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Video/Image of the Week – Trauma?

A 2 yo male was brought to the HUM ED for fever and facial swelling that began 4 days prior after a fall while playing.  On exam, the patient had swelling of the scalp and right frontal region and was unable to open his right eye.
The EM docs obtained the following x-ray during the workup and were concerned for child abuse due to findings on the bilateral collar bone:
Are these findings the result of past trauma??
No!  This was not a case of child abuse.  While multiple unexplained fractures in young children should raise suspicion of child abuse, these findings are the result of normal ossification of the clavicles, and in this case, trauma was a distraction from the real disease process that needed to be addressed:  a scalp abscess.


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Large Volume Pericardiocentesis

Dr. Menager, PGY-1 EM resident performed this ultrasound on a 47 yr old man complaining of shortness of breath over the last month, worsening in the last day,  associated with increasing lower extremity edema.

PERIOCARDIOCENTESIS PERFORMED – 1500cc removed from pericardium

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How to Perform an US-Guided Pericardiocentesis

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We see patients with pericardial effusions often in the emergency department.   When those effusions are causing tamponade, a pericardiocentesis can be life-saving procedure.  A few months ago, Dr. Plantin, PGY-2 EM resident at HUM, performed his first pericardiocentesis. To watch a video to see how he did, and to learn how to safely perform this procedure, click on the video link above. (video on EMin5.com)

With high rates of tuberculosis, we really do see many pericardial effusions that require drainage.  In fact, Dr. Plantin performed his second pericardiocentesis on his very next shift!  Learn how to perform this procedure now so when the time comes for you to perform it, you will be ready


Comfort Care in the Emergency Department

An 80 yr old male presented to the HUM ED complaining of acute onset epigastric and abdominal pain that started approximately 12 hours prior to arrival and was followed by multiple episodes of coffee ground emesis.  Patient arrived to the ED holding his abdomen and screaming in pain.

Blood pressure: 100/60  Heart rate: 150  RR: 28  Saturation: 88% on non-rebreather

Abdominal exam revealed a rigid abdomen with significant rebound and involuntary guarding.

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