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Here you will find information regarding rotation schedules, academic resources, wellness and facts about our program and residents. Check out our bios and photos. Please also visit the Emergency Department's official residency website. This site is intended for Mount Sinai EM residency purposes only, and no information on these pages is intended or should be construed as medical advice. Read more.

Ultrasound Signs of Appendicitis

 

             

 

Appendicitis on ultrasound - the first step is to identify the appendix by finding a blind-ending tubular structure arising from the base of the cecum.

The sonographic signs of appendicitis include:

  • dilated appendix > 6mm outer diameter (left image)
  • noncompressible
  • distinct appendiceal wall layers due to edema (left image)
  • target appearance (axial section)
  • appendicolith - an echogenic focus with posterior shadowing
  • periappendiceal fluid collection (right image)
  • echogenic and prominent periappendiceal and pericecal fat
  • surrounding hypervascularity on color Doppler (centre image)

 

Credit:  http://radiologysigns.tumblr.com/post/29603927330/appendicitis-on-ultrasound

Visual Diagnosis

52F h/o Protein C deficiency with recent PE diagnosis started on anticoagulation 5 days ago presents with the following skin lesions.  Diagnosis?

 

 

 

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Dimer Dimes

Quantitative D-dimer is a common screening tool to rule-out pulmonary embolism in low-risk population but is there more that it can tell us?

 

Yes, there have been studies linking increasing d-dimers to: 1) likelihood of PE, 2) location of PE, and 3) clot burden.

1. The level of d-dimer has been shown that with increasing d-dimer magnitude, there is an increasing chance of diagnosing pulmonary embolism by computed tomography with correlatory values as follows (as published by Kaush)[1]:

D-Dimer        % with PE

0.58-1.0        3.6%

1.0-2.0           8.0%

2.0-5.0          16.2%

5.0-20           35.3%

>20                 45.5%

 

2. There have also been some studies showing correlation between d-dimer magnitudes and location of clot, showing the higher the d-dimer, the more likely the PE is proximal/main (median >5.0) pulmonary artery vs. lobar vs. segmental [2].

 

3. Higher d-dimer values showing higher clot burden as calculated by CT clot burden scoring  for d-dimer values >4.0 (avg clot score 10 vs. 5) [3]. However, clot scoring varies in its predictive value of outcomes and is not a reliable predictor of patient mortality [4,5,6].

References

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Severe Aortic Stenosis

Thirsty (for knowledge) Thursday

 

Patient is 72 yo F wtih PMH of HTN, severe aortic stenosis presented to ED with dizziness and shortness of breath, progressively worse over the last 2 weeks, both symptoms worse with exertion. Patient progressively becomes hypotension to 70′s/40′s but still responsive, you strongly suspect this is secondary to the patient’s severe aortic stenosis. What is the pressor of choice in aortic stenosis?

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Ebola Screening Guidelines

Thanks to Dr. Sallustio for these guidelines on screening for Ebola infections in the Emergency Department

Ebola Screening Guidlines

Jeremy Faust


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