Dr. Michael Woo and Dr. Gaby Blecher

Another update from Down Under...I had the opportunity to spend the day with Dr. Gaby Blecher and the Emergency Registrars at Monash Medical Centre in Melbourne, Australia. It was wonderful to catch up with Dr. Blecher who did a research fellowship at UOttawa with Dr. Stiell and completed his thesis on Point-of-care ultrasonography for DVTs in ED patients. He is now incorporating PoCUS as part of clinical care for EPs at Monash Medical Centre. I was able to present the role of PoCUS in patients presenting with shortness of breath and take part in their journal club. Taking part in their POCUS meeting was enlightening as they have advanced their QA system and have strong collaborations with Radiology. This was an enthusiastic group with lots of ideas. Looking forward to sharing these ideas with you all and developing future collaborations. (Oh yeah, I have enjoyed the surf, sun, and food as well! :)

Pericardial Effusion - Seen one lately?

A 60 year old man presents with shortness of breath on exertion.  You work him up, but chest x-ray, spirometry, ECG, and labs (troponin and D-dimer) are all normal.  Send him home, I guess...

Have you considered occult pericardial effusion?  I have diagnosed about six unexpected pericardial effusions in the last year, and I have learned a few lessons:

1) this is not as rare a diagnosis as you think
2) patients can look really good, even with impending tamponade

This is an easy diagnosis to miss, but in 2013, I don't think that's acceptable anymore.  Any well-trained emergency physician should be thinking about it and has a tool at hand to make the diagnosis quickly and cheaply.

The first video here is in the subxiphoid view.

The next video is the same patient, showing the effusion in the parasternal long.

The third video is from a different patient.  Notice here how the right ventricular wall is collapsing inward at end-diastole.  This is an echocardiograhic sign of tamponade.  For the clinician, tamponade should be a clinical diagnosis, but if you see this at the bedside, be worried!

Occult pericardial effusion is not hard to diagnose.  You just need to think of it, and be liberal in your use of PoCUS.  Unexplained dyspnea, weakness, hypotension, or tachycardia?  Get out your probe!

Greetings from Melbourne, Australia.
One of the great things about academic emergency medicine is the opportunity to travel and meet other interesting emergency physicians. I had the opportunity to attend journal club with staff and emergency registrars as well as share a presentation on the role of PoCUS in patients presenting with shortness of breath. It was wonderful to share ideas and learn the different approaches to emergency care. The Alfred Hospital is the major trauma centre in Melbourne and a fantastic facility. Thank you to my hosts and I look forward to collaborating on projects in the future!

Trauma Bay with overhead plain film imaging. Spot the US machine!

 

 

My hosts in Melbourne standing next to the Geiger counter :)

No need with US!

EMUS Journal Club Wednesday March 6

9:15 am, Civic Small Conference Room

Sonographic Assessment of the optic nerve sheath in idiopathic intracranial hypertension
Jochen Bauerle, Max Nedelmann
J Neurol (2011) 258:2014-2019.

See you there!