When a patient presents to the emergency department with atraumatic monoarticular arthritis, it is important to rapidly determine the etiology because septic arthritis is a medical emergency that can lead to significant morbidity and mortality…
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A 32-year-old female with no significant past medical history presents to the emergency department with complaints of nausea, vomiting, and bloating. The patient reports her last menstrual period was about 2 months prior to presentation. She was evaluated about one-month ago, at which time she was told that a pelvic ultrasound revealed an intrauterine gestation sac without a fetal pole or yolk sac, suspicious for early pregnancy failure. The patient subsequently developed vaginal bleeding, associated with abdominal cramping, nausea, and vomiting. She interpreted these symptoms as a miscarriage. The patient states that the vaginal bleeding has since subsided, but she endorses continued and progressive nausea, vomiting, and bloating. She is unable to tolerate oral intake. She denies fever, headache, abdominal pain, back pain, vaginal discharge/odor/pain, dysuria, or diarrhea…
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A 3 year-old male presents to the pediatric emergency department with leg pain. Prior to arrival, the patient had been at daycare and was found crying, reporting pain to his right leg. The daycare staff denied any specific trauma and noted that he had been playing happily throughout the morning. His parents were understandably concerned and dad reported that this had been his fourth visit to the emergency department for fractures since he started walking at 12 months of age…
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We use ultrasound for a multitude of procedures in the emergency department, including central and peripheral venous access, abscess drainage, and joint aspiration. Less common, but just as useful, is the use of ultrasound to help identify landmarks when performing a lumbar puncture (LP). While the traditional method of LP is based on palpating anatomical landmarks, this is becoming increasingly difficult as the patient population becomes more obese. It may also be difficult in patients who have abnormal spinal anatomy or in those who have had previous spinal surgery. When palpating anatomy is difficult, ultrasound can be a useful tool to help identify appropriate landmarks and increase your LP success rate…
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