My Patient is Short of Breath: Have They Got a Pneumothorax?

Clinical diagnosis of pneumothorax in the emergency department (ED) resuscitation room can be difficult and in certain circumstances chest radiography is either impractical or the delay is unacceptable. The diagnosis must also be considered in other clinical areas such as critical care, theatres, respiratory units and acute medical units. Erect chest radiography is the standard first-line diagnostic test for pneumothorax in the ED, but the sensitivity is low (59–81%). For many patients in ED, critical care and theatre, an erect chest radiograph is not possible as the patient must remain supine. The sensitivity for a supine chest radiograph has been reported as being 45–75%. Ultrasound has been shown to be more sensitive than chest radiography in the diagnosis of pneumothorax in certain settings. This paper outlines the evidence for ultrasound in the diagnosis of pneumothorax in the point of care setting; it describes the technique and discusses the clinical application of this imaging modality.

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Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽

10.24908/pocus.v3i1.13310 ◽

2018 ◽

Vol 3 (1) ◽

pp. 13-14

Author(s):

Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽

Maryam Al Ali, MBBS

Keyword(s):

Emergency Department ◽

Critical Care ◽

Case Report ◽

Soft Tissue ◽

Necrotizing Fasciitis ◽

Soft Tissue Infection ◽

Critical Care Unit ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

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Utilisation of musculoskeletal ultrasonography for the evaluation of septic arthritis in a patient presenting to the emergency department with fever during the era of COVID-19

BMJ Case Reports ◽

10.1136/bcr-2021-242370 ◽

2021 ◽

Vol 14 (4) ◽

pp. e242370

Author(s):

Jiodany Perez ◽

Stefani Sorensen ◽

Michael Rosselli

Keyword(s):

Emergency Department ◽

Septic Arthritis ◽

Glenohumeral Joint ◽

Imaging Modality ◽

Point Of Care ◽

Significant Morbidity ◽

Anchoring Bias ◽

Septic Bursitis ◽

Musculoskeletal Ultrasonography ◽

Point Of Care Ultrasonography

Prompt recognition and treatment of septic arthritis are crucial to prevent significant morbidity and mortality in affected patients. During the current COVID-19 pandemic, anchoring bias may make an already challenging diagnosis like septic arthritis more difficult to diagnose quickly and efficiently. Musculoskeletal (MSK) point of care ultrasonography (POCUS) is an imaging modality that can be used to quickly and efficiently obtain objective findings that may help a clinician establish the diagnosis of septic arthritis. We report a case where MSK POCUS was a key element in establishing the diagnosis of glenohumeral joint septic arthritis and subdeltoid septic bursitis for a patient that presented to the emergency department with a fever during the era of the COVID-19 pandemic.

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Paediatric ultrasound

Point of Care Ultrasound for Emergency Medicine and Resuscitation ◽

10.1093/med/9780198777540.003.0011 ◽

2019 ◽

pp. 217-224

Author(s):

Jason Fischer ◽

Lianne McLean

Keyword(s):

Critical Care ◽

Abdominal Pain ◽

Pyloric Stenosis ◽

Imaging Modality ◽

Point Of Care ◽

Adult Patients ◽

Point Of Care Ultrasound ◽

Lung Pathology ◽

Skull Fractures ◽

Body Habitus

This chapter highlights the increasing use of point-of-care ultrasound (PoCUS) in children. The size and body habitus of infants and children are often ideal for sonographic visualization and make PoCUS an ideal imaging modality for paediatric patients. PoCUS applications that have been traditionally used for adult patients are increasingly being adopted for the care of children. Paediatric-specific applications are also being developed for problems common and unique to paediatrics. Focused abdominal scans for appendicitis, intussusception, and pyloric stenosis are now frequently used in patients presenting with abdominal pain or vomiting. PoCUS can differentiate lung pathology and is helpful in the assessment of suspected skull fractures in non-verbal infants. Ongoing integration of PoCUS into shock, trauma, and triage algorithms support its increasing role in paediatric emergency and critical care.

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Prevalence of pneumonia in children under 12 years of age who undergo abdominal radiography in the emergency department

CJEM ◽

10.1017/s1481803500015293 ◽

2007 ◽

Vol 9 (05) ◽

pp. 347-351 ◽

Cited By ~ 6

Author(s):

Valérie Homier ◽

Colette Bellavance ◽

Marianne Xhignesse

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Chest Radiograph ◽

Chest Radiography ◽

Acute Abdominal Pain ◽

Tertiary Care ◽

Abdominal Radiograph ◽

Upper Respiratory Tract ◽

Abdominal Radiography ◽

X Ray

ABSTRACT Objective: Pneumonia is a well-known cause of acute abdominal pain in children. However, the utility of chest radiography in this setting is controversial. We sought to determine the prevalence of pneumonia in children under 12 years of age who had abdominal pain and underwent abdominal radiography when visiting an emergency department (ED). We also aimed to describe the signs and symptoms of children diagnosed with pneumonia in this context. Methods: We conducted a retrospective analysis of electronic data from ED visits to a tertiary care centre by children 12 years of age and under who were seen between June 1, 2001, and June 30, 2003, and who underwent both an abdominal and a chest radiograph during the same visit, or an abdominal x-ray at a first visit as well as a chest x-ray in the 10 days following the initial visit. Results: Of 1584 visits studied, 30 cases of pneumonia were identified, for a prevalence of 1.89% (95% confidence interval 1.22%–1.56%). If chest radiography had been limited to children who presented with fever, cough and symptoms of an upper respiratory tract infection (URTI), the diagnosis of pneumonia would have been missed in only 2/1584 visits (0.13%). Conclusion: Children aged 12 years and under presenting to the ED with acute abdominal pain and in whom an abdominal radiograph is requested need only undergo a chest radiograph in the presence of cough, fever or other symptoms of a URTI.

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