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drshukla14

5 Oct, 9 tweets, 3 min read

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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drshukla14

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