Clinical Concepts in CT Imaging of the Chest

Clinical Concepts in CT Imaging of the Chest

A 45 yo Female presents to the ED with sudden onset of chest pain, described as worse when taking a deep breath.  She is significantly short of breath and appears distressed.  She recently underwent a total right knee arthroplasty and reports having been bedridden secondary to pain.  Physical exam is remarkable for a right lower extremity with surgical incisions that clean, dry, intact; however, her left lower extremity is swollen with significant tenderness along the popliteal fossa and calf.  

Vitals: Temp 99.2HR 120RR: 28 BP:  130/80 SpO2 90% on RA.

A CTPA is ordered...

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Interpretation of Cervical Spine CT's

Interpretation of Cervical Spine CT's

It's 6pm in the ED on a sunny summer afternoon- you're working as a single coverage physician at a level 3 trauma center.  You are noticing an uptrend in the trauma patients being brought in over the past few hours. While log rolling yet another patient, an EMS provider tells you that they have been making runs nonstop- all of the hospitals downtown are overloaded, and it doesn't look like it will slow down anytime soon. Your modest trauma bay is already full, and you're starting to sweat about the state of the department- there are 4 patients in the pod you haven't even seen yet, 2 with abnormal vital signs.

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CT Abdomen and Pelvis - Hollow Viscus

CT Abdomen and Pelvis - Hollow Viscus

It's weird how you get runs of patients in the ED.  Some days it seems like it's nothing but wall-to-wall low risk chest pain, altered mental status, or back pain.  Today (and a lot of other days), it's abdominal pain.  Scanning the board you see seemingly nothing but Level 3 acuity patients with the chief complain of "Abdominal pain."  Out of the scores of patient's, you seen so far, the last 2 worry you the most:

Andrea is a very pleasant 20 year old student from a local college.  She came in after having symptoms of right lower quadrant pain over the course of the past 8-12 hours.  She didn't recall any migratory symptoms but does endorse a lack of appetite, nauseousness, 2 episodes of vomiting (started after the pain), and steadily worsening pain.

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Isn't that CT Enough? - Water Cooler Breakdown of CT vs CT/LP for SAH

Isn't that CT Enough? - Water Cooler Breakdown of CT vs CT/LP for SAH

Why Should You Care?

  • Headache approximates 2% of presenting complaints to the ED, and SAH is identified in approximately 1% of those patients with headache in the ED.
  • Overall mortality of SAH is high, estimated at 25-50% of patients dying within 6 months
  • If not fatal, SAH leaves approximately 33% of survivors with some appreciable neurological deficit affecting their ADLs.
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