Drs. Angela Pikus, Alex Blackwell, Mark Baumgarten, Rosa Malloy-Post are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
• Naloxone-Associated Aspiration Pneumonitis & Pulmonary Edema
• Superior Vena Cava Syndrome
• Pulmonary Aspergillosis And The “Air Crescent Sign”
• Needle-Chest Decompression & Recent Pneumothorax Literature
Dr. Escobar’s CMC X-Ray Mastery Project: December CasesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Blunt hemothorax
- Pulmonary contusion
- Lung Cancer with Bone Metastases
- Pneumomediastinum
- Pneumopericardium
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery October CasesSean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Dr. Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics including:
• Scoliosis
• Pneumothorax
• Parapneumonic Effusion
• Cardiomegaly
• Vaping associated lung injury
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: February CasesSean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Dr. Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics including:
• Myocarditis
• Pulmonary Contusions
• Clavicle Fracture
• Pneumonia
• Acute Chest Syndrome
• Pleural Effusion
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: May CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
Subcutaneous air
Osteopenia
Bronchiolitis
Constipation
Asthma exacerbation
Alveolar Rhabdomyosarcoma
Aspirated Foreign Bodies
Small Bowel Obstruction
Kyphoscoliosis
Pneumatocele
Cecal Volvulus
EMGuideWire's Radiology Reading Room: PneumomediastinumSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Pneumomediastinum and is brought to you by Jacob Leedekerken, MD and Chelsea Wilson, MD.
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: February CasesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
Bullous Lung Disease
Influenza Myocarditis Requiring Circulatory Support
Free Air representing:
Pneumothorax
Tension Pneumothorax
Pneumoperitoneum
Subdiaphragmatic Abscess
Pneumobilia
Subcutaneous Free Air
Pneumomediastinum
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: August CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
- Pneumatocele
- Croup
- Pulmonary Contusion
- Blast Injury
- Bowel Obstruction
- Lobar Pneumonia
- Cavitary Lung Lesions
- Ileus
- Malposition of Central Line
Drs. Escobar’s CMC X-Ray Mastery Project: November CasesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. They are joined by Marianne Dannemiller, PA who is an APP for Sanger Heat & Vascular Institute. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Aortic Aneursym
- Endovascular Aortic Repair (EVAR)
- EVAR Endoleak
- Right Sided Aortic Arch
- Tension Pneumothorax
- Thyroid Mass
Dr. Escobar’s CMC X-Ray Mastery Project: December CasesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Blunt hemothorax
- Pulmonary contusion
- Lung Cancer with Bone Metastases
- Pneumomediastinum
- Pneumopericardium
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery October CasesSean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Dr. Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics including:
• Scoliosis
• Pneumothorax
• Parapneumonic Effusion
• Cardiomegaly
• Vaping associated lung injury
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: February CasesSean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Dr. Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics including:
• Myocarditis
• Pulmonary Contusions
• Clavicle Fracture
• Pneumonia
• Acute Chest Syndrome
• Pleural Effusion
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: May CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
Subcutaneous air
Osteopenia
Bronchiolitis
Constipation
Asthma exacerbation
Alveolar Rhabdomyosarcoma
Aspirated Foreign Bodies
Small Bowel Obstruction
Kyphoscoliosis
Pneumatocele
Cecal Volvulus
EMGuideWire's Radiology Reading Room: PneumomediastinumSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Pneumomediastinum and is brought to you by Jacob Leedekerken, MD and Chelsea Wilson, MD.
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: February CasesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
Bullous Lung Disease
Influenza Myocarditis Requiring Circulatory Support
Free Air representing:
Pneumothorax
Tension Pneumothorax
Pneumoperitoneum
Subdiaphragmatic Abscess
Pneumobilia
Subcutaneous Free Air
Pneumomediastinum
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: August CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
- Pneumatocele
- Croup
- Pulmonary Contusion
- Blast Injury
- Bowel Obstruction
- Lobar Pneumonia
- Cavitary Lung Lesions
- Ileus
- Malposition of Central Line
Drs. Escobar’s CMC X-Ray Mastery Project: November CasesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. They are joined by Marianne Dannemiller, PA who is an APP for Sanger Heat & Vascular Institute. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Aortic Aneursym
- Endovascular Aortic Repair (EVAR)
- EVAR Endoleak
- Right Sided Aortic Arch
- Tension Pneumothorax
- Thyroid Mass
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: September CasesSean M. Fox
Drs. Breeanna Lorenzen and Travis Barlock are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
• Aortic Transection
• Hemothorax
• Innominate Artery Transection
• Dextrocardia
• Situs Inversus
• Pneumonia
• Complete Lung Consolidation
• Septic Pulmonary Emboli
• Pulmonary Metastases
• Pneumothorax
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #5 CasesSean M. Fox
Dr. Michael Gibbs is a Professor of Emergency Medicine and interested in educating others. Radiology is a passion of his. Follow along with the EMGuideWire.com team as they post Dr. Gibbs's weekly educational, self-guided radiology slides on: Acute aortic dissection, cardiomegaly, right mainstem intubation, right middle lobe pnuemonia, lung ass, pulmonary necrosis
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1Sean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team as they post these weekly educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics!
Drs. Milam and Thomas's CMC X-Ray Mastery Project: April CasesSean M. Fox
Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on:
• Esophageal Perforation
• Perforated Viscous
• Pneumothorax
• Traumatic Diaphragmatic Hernia
• Pulmonary Contusion
• COVID-19 associated Pneumonia
• COVID-19
• Influenza Like Illness
Drs. Milam and Thomas's CMC X-Ray Mastery Project: August CasesSean M. Fox
Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on: Aortic Dissection, Hiatal Hernia, Pleural Effusion, Metastatic Cancer, Cystic Fibrosis, Pulmonary Contusions, Esophageal-pleural Fistula, Diaphragmatic Hernia, Pulmonary Artery Hypertension, Hemorrhagic Pericardial Effusion, Pulmonary Infarct
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: January CasesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. Lauren Ramsey, PA-C works with the Sanger Heart & Vascular Institute. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Atrial Myxoma
- Cardiac Lymphoma
- Small Cell Lung Cancer
- Metastatic Cervical Squamous Carcinoma
- Spontaneous Pneumothorax
Acute Chest Syndrome - EMGuidewire's Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Acute Chest Syndrome and is brought to you by Angela Pikus, MD, Mark Baumgarten, MD, Andres Gil Bustamante, and Ahmed Mashal, MD. As always, Michael Gibbs, MD serves as the projects editor.
EMGuideWire's Radiology Reading Room: PneumoniaSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Pneumonia and is brought to you by Elissabeth Hagler, MD and Tom Shuman, MD. Guest Editor is Michael Leonard, MD, Infectious Disease specialist.
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: December CasesSean M. Fox
Drs. Breeanna Lorenzen and Travis Barlock are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Acute Chest Syndrome
- Multifocal Pneumonia
- Hiatal Hernia
- Hemopneumothorax
- Aortic Transection
- Pneumomediastinum
- Pulmonary Infarction
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: September CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
• Non-accidental Trauma (NAT)
• Hyperinflated Lungs
• Esophageal Foreign Body
• Neonatal Pulmonary Abscess
• Neonatal Pneumatocele
• Tuberculosis
• Interstitial Lung Disease of Prematurity
• Disseminated Neonatal HSV
• Aspirated Foreign Body
Drs. Milam and Thomas's CMC X-Ray Mastery Project: June CasesSean M. Fox
Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on:
• Pneumothorax
• Non-cardiogenic Pulmonary Edema
• COVID – 19
• Right Lower Lobe Pneumonia
• Diaphragmatic Hernia
• Lung Abscess
• Miliary Tuberculosis
• Asbestosis
EMGuideWire's Radiology Reading Room: Septic Pulmonary EmboliSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Septic Pulmonary Emboli and is brought to you by Victoria Serven, MD, Travis Barlock, MD, and Katherine Sillman, NP.
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: January CasesSean M. Fox
This document provides an overview of an ongoing chest x-ray interpretation series aimed at promoting mastery of chest x-ray interpretation. It discusses several cases presented in the series, including a perforated gastric ulcer, pulmonary arterial hypertension, a ruptured diaphragm, cavitary tuberculosis, pneumocystis pneumonia with spontaneous pneumothorax, and lower rib fractures with an associated splenic injury. The goal of the series is to teach anatomy and common pathologies through case examples. Contributors to the series come from various medical centers and specialties around the world.
Drs. Milam and Thomas's CMC X-Ray Mastery Project: May CasesSean M. Fox
Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on:
• Spontaneous Pneumothorax
• Esophageal Stent
• Iatrogenic Pneumothorax
• Pleural Effusion
• Shoulder Dislocation
• Proximal Humeral Fracture
• Aspiration Event
• Subcutaneous Emphysema
• Metastatic Germ Cell Cancer
• ARDS
• Right Lower Lobe Pneumonia
• Mediastinal Mass
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery August CasesSean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Dr. Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics including: Tetralogy of Fallot, Pneumonia, Bronchiolitis, Esophageal Foreign Body, Pneumothorax, ECMO
Drs. Milam and Thomas's CMC X-Ray Mastery Project: February CasesSean M. Fox
Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on:
• Mycoplasma pneumonia
• Thoracic aortic aneurysm
• Hydropneumothorax
• Sternal fracture
• Foreign body
• Iatrogenic pneumothorax
• Pulmonary contusion
• Type A aortic dissection
• Cardiomegaly
• PCP pneumonia
• Pneumothorax
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery November CasesSean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Dr. Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics including:
- Tension Pneumothorax
- Atelectasis
- Esophageal Obstruction / Achalasia
- Right Upper Lobe Mass
- Right Upper and Right Middle Lobectomies
- Esophageal Foreign Body
- Transposition of the Great Vessels
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: November CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
- Line Identification
- Thoracic Trauma
- Neutropenic Fever
- ARDS
- ECMO
- Pneumomediastinum
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: April CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
• Tension pneumothorax
• MIS-C
• Fungal Pneumonia
• Systemic JIA
• Large Pericardial Effusion
• Post-obstructive Pulmonary Edema
• Normal Thymus
• Pneumonia
- This document describes a rare case of right hemidiaphragm paralysis following repair of esophageal atresia and tracheoesophageal fistula.
- The infant underwent an extrapleural ligation of the fistula with primary anastomosis and was discharged after two weeks. However, at two months he presented with shortness of breath and pneumonia.
- After conservative management failed, the infant underwent a right-sided thoracotomy with plication of the paralyzed diaphragm. Post-operatively his symptoms resolved.
Implanted Devices - VP Shunts: EMGuidewire's Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Ventriculoperitoneal Shunts and their Complications and is brought to you by Brandon Friedman, MD, Kelsey Patterson, and L. Erin Miller MD. It is has special guest editor: Scott Wait, MD
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Sternal Fractures and Dislocations and is brought to you by Carrie Bissell, MD, Aaron Fox, MD, Kendrick Lim, MD, Stephanie Jensen, MD, and Olivia Rice, MD. It is has special guest editor: Sean Dieffenbaugher, MD and Laurence Kempton, MD
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The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Septic Pulmonary Emboli and is brought to you by Victoria Serven, MD, Travis Barlock, MD, and Katherine Sillman, NP.
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: January CasesSean M. Fox
This document provides an overview of an ongoing chest x-ray interpretation series aimed at promoting mastery of chest x-ray interpretation. It discusses several cases presented in the series, including a perforated gastric ulcer, pulmonary arterial hypertension, a ruptured diaphragm, cavitary tuberculosis, pneumocystis pneumonia with spontaneous pneumothorax, and lower rib fractures with an associated splenic injury. The goal of the series is to teach anatomy and common pathologies through case examples. Contributors to the series come from various medical centers and specialties around the world.
Drs. Milam and Thomas's CMC X-Ray Mastery Project: May CasesSean M. Fox
Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on:
• Spontaneous Pneumothorax
• Esophageal Stent
• Iatrogenic Pneumothorax
• Pleural Effusion
• Shoulder Dislocation
• Proximal Humeral Fracture
• Aspiration Event
• Subcutaneous Emphysema
• Metastatic Germ Cell Cancer
• ARDS
• Right Lower Lobe Pneumonia
• Mediastinal Mass
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery August CasesSean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Dr. Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics including: Tetralogy of Fallot, Pneumonia, Bronchiolitis, Esophageal Foreign Body, Pneumothorax, ECMO
Drs. Milam and Thomas's CMC X-Ray Mastery Project: February CasesSean M. Fox
Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on:
• Mycoplasma pneumonia
• Thoracic aortic aneurysm
• Hydropneumothorax
• Sternal fracture
• Foreign body
• Iatrogenic pneumothorax
• Pulmonary contusion
• Type A aortic dissection
• Cardiomegaly
• PCP pneumonia
• Pneumothorax
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery November CasesSean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Dr. Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics including:
- Tension Pneumothorax
- Atelectasis
- Esophageal Obstruction / Achalasia
- Right Upper Lobe Mass
- Right Upper and Right Middle Lobectomies
- Esophageal Foreign Body
- Transposition of the Great Vessels
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: November CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
- Line Identification
- Thoracic Trauma
- Neutropenic Fever
- ARDS
- ECMO
- Pneumomediastinum
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: April CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
• Tension pneumothorax
• MIS-C
• Fungal Pneumonia
• Systemic JIA
• Large Pericardial Effusion
• Post-obstructive Pulmonary Edema
• Normal Thymus
• Pneumonia
- This document describes a rare case of right hemidiaphragm paralysis following repair of esophageal atresia and tracheoesophageal fistula.
- The infant underwent an extrapleural ligation of the fistula with primary anastomosis and was discharged after two weeks. However, at two months he presented with shortness of breath and pneumonia.
- After conservative management failed, the infant underwent a right-sided thoracotomy with plication of the paralyzed diaphragm. Post-operatively his symptoms resolved.
Similar to Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Project: Case #45 (20)
Implanted Devices - VP Shunts: EMGuidewire's Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Ventriculoperitoneal Shunts and their Complications and is brought to you by Brandon Friedman, MD, Kelsey Patterson, and L. Erin Miller MD. It is has special guest editor: Scott Wait, MD
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Sternal Fractures and Dislocations and is brought to you by Carrie Bissell, MD, Aaron Fox, MD, Kendrick Lim, MD, Stephanie Jensen, MD, and Olivia Rice, MD. It is has special guest editor: Sean Dieffenbaugher, MD and Laurence Kempton, MD
Diaphragmatic Injuries - Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Diaphragm Injury and is brought to you by Kylee Brooks, MD, Parker Hambright, MD, Alexis Holland, MD, and William Lorenz, MD. It is has special guest editor: Kyle Cunningham, MD
Adult Orthopedic Imaging Series: Presentation #2 Native Hip DislocationsSean M. Fox
Drs. Carrie Bissell, Aaron Fox, and Kendrick Lim are Emergency Medicine Residents at Carolinas Medical Center and are interested in emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine and Dr. Laurence Kempton, an Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides that focus on Adult Orthopedic cases. This set will cover:
- Hip Dislocations
Neuroimaging Mastery Project: Presentation #5 Subdural HematomasSean M. Fox
Drs. Faith Meyers, Madison Watts and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center who are interested in medical education. Dr. Rebecca DeCarlo, MD is a Neurosurgical resident at Carolinas Medical Center. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Subdural Hematomas. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
- Subdural Hematomas
Neuroimaging Mastery Project Presentation #4: Acute Epidural HematomasSean M. Fox
Drs. Faith Meyers, Madison Watts and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center who are interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Atraumatic Neurosurgical Intracranial Infections. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
- Acute Epidural Hematomas
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow FracturesSean M. Fox
The document provides an overview of commonly encountered pediatric elbow injuries seen in the emergency department setting. It reviews the anatomy and imaging evaluation of pediatric elbow fractures including the supracondylar humerus, radial neck, lateral condyle, and medial epicondyle fractures. Specific radiographic findings that help identify subtle fractures are discussed. Challenges in pediatric elbow imaging related to ossification centers are also covered. The goal is to help emergency physicians accurately diagnose pediatric elbow fractures on radiographs.
Adult Orthopedic Imaging Mastery Project - Pelvic Ring FracturesSean M. Fox
The document discusses different types of pelvic ring injuries including lateral compression, anterior-posterior compression, and vertical shear fractures. It emphasizes the importance of early resuscitation, pelvic stabilization, and considering advanced measures or angiography to control hemorrhage in unstable patients. The case examples demonstrate imaging features and management approaches for different pelvic fracture patterns.
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptxSean M. Fox
Drs. Faith Meyers and Steven Perry are Emergency Medicine Residents and Trent VanHorn is a Neurosurgical Resident at Carolinas Medical Center who are interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Atraumatic Neurosurgical Intracranial Infections. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
This set will cover:
Atraumatic Neurosurgical Intracranial Infections
Subdural Empyema and Brain Abscess
CMC Neuroimaging Case Studies - Cerebral Venous Sinus ThrombosisSean M. Fox
Drs. Faith Meyers, Steven Perry, Madison Watts, and Brandon Friedman are Emergency Medicine Residents at Carolinas Medical Center and interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Cerebral Venous Sinus Thrombosis. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
This set will cover:
- Cerebral Venous Sinus Thrombosis
Abdominal Imaging Case Studies #27.pptxSean M. Fox
Drs. Kylee Brooks and Parker Hambright are Emergency Medicine Residents and Drs. Alexis Holland and William Lorenz are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham, Brent Matthews, and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
• Iatrogenic Esophageal Perforation
• Emphysematous Cystitis
• Meckel’s Diverticulum
• Paraesophageal Hernia
Blood Can Be Very Very Bad - CMC Neuroimaging Case StudiesSean M. Fox
Drs. Faith Meyers and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center and interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this initial educational slideset, they are also joined by Dr. Andrew Perron, the creator of the “Blood Can Be Very Bad” Head CT interpretation framework. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
This set will cover:
- The Neuroimaging Framework “Blood Can Be Very Very Bad.”
Drs. Angela Pikus, Alex Blackwell, Mark Baumgarten, Rosa Malloy-Post are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
• Abnormalities of the Thoracic Aorta
o Traumatic aortic disruption
o Thoracic aortic aneurysm with acute dissection
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane OxygenationSean M. Fox
Drs. Kaley El-Arab and Brandon Friedman are Emergency Medicine Residents at Carolinas Medical Center and interested in medical education and Critical Care. They have teamed with Ms. Emily Lipitz a PA with the Sanger Heart & Vascular Institute. Along with the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and Dr. John Symanski, a cardiologist from the Sanger Heart & Vascular Institute, they aim to help augment our understanding of emergent imaging of implanted devices. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Extracorporeal Membrane Oxygenation
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...Sean M. Fox
Drs. Kylee Brooks and Parker Hambright are Emergency Medicine Residents and Drs. Alexis Holland and William Lorenz are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham, Brent Matthews, and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s cases include:
- Pyogenic Liver Abscess
- Bladder Rupture
- Sigmoid Volvulus
CMC Pediatric X-Ray Mastery: 27th Case SeriesSean M. Fox
This document presents a series of pediatric chest x-ray cases for interpretation and learning. It discusses six cases, providing images and summaries of the findings. The cases include a clavicle fracture, congenital diaphragmatic hernia, normal thymic shadow, duodenal atresia, Hirschsprung's disease, and malpositioned lines and tubes. The goal is to promote mastery of chest x-ray interpretation through discussion of real cases submitted from various medical centers and countries.
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...Sean M. Fox
Dr. Haley Dusek is an Emergency Medicine Resident and interested in pediatric emergency medicine and medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, and supervision of Dr. Danielle Sutton, a Pediatric Emergency Medicine specialist, and Dr. Virginia Casey, a Pediatric Orthopedic Surgeon, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
• Tufts fracture
• Mallet fracture
• Seymour fracture
• Volar Plate Injury
• Base fracture
• Phalangeal neck
• Condyle fracture
• Phalanx dislocations
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Sean M. Fox
This document provides an overview of an ongoing chest x-ray interpretation series aimed at promoting mastery of chest x-ray interpretation. It discusses topics covered in prior presentations including peripartum cardiomyopathy, left ventricular assist devices, and pleural effusions. Appendices provide references for articles related to peripartum cardiomyopathy. The document also announces that next month's presentation will cover new diagnoses.
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case SeriesSean M. Fox
Drs. Daniel Escobar, Angela Pikus, and Alex Blackwell are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
- Traumatic Pneumothorax
- Flail Chest And Surgical Rib Fixation
- Traumatic Pulmonary Pseudocyst
- Stab Wound To The Heart
CMC Pediatric X-Ray Mastery: 26th Case SeriesSean M. Fox
Drs. Kaley El-Arab and Taylor Anderson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
- Penetrating Chest Trauma
- Meconium Aspiration Syndrome
- Respiratory Distress Syndrome
- Pneumothorax
- Pneumatosis
- Rickets of prematurity
- Disseminated HSV
- VACTERL
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
How Barcodes Can Be Leveraged Within Odoo 17Celine George
In this presentation, we will explore how barcodes can be leveraged within Odoo 17 to streamline our manufacturing processes. We will cover the configuration steps, how to utilize barcodes in different manufacturing scenarios, and the overall benefits of implementing this technology.
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
🔥🔥🔥🔥🔥🔥🔥🔥🔥
إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
💀💀💀💀💀💀💀💀💀💀
تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
🔥🔥🔥🔥🔥🔥🔥🔥🔥
This presentation was provided by Rebecca Benner, Ph.D., of the American Society of Anesthesiologists, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Project: Case #45
1. Adult Chest X-Rays Of The Month
Angela Pikus, MD, Mark Baumgarten, MD,
Alex Blackwell, MD, Rosa Malloy-Post, MD
Departments of Emergency Medicine
Carolinas Medical Center & Levine Children’s Hospital
Michael Gibbs, MD - Faculty Editor
CMC Imaging Mastery Project
Presentation #45
2. Disclosures
This ongoing imaging interpretation series is proudly sponsored by the
Emergency Medicine Residency Program at Carolinas Medical Center.
The goal is to promote diagnostic imaging interpretation mastery.
There is no personal health information [PHI] within, and all ages have
been changed to protect patient confidentiality.
6. 35-Year-Old-Male
Found Down At
Home, Obtunded
And Covered In
Vomit. Given 4mg
Of Narcan By EMS.
Hypoxemic And
Combative On ED
Arrival.
ED Vital Signs
T 97.1, HR 149, RR 31,
BP 128/79, SPO2 86%
Initial ED Chest X-Ray
10. Image From Biology Forums.
The Obtuse Take-Off Angle Of The Right Mainstem
Bronchus Makes Right Lung Aspiration More Likely.
11. 27-Year-Old-Male
Found Down By
EMS Following A
Suspected
Overdose. 6 mg Of
IM Naloxone Given.
ED Vital Signs
T: 99.5, HR: 110, RR: 30,
SPO2: 78% On 10L
GCS = 8 In The ED.
Initial ED Chest X-Ray
13. 1 Hour Later
Given Persistent
Hypoxia, The
Patient Was Placed
On A Naloxone
Drip.
ED Vital Signs
T 99.5, HR 103, RR 43,
SPO 72% On 10L
Diagnosis: Naloxone-Related Pulmonary Edema
15. 4 Hours Later
The Patient Is
Intubated But
Remains
Persistently
Hypoxemic.
A Decision Is Made
To Initiate
V-V ECMO
Support.
Worsening Infiltrates With Near “White Out”
19. Extracorporeal Membrane Oxygenation (ECMO)
Indications: Acute, severe reversible respiratory or cardiac failure with
a high risk of death that is refractory to conventional therapies.
V-V = veno-venous
V-A = veno-arterial
20. V-V ECMO
Support for severe pulmonary failure (w/o cardiac failure).
Clinical Condition Appropriate For V-V ECMO
• Pneumonia
• ARDS
• Acute GVHD
• Pulmonary contusion
• Smoke inhalation
• Status asthmaticus
• Airway obstruction
• Aspiration
• Bridge to lung transplant
• Submersion injury
21. Figure 1: V-V ECMO
Blood is drained from the femoral vein
and returned to the right heart.
22. Figure 2: V-V ECMO
Central venous blood is drained, and
oxygenation blood is returned to the
right atrium.
23. V-A ECMO
Support for cardiac failure (+/- pulmonary failure).
Clinical Condition Appropriate For V-A ECMO
• Graft failure post heart or heart
lung transplant
• Non-ischemic cardiogenic shock
• Failure to wean post
cardiopulmonary bypass
• Bridge to LVAD
• Drug overdose
• Sepsis
• Pulmonary embolus
• Cardiac or major vessel trauma
• Massive pulmonary hemorrhage
• Pulmonary trauma
• Acute anaphylaxis
24. Figure 3: V-A ECMO
Central venous blood is drained, and
oxygenation blood is returned to the
arterial system.
25. Naloxone-Induced
Non-Cardiogenic
Pulmonary Edema
• Rare and thought to occur in 0.2-3.6% of patients
(based on data from elective post-operative
anesthetic reversal).
• Mostly reported in patients with co-existing cardiac
disease and/or in young adults with obstructive sleep
apnea.
• Thought to be caused by catecholamine release
which antagonizes the mu-opioid receptors in the
adrenal medulla; leading to increased pulmonary
blood volumes and pressures, and increased capillary
permeability.
Jiwa, Nasheena et al. “Naloxone-Induced Non-Cardiogenic
Pulmonary Edema: A Case Report.” Drug Safety - Case Reports
Vol. 5,1 20. 10 May. 2018, doi:10.1007/s40800-018-0088-x
26. Objective
To determine whether administration of higher doses of naloxone for the treatment of opioid
overdose is associated with increased pulmonary complications.
Methods
Retrospective, observation study of 1,831 patients treated with naloxone by the City of
Pittsburgh EMS. “High-dose” naloxone was defined as a total administration exceeding 4.4 mg.
27. Results
• Patients receiving high dose naloxone were 62% more likely to have a pulmonary complication
(42% versus 26% absolute risk; odds ratio 2.14; 95% CI 1.44 to 3.18).
• When the initial dose of naloxone exceeded 0.4 mg, there was an increased risk of pulmonary
complications (27% versus 13% absolute risk; odds ratio 2.57; 95% CI 1.45 to 4.54).
• Pulmonary edema occurred in 1.1% of patients.
Recommendations
• Naloxone-associated pulmonary complications are rare and dose-dependent.
• Titrate naloxone carefully to achieved the desired clinical effect.
29. What Should You
Look For
On Chest X-Ray?
Pulmonary Interstitial Edema
• Kerley B lines
• Peri-bronchial cuffing
Pulmonary Alveolar Edema
• “Bat wing” pattern
• Air bronchograms
Cardiomegaly
Pulmonary Vascular Engorgement
• Vascular cephalization
30. 42-Year-Old With
5 Months Of
Progressive Chest
Discoloration,
Dyspnea,
Dysphagia And
Hoarseness.
Sent To The ED
After His PCP
Ordered A Chest
CT.
CT Scout Film
31. Large Irregular Mediastinal Mass
42-Year-Old With
5 Months Of
Progressive Chest
Discoloration,
Dyspnea,
Dysphagia And
Hoarseness.
Sent To The ED
After His PCP
Ordered A Chest
CT.
34. • A Core Biopsy Demonstrated Primary Mediastinal B-Cell Lymphoma (PMBCL).
• A Staging PET Scan Demonstrated A Large Hypermetabolic Mediastinal Mass With No
Other Disease Outside The Chest, Consistent With Stage 1.
• Treatment Was Initiated With Steroids, Chemo & Radiation Therapy.
35. After 1 Month Of Treatment The Size Of The Mass Is Reduced
36. 43-Year-Old With
3 Weeks Of
Progressive Right
Arm & Neck
Swelling.
www.EMguidewire.com October 2019
37. 43-Year-Old With
3 Weeks Of
Progressive Right
Arm & Neck
Swelling.
What Is
This?
www.EMguidewire.com October 2019
Notice The Leftward
Deviation Of The
Trachea & Spine
38. 43-Year-Old With 3 Weeks Of Progressive Right Arm & Neck Swelling
Lung
Mass
Compressed
Superior
Vena Cava
Superior Vena Cava Syndrome
www.EMguidewire.com October 2019
39.
40. Superior Vena Cava Syndrome
Anatomy And Physiology:
• Obstruction by the superior vena cava caused by either extrinsic
compression, i.e.: masses in the middle and anterior mediastinum
(tumor, infectious process, adenopathy, aortic aneurysm…), or
intrinsic obstruction, i.e.: thrombosis.
• Collateral flow to the inferior vena cave or azygous vein is established.
• Edema of the head, neck and upper extremities results.
• The severity of symptoms depends on the degree of obstruction and
the speed of onset.
41.
42. Superior Vena Cava Syndrome
Causes:
Overall
Thrombosis And Non-Malignant Causes
Increased use of catheters and pacemakers
35%
Malignant Causes
Non-small cell lung cancer
Small-cell lung cancer
Lymphoma
Metastatic
Cancer
50%
25%
10%
10%
65%
43. Superior Vena Cava Syndrome
Pathophysiology:
Edema Manifestations
Scalp/Face/Arms Physically striking but usually of little
consequence
Eyes Visual symptoms
Brain Headaches, confusion, encephalopathy
Larynx Stridor, hoarseness, airway obstruction
44.
45. 48-Year-Old
Homeless Male With
No Past Medical
History Presents
With 3-5 Days Of
Body Aches, Cough,
Fever.
ED Vital Signs Are Stable
46. Circular Right Upper Lobe Density
48-Year-Old
Homeless Male With
No Past Medical
History Presents
With 3-5 Days Of
Body Aches, Cough,
Fever.
ED Vital Signs Are Stable
48. Air Crescent Sign: Circular Lesion With A Central
Density Partially Surrounded By A Rim Of Air.
48-Year-Old Homeless Male With 3-5 Days Of Body Aches, Cough, Fever.
49. 48-Year-Old Homeless Male With 3-5 Days Of Body Aches, Cough, Fever.
Air Crescent Sign: Circular Lesion With A Central
Density Partially Surrounded By A Rim Of Air.
50. Air Crescent Sign
• Half-moon-shaped collection of air in the
periphery of an intracavitary nodule,
separating the nodule from the cavity wall.
• Aspergillosis is the most common cause.
• The differential also includes cavitary
bronchogenic carcinoma, intracavitary
clot, and Rasmussen’s aneurysm in the
setting of prior tuberculosis.
• Rarer causes include foreign bodies, thick
pus, teratoma, and hydatid cysts.
Repositioning the patient (supine and
prone) during CT can help identify the
etiology. A mobile central mass suggests a
fungus ball or clot. A fixed central mass
suggests carcinoma or aneurysm.
51. QJM: An International Journal of Medicine 2019:47-48.
Clinical Picture: Diabetes Mellitus and Air Crescent Sign
66-year-old with poorly controlled diabetes presents with cough, fever, and dyspnea. He was admitted and started on
levofloxacin. His condition worsened and on Day 3 a chest CT revealed bilateral consolidation with several areas rimmed by
air (air crescent sign →). Bronchoscopy confirmed Aspergillosis and the patient responded well to amphotericin B.
52. Diagnostic & Interventional Radiology 2015; 96:435-442.
Pulmonary Aspergillosis
Lobectomy pathologic specimen demonstrating an
aspergilloma (“fungus ball”) within a cavity.
53. Infectious and Non-Infectious Diseases Causing the Air Crescent Sign:
A State-of-the-Art Review
Lung 2018:1-10. //doi.org/10.1007/s00408-017-0069-3.
Ruptured Hydatid Cyst Metastatic Uterine Cancer
54. Supine
Prone
Rasmussen’s Aneurysm
• No mobility with positioning
• Nodule enhancement
40-Year-Old Presenting With One Month Of Cough, Fever,
Weight Loss And Recent Hemoptysis.
Nodule Enhancement
Lung 2018:1-10. //doi.org/10.1007/s00408-017-0069-3.
55. Back To Our Patient
• The patient was admitted and treated with IV antibiotics
• AFB x3 and QuantiFERON were both negative for tuberculosis
• The diagnosis of Aspergillosis was confirmed by the analysis of
bronchoscopy samples and cultures
• The patient responded well to treatment with amphotericin B
59. Systematic review of 15 studies.
Thickness (mm)
MCL 42.79
MAL 39.85
AAL 34.33
MCL: Mid-Clavicular Line
MAL: Mid Axillary Line
AAL: Anterior Axillary Line Injury. 2016;47:797-804-564.
60. Emergency Needle
Thoracostomy Set
COLLAPSED EXPANDED
Cook products services program Portal
Order Number
Order Number Reference Part Number
Reference Part Number
Instructions
Instructions
for Use
for Use
MR
MR
Status
Status
Catheter
Catheter
Fr
Fr
Catheter
Catheter
Length
Length
cm
cm
Needle
Needle
gage
gage
More Info
More Info
Sets
Sets
G13722 C-TPTS-8.5-6.0-FSNS — 8.5 6 15 Expand »
G55524 C-TPTS-8.5-8.7-FSNS — 8.5 8.7 15 Expand »
Dry Sets
Dry Sets
G27292 C-TPTSJ-8.5-6.0-FSNS — 8.5 6 15 Expand »
Specifications
Specifications
Be Sure Your Catheter Is Long
62. Objective
To compare the diagnostic accuracy POCUS with chest X-ray for the diagnosis of
pneumothorax in Emergency Department (ED) trauma patients.
Methods
Comprehensive literature review from database inception to April 2020 – all prospective
paired accuracy studies were included. 13 studies were part of the analysis – capturing 410
traumatic pneumothorax patients out of 1271 patients).
Results
POCUS:
CXR:
Sensitivity 0.91 (95% CI 0.85 to 0.94); Specificity 0.99 (95% CI 0.97 to 1.00)
Sensitivity 0.47 (95% CI 0.31 to 0.63); Specificity 1.00 (95% CI 0.97 to 1.00)
Conclusions
The diagnostic performance of POCUS is superior to chest X-ray for the diagnosis of
pneumothorax in ED trauma patients.
63. Absence Of Lung Sliding Dynamic movement of the visceral on the parietal pleura during respirations.
Absence Of B-Lines Reverberation artifacts that disappear when air accumulates in the pleural space.
Lung Sliding B-Lines
64. Lung Point Sign Highly specific U/S finding that represents the point where the visceral pleura (lung) begins
to separate from the parietal pleura (chest wall) at the edge of the pneumothorax.
65. What Is The Latest Literature On The Management Of
Traumatic Pneumothorax In Stable Patients?
66. J Trauma Acute Care Surg. 2022;92: 951-957.
Objective
To assess a previously developed guideline to observe any pneumothorax (PNTX) <35 mm in stable patients.1,2
Methods
Single-center, retrospective, before (2015-2016) and after (2018-2019) review of all patient with CT-guided PNTX.
Patients with concurrent hemothorax, on mechanical ventilation, and dying in <24 hours were excluded.
Results
266 patients (37% before 2017 and 63% after 2017) were included and there were no demographic differences
between groups. Tube thoracostomy placement decreased from 28.3% to 18%. There were no differences in
hospitalization outcomes, complications, or mortality.
Conclusion
The 35 mm Guideline is an effective tool to decrease unnecessary tube thoracostomy in stable patients without
evidence of hemothorax.
1Pneumothorax dimensions were determined using measurement of an axial chest CT.
2By protocol chest X-rays were repeated at 4 and 24 hours.
67. J Trauma Acute Care Surg. 2019;86: 557-564.
The Original 2019 Study
• Retrospective review 2011-2016
• 832 total pneumothorax patients
• Hemothorax & ventilated patients excluded
• Patients divided into <35 or >35 mm
• 257 patients had a PNTX <35 mm
Observation was successful in 91%
Important Caveats:
• This approach is only for non-ventilated patients
• Longer hospitalizations may result
• Several factors will impact decision making
68. Diagnoses This Month
• Naloxone-Associated Aspiration Pneumonitis & Pulmonary Edema
• Superior Vena Cava Syndrome
• Pulmonary Aspergillosis And The “Air Crescent Sign”
• Needle-Chest Decompression & Recent Pneumothorax Literature