Ultrasound Findings in Tension Pneumothorax: A Case Report.

BACKGROUND: Delayed recognition of tension pneumothorax can lead to a mortality of 31% to 91%. However, the classic physical examination findings of tracheal deviation and distended neck veins are poorly sensitive in the diagnosis of tension pneumothorax. Point-of-care ultrasound is accurate in identifying the presence of pneumothorax, but sonographic findings of tension pneumothorax are less well described. CASE REPORT: We report the case of a 21-year-old man with sudden-onset left-sided chest pain. He was clinically stable without hypoxia or hypotension, and the initial chest x-ray study showed a large pneumothorax without mediastinal shift. While the patient was awaiting tube thoracostomy, a point-of-care ultrasound demonstrated findings of mediastinal shift and a dilated inferior vena cava (IVC) concerning for tension physiology, even though the patient remained hemodynamically stable. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case demonstrates a unique clinical scenario of ultrasound evidence of tension physiology in a clinically stable patient. Although this patient was well appearing without hypotension, respiratory distress, tracheal deviation, or distended neck veins, point-of-care ultrasound revealed mediastinal shift and a plethoric IVC. Given that the classic clinical signs of tension pneumothorax are not uniformly present, this case shows how point-of-care ultrasound may diagnose tension pneumothorax before clinical decompensation.

Diagnosis of an Occult Hip Fracture by Point-of-Care Ultrasound.

BACKGROUND: Hip fractures are common injuries, particularly among elderly patients. Although plain radiographs are the initial imaging modality of choice, approximately 10% of hip fractures are not radiographically evident. Failure to diagnose a hip fracture in the emergency department may result in delayed diagnosis and potentially devastating consequences. CASE REPORT: We report the case of an 81-year-old woman with right hip pain after a fall. Although plain radiographs of the right hip and femur were negative for fracture, point-of-care ultrasound of the right hip demonstrated a cortical disruption in the femur consistent with a fracture. Given the clinical and ultrasound findings, computed tomography of the bony pelvis and proximal femurs was performed, which confirmed an oblique complex fracture of the right femur through the greater and lesser trochanters. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Point-of-care ultrasound, in conjunction with clinical suspicion, may help identify patients who require more advanced imaging to identify occult hip fractures.

Web-based teaching in point-of-care ultrasound: an alternative to the classroom?

OBJECTIVES: To evaluate two educational methods for point-of-care ultrasound (POC US) in order to: 1) determine participant test performance and attitudes in using POC US and 2) compare cost and preparation time to run the courses. METHODS: This was a pilot study conducted at a county teaching hospital. Subjects were assigned to participate in either a large group course with live classroom lectures (Group A) or a group asked to watch 4.5 hours of online prerecorded lectures (Group B). Both groups participated in small-group hands-on training after watching the lectures. Both groups took a pre- and post-course exam, and completed course surveys. Cost and time spent running the courses were also compared. RESULTS: Forty-seven physicians participated in the study. The pre-test and post-test scores between the two groups did not differ significantly. Of those with prior ultrasound experience, the majority of both groups preferred to continue classroom-based teaching for future courses. Interestingly, in the groups who had no ultrasound experience prior to their course participation, there was a higher percentage who preferred web-based teaching. Lastly, Group B was shown to have the potential to take less preparatory time when compared to Group A. CONCLUSION: A web-based curriculum in POC US appears to be a promising and potentially time saving alternative to live classroom lectures and seems to offer similar educational benefits for the postgraduate learner.