCUS in the Emergency Department

An 83-year-old male with a history of HFrEF (40%), CAD, hypertension, and hyperlipidemia presented to the ED with generalized weakness and fatigue. His vitals were remarkable for hypotension with a MAP of 58. On physical exam, the patient appeared non-toxic and was able to answer questions appropriately. He did not appear frankly fluid overloaded, other than mild, chronic peripheral edema. Additional laboratory studies and chest x-ray were performed. A fluid bolus was given to treat his hypotension, however there was minimal response. Given his heart failure, there was concern that aggressive fluid resuscitation would result in pulmonary edema. Additionally, inserting a central line and starting vasopressors is not without risk. Fortunately, this clinical team knows how to use ultrasound to do a proper volume assessment to manage this patient appropriately…

Ultrasound, ResuscitationJoshua NimsApril 11, 2022POCUS, ShockComment

Geriatrics Going to Ground : Ultrasound-Guided Femoral Nerve Block

“It would be unusual to go too many shifts as an emergency medicine provider without seeing the classic elderly female patient with hip pain after a fall. On exam, the patient would likely be uncomfortable with their hip appearing shortened and externally rotated on exam. Before you even view the X-ray, you know they likely fractured their hip. You ascertain whether it was a mechanical fall, if there were other injuries, if the injury is open or closed and if the patient is neurovascularly intact. You proceed to order your imaging and consider your plan for pain control. Sound familiar…”

Renal Ultrasound: Hydronephrosis and Stones

Renal ultrasound can be important in determining diagnosis, management, and next steps in the evaluation of a patient with flank or abdominal pain, hematuria, concern for stone and more.

Ultrasound, RadiologyNaomie ShemboMarch 4, 2022Ultrasound, Renal Ultrasound Review, Hydronephrosis, Kidney stonesComment

Ocular Scanning in ICH

A 20-year-old female presents to the emergency department (ED) with a chief complaint of a headache. Her headache started 8 days ago and is described as bifrontal. It is positional and gets worse when she bends forward but improves when she is sitting or standing. She had presented to 3 other EDs prior to this visit for her symptoms, and each time she was discharged with an intractable headache after receiving a migraine cocktail to no effect…

Sclerochoriodal calcification - What is it and what is its clinical significance?

…3 days of floaters and “lightning bolt” white flashes in the temporal field of her right eye in the absence of eye trauma. She also reported right periorbital pain. She did not have blurry vision, diplopia, loss of vision, scalp tenderness, jaw claudication, fevers, chills, or weight loss. She denied photophobia despite wearing sunglasses in the Emergency Department. Her mother had died from choroidal melanoma, but the patient had not seen an ophthalmologist in 15 years.

Her uncorrected visual acuities were 20/60 OD and 20/40 OS. Intraocular pressure, pupillary reaction, and extraocular movements were normal. Point of care ultrasound (POCUS) revealed three hyperechoic, solid lesions with posterior acoustic shadowing in her right eye….

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