Patient with epig pain and multiple ED visits with neg CT and non-specific labs - but persistent pain. What do you do? GI cocktail + famotidine and discharge? How about a little #POCUS first. #FOAMed #FOAMus #Ultrasound #MedTwitter @mtabbut @laurarbrownmd @RJonesSonoEM
And the transverse view. What do you think now? Poll below in thread. #Whatsthedx #EmergencyMedicine @DianeGramer @SLWerner_EM @ClaridgeJeffrey @vanessapho @ladha_prerna
What do you think?
Patient with acute cholecystitis. Note here the stones layering in the dependent portion of the gallbladder (red arrows) with the posterior dark shadowing dark shadowing (blue arrows)
With gallbladder dissension (>4cm) in the transverse orientation.
And gallbladder wall thickening (>3mm)
And even a small amount of pericholecystic fluid.
Take home points:
1. Don't forget to consider the gallbladder in patients with epig pain and non-specific labs.
2. Cholecystitis is a clinical dx with sono findings (stones + wall thick, biliary dissension, PCF, sono-murphy sign).
Take home points 2/2:
3. If pt condition changes or doesn't improve - don't be afraid to re-image - perhaps a different way.

Good article about #POCUS for Acute Chole.

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More from @MH_EMultrasound

11 Mar
Goal and benefit of POCUS is to rapidly narrow the differential diagnosis through asking and answering defined clinical questions.
POCUS will narrow the differential more rapidly
Read 18 tweets
10 Mar
Patient with hx ESRD on dialysis and multiple previous central catheters. Needs central line. #POCUS as shown. Go ahead and place the line? Poll in thread. #FOAMed #FOAMus #MedTwitter #EmergencyMedicine @mtabbut @RJonesSonoEM @SLWerner_EM @NephroP @siddharth_dugar
Place the line here?
Answer: This patient with chronic thrombus at the shown location. Best to look for a different location.
Read 4 tweets

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