1/n #POCUS M/68, vomiting since 6 hours, back pain since 1 h. Says no to chest pain /abd pain / dyspnea. Diaphoretic, vomiting, HR 90, RR 24, BP 128/70, SpO2 91% (air). Reduced BS left side, Abd distended, nontender. ECG normal. Is it acute aortic? Tried to get PLAX heart -
2/n - scanning right parasternal area - found the heart - hyperdynamic, but nothing grossly wrong there.
3/n #POCUS Another look at left hemithorax anteriorly (parasaggital plane, mid-clavicular line, 4th. ICS)
4/n Scanning left hemithorax long axis cranial-caudal slide 3rd ICS ant axillary - looks like eventration of left hemidiaphragm with distended stomach below it
5/n scanning abdomen - features of small bowel obstruction. Dilated jenunal loop in near field, with bidirectional peristalsis, and dilated ileum in far field
6/n - all of the above within 10 min of patient arrival. Proceeded to insert NGT, called for portable CXR
- no surprise.
7/n - surgical colleagues at bedside, pt taken for surgery (via CT)
8/8 - Surgery: terminal ileum stricture obstructed by a phytobezoar. Resection/anastomosis, SICU, extubated at 48 h, doing well.

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More from @DrShukla14

30 Sep
Thread 1/4 - #POCUS Case - MPA+bilateral PE. HR 110, BP 94/68, Sats 98% room air. Subjectively, patient feels well, no dyspnea/pain. Warm skin. Shifted to EM Resus. Lytic or not? Young pt, no known co-morbids / provocation.
2/4 #POCUS - RV does not seem dilated
3/4 #POCUS - IVC seems collapsed
Read 5 tweets
4 Jul
#POCUS case - F/80. Known mesenteric stenosis (celiac origin, and SMA). Has upper abdominal pain off and on - ? mesenteric angina. Now presents with severe upper abdominal pain. Tender+++ epigastrium, no peritonism. Normal GB ultrasound and lipase. Lactate 0.4. Previous CT:
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#POCUS Color doppler SMA
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27 Jun
Thread 1/n. #POCUS findings in a M/31, leg swelling and abdomen distention progressive since 1/12. Starting with right IJV (high gain setting)
Abdomen RUQ Image
Abdomen LUQ
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22 Sep 19
Thread - (1/n) #POCUS findings in Left Main coronary occlusion.. this is not a STEMI - its WORSE ! M/50, 12 h intermittent chest pain. 2 hours of constant chest pain. Normal BP, no rales... but.. ECG horrible.
Thread - (2/n) #POCUS findings in Left Main coronary occlusion
Thread - (3/n) #POCUS findings in Left Main coronary occlusion: Cardiology fellow seeing patients .. they (and I) can't appreciate any rales.. but this is how lungs appear all over anteriorly
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16 Sep 19
#POCUS guided above elbow radial nerve block thread (1/n) Identification or radial nerve
#POCUS guided radial nerve block thread (2/n): Actual block administration
#POCUS guided radial nerve block thread (3/n): This patient's abscess was eminently suitable for this block: M/50, diabetic, throbbing pain, temp 39.5
Read 5 tweets
16 Jul 19
Patient referred for arthrocentesis, suspected septic arthritis. #POCUS shows triceps abscess, NO effusion. Aspiration attempt could have contaminated the joint & CAUSED septic arthritis. Consider scanning before sticking any needles. Image
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