Interview – Vicky Noble – US training in medical schools

We interviewed with world renowned emergency and critical care US expert “Vicky Noble” about US training in medical schools.

Read US Chapters and Posts

Bat Sign

Dear students/interns, learn ultrasonographic anatomy and clinical ultrasound basics to improve your decision making processes.

bat2

The bat sign is critical for correct identification of the pleural line. Always begin lung ultrasound by identifying the bat sign before proceeding to look for artifacts and pathologies.

This sign is formed when scanning across 2 ribs with the intervening intercostal space.

The wings are formed by the 2 ribs, casting an acoustic shadow. The body is the first continuous horizontal hyperechoic line that starts below one rib and extends all the way to the other. (see above video) The body is the pleural line, i.e., parietal pleural. Normally, the pleural line is opposed to and hence indistinguishable from the lung line (formed by the visceral pleura).

To learn more about it, read chapter below.

Read "Blue Protocol" Chapter

From experts to our students! – eFAST

Selected Imaging Modalities

628.14 - acetabular fx 2

eFAST

by Ashley Bean, Brian Hohertz and Gregory R. Snead Introduction The objective of the extended focused assessment for sonography in trauma (eFAST) is to detect

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PoCUS – RUSH Protocol

by Rasha Buhumaid Why use POCUS in undifferentiated hypotension? Hypotension is a high-risk sign which is associated with increased morbidity and mortality rate. The differential

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BLUE protocol

by Toh Hong Chuen Case Presentation A 68-year-old man with a history of congestive cardiac failure (CCF) and chronic obstructive pulmonary disease (COPD) presented with breathlessness

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How to Read C-Spine X-Ray

by Dejvid Ahmetović and Gregor Prosen Introduction C-spine x-ray interpretation is one of the fundamental skills of emergency physicians. Although current guidelines lead us to

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How to read chest x-rays

by  Ozlem Koksal Introduction Chest X-ray interpretation is one of the fundamental skills of every doctor. Emergency physicians are particularly exposed to various chest x-rays

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How to read head CT

by Reza Akhavan and Bita Abbasi For a standard approach to read head/brain computed tomography (CT) scan, one should adhere to systematic algorithms. The predefined

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How to read pelvic x-rays

by Sara Nikolić and Gregor Prosen Introduction Pelvic fractures carry life‐threatening injury potential which should be identified or suspect during the primary assessment of patients with

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A 22-year-old male

Appendicitis

Acute Appendicitis

by Ozlem Dikme, Turkey

A previously healthy 22-year-old male was brought to the emergency department (ED) with recently-started abdominal pain. He had not eaten anything since that morning due to loss of appetite. He was nauseated and vomited three times. His abdominal pain started around the umbilicus and epigastric area. His pain increased as it moved towards his right lower quadrant (RLQ). The maximum pain was felt on the right iliac fossa. He had not taken any medication. His social history revealed that he was non-drinker, non-smoker and did not use any illicit drugs. His diet mostly consisted of carbohydrates. The past and family histories were unremarkable. His blood pressure was 120/70 mmHg, pulse rate was 100/min, the temperature was 37.8°C (100°F), and respiration rate was 22/min. 

What is the cut-off number in Alvarado score to suspect appendicitis?

Touch Me

Alvarado Score

1-4 appendicitis unlikely, 5-6 appendicitis possible, 7-8 appendicitis probable, 9-10 appendicitis very probable
Answer
51.1 - abdominal - pain - appendicitis ultrasound

Physical examination showed normal bowel sounds, tenderness and voluntary guarding, particularly over the right iliac fossa. The costa-vertebral angles were not tender. Oral intake was stopped, intravenous (IV) catheter was inserted, blood and urine tests were planned, and fluid therapy was started. The urinalysis was normal. White blood cell (WBC) count was 14,500 with 89% polymorphous and 11% lymphocytes. The ultrasonography (USG) showed a non-compressible tubular structure of 9 mm in diameter at RLQ. He admitted to the surgical ward with the diagnosis of acute appendicitis.