crepitus emphysema effusion

Orbital Emphysema following ocular trauma and sneezing.

#Orbital #Emphysema #ocular #physicalexam #ophthalmology #clinical #video #crepitus

Orbital Emphysema ... #Orbital #Emphysema ... clinical #video #crepitus

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Subcutaneous Emphysema on Physical Exam

Dr. Manrique Umana @umanamd

#Subcutaneous #Emphysema #PhysicalExam #clinical #video #neck #crepitus

Subcutaneous Emphysema ... #Subcutaneous #Emphysema ... #video #neck #crepitus

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Palpable Skin Crepitus on Physical Exam

Notice these air bubbles under the skin. An 86-year-old woman with

Palpable Skin Crepitus ... history of severe emphysema ... extensive palpable crepitus ... is crepitus on ... skin #Palpable #Crepitus

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Fournier’s Gangrene - Physical examination was notable for necrotic-appearing tissue in the scrotum and perineum, with

induration and crepitus ... revealed subcutaneous emphysema ... FourniersGangrene #Emphysema

Radiographic Features of Pulmonary Diseases
- Pneumonia
- Atelectasis
- Emphysema
- Pneumothorax
- Effusion
-

Atelectasis - Emphysema ... Pneumothorax - Effusion ... Reticular - Emphysema

Patellofemoral Syndrome - Pathogenesis and clinical findings
• Anterior Knee Pain with possible symptoms of 'catching'

patellofemoral joint (crepitus ... • Secondary effusion ... joint with MRI effusion

Neck Subcutaneous Emphysema on Physical Exam

#Subcutaneous #Emphysema #PhysicalExam #clinical #video #neck #crepitus

Neck Subcutaneous Emphysema ... #Subcutaneous #Emphysema ... #video #neck #crepitus

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Neck Subcutaneous Emphysema ... #Subcutaneous #Emphysema ... #video #neck #crepitus

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Light's Criteria for Pleural Effusions

#Diagnosis #Pulmonary #Lights #Criteria #Pleural #Effusion #Differential

** GrepMed Recommended Text: Pocket Medicine:

Criteria for Pleural Effusions ... Criteria #Pleural #Effusion

Low Attenuation pattern
1. Lymphangiomyomatosis (LAM): uniform cysts in woman of child-bearing age; no history of

adenopathy and pleural effusion ... Centrilobular emphysema

Osteoarthritis (OA): Clinical findings
• Stimulation of joint nociceptors in subchondral bone -> Pain with loading

of the joint -> Crepitus ... production -> Joint effusion

Pathophysiology #COPD #Emphysema

#Emphysema Vs #Bronchitis

Pathophysiology #COPD #Emphysema

Pulmonary Tuberculosis - Patterns of Involvement
• Scarring, Nodules and Consolidation
- Lobar

- Loculated effusion ... or empyema ... - Pleural effusion

Empyema Necessitans (EN) on Chest Wall Physical Examination

Pulmonary teaching case: you are called to the bedside

Empyema Necessitans ... This is Empyema ... infected pleural effusion ... Because Empyema ... of the pleural effusion

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Causes of Dyspnea - Differential Diagnosis Algorithm
Cardiac:
• Dysrhythmia
• Ischemia
• Cardiomyopathy
• Valvular disease

Atelectasis • Emphysema ... Pleura: • Pleural effusion

The fourth pattern includes abnormalities that result in decreased lung attenuation or air-filled lesions.
These include:
- Emphysema
-

These include: - Emphysema ... TractionBronchiectasis #Cysts #Emphysema

Bronchitis • Emphysema

Acute Hypoxemia - Differential Diagnosis
• Hyperacute: Aspiration, Flash Pulmonary Edema, Mucous Plugging, Bronchospasm, Pulmonary Embolism,

Hemorrhage • Impaired Diffusion ... Pulmonary Embolism, Emphysema

Radiographic appearances of pulmonary diseases in HIV/AIDS Patients
• Diffuse Interstitial Infiltrates: Pneumocystis jirovecii, M.tuberculosis, Histoplasma

disease • Pleural effusion ... Parapneumonic effusion ... ; empyema, M.tuberculosis ... (NHL, primary effusion

Boerhaave Syndrome
Postemesis
Iatrogenic (most common)
Left Posterolateral most common

Mackler's Triad:
Lower Chest Pain
Vomiting
Subcutaneous Emphysema

#Boerhaave #Syndrome #Diagnosis #Signs

Subcutaneous Emphysema

Causes of Knee Effusions - Differential Diagnosis Framework

Knee Effusion Red Flags:
1. Fever/Chills/Joint pain/Night sweats/Weight loss
- DDX:
-

Causes of Knee Effusions ... Framework Knee Effusion ... Infectious Knee Effusions ... Traumatic Knee Effusions ... Malignant Knee Effusions

Empyema Necessitans (EN) on Chest POCUS

Pulmonary teaching case: you are called to the bedside of a

Empyema Necessitans ... This is Empyema ... infected pleural effusion ... Because Empyema ... @nickmmark #Empyema

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Antibiotics and CNS Diffusion

1. Drugs with good CNS diﬀusion:

- Fluoroquinolones, Fluconazole, voriconazole, Rifampin, Oxazolidinones, Metronidazole

2. Drugs

Antibiotics and CNS Diffusion ... Antibiotics #CNS #Diffusion ... #BloodBrain #Perfusion

Lung Auscultation and Physical Exam Findings in Selected Lung Disorders

#PhysicalExam #Auscultation #Pulmonary #Percussion #Dullness #Fremitus #BreathSounds

Percussion #Dullness #Fremitus

Pleural Effusion - Workup, Diagnostic Algorithm #Diagnosis #EM #IM #PCC #Pleural #Effusion #Transudative #Exudative #Differential #Algorithm

Pleural Effusion ... #PCC #Pleural #Effusion

severe underlying emphysema

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Ascites, pericardial effusion, and left pleural effusion on subcostal 4-chamber POCUS echocardiogram

Subcostal window in SLE patient.

Ascites, pericardial effusion ... and left pleural effusion ... Ascites, pericardial effusion ... , left pleural effusion ... #pericardial #effusion

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POCUS Pearls for Tamponade
- Pericardial Effusion
- Diastolic Right Ventricular Collapse
- Systolic Right Atrial Collapse
- Plethoric Inferior

- Pericardial Effusion ... Evaluation #Cardiology #Effusion

Illustrations showing elements of a shoulder assessment. Also included on a shoulder assessment would be determination

), atrophy and crepitus

Electrical Alternans demonstrated in Pericardial Effusion (Swinging Heart)

- HeartToProve @HeartToProve

#Electrical #Alternans #Clinical #POCUS #Echocardiogram #Pericardial #Effusion

in Pericardial Effusion ... #Pericardial #Effusion

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- Pericardial Effusion ... Evaluation #Cardiology #Effusion

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Emphysema C.

Hemorrhagic Pericardial Effusions (Hemopericardium)- Differential Diagnosis Framework

IATROGENIC DISEASE
Secondary to invasive cardiac procedures

NONIATROGENIC
• Malignancy (e.g., metastatic spread:

Hemorrhagic Pericardial Effusions ... tuberculous pericardial effusions ... #Pericardial #Effusion

Step by step approach for diagnosis of pleural effusion by Lung Ultrasound

https://doi.org/10.1007/s12630-018-1062-x

#Diagnosis #POCUS #Lung #Pleural #Effusion

diagnosis of pleural effusion ... Lung #Pleural #Effusion

Plankton Sign on Lung POCUS

Plankton sign = floating debris --> the swirling, punctiform internal echoes within

anechoic pleural effusion ... nature of the effusion ... POCUS #clinical #effusion

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How a Chest Tube Drainage System Works

Bottle 1: Fluid Collection. This is a simple collection bottle

from your pleural effusion ... pus from your empyema

$Differential Diagnosis of Pericardial Effusion Trauma Pericarditis Recent MI Autoimmune Neoplastic Endocrine/Metabolic Venous Congestion Medications - Dr. Tom Fadial https://twitter.com/thame #Pericardial$

of Pericardial Effusion ... #Pericardial #Effusion

Malignant Complex Pleural Effusion on Lung POCUS
You are starting your RUSH exam on febrile/hypotensive patient with

Complex Pleural Effusion ... malignant pleural effusion ... U/S could be empyema ... top of malignant effusion ... Complex #Pleural #Effusion

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Hypoxemia Differential Diagnosis Algorithm by A-a Gradient

Normal A-a Gradient:
• ↓ Atmospheric pressure
• Hypoventilation: CNS

(↑Shunting), ↓Perfusion ... Dead space) • ↓Diffusion

Upper lung zone preference is seen in:
- Inhaled particles: pneumoconiosis (silica or coal)
- Smoking related diseases

(centrilobular emphysema

Spine sign: visualization of the vertebral bodies in the thoracic cavity above the diaphragm indicative of

indicative of pleural effusion ... absence of pleural effusion ... Clinical #Pleural #Effusion

Exudative Pleural Effusions ... Exudative #Pleural #Effusions

Arthrocentesis - Joint Fluid Analysis

Effusion Characteristics (Color, Clarity, WCC, PMN, Crystals, Bacteria) by Disease Process:
OA,

Fluid Analysis Effusion ... Syonvial #Fluid #Effusion

Main Lung Ultrasound differences between COVID-19 involvement and other conditions that may yield respiratory symptoms
•

Consolidations, Pleural effusion ... Large pleural effusion ... localized pleural effusion

Hypoxemic Respiratory Failure - Differential Diagnosis Framework
DECREASED INSPIRED OXYGEN
• Low PATM Can decrease first part

syndrome, OSA DIFFUSION ... of reversible diffusion ... defects) VENTILATION/PERFUSION ... gradients of both perfusion ... with adequate perfusion

pleural effusion

Shoulder Effusion Ballottement on Physical Examination

Shoulder effusion. You can ballot and see fluid return at posterior

Shoulder Effusion ... Examination Shoulder effusion ... #Shoulder #Effusion

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Massive Pericardial Effusion on Echocardiogram

I recently saw the largest pericardial effusion of my life. Something out

Massive Pericardial Effusion ... largest pericardial effusion ... #Pericardial #Effusion

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Light's Criteria

Medical Nugget on Light's Criteria for diagnosis of Exudative Pleural Effusion in adults and children.

Exudative Pleural Effusion ... Pediatrics #Diagnosis #Effusion

Causes of Hypoxemia- Differential Diagnosis Algorithm
Ventilation/perfusion Mismatch
• Airway Disease (Asthma, COPD)
• Vascular (PE*)
•

Algorithm Ventilation/perfusion ... Parenchymal Disease Diffusion

#Pericardial #Effusion

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Knee Effusion: Trauma induced swelling of right knee.

Charlie Goldberg, M.D. - UCSD Catalog of Clinical Images

#Clinical

Knee Effusion: Trauma ... #Photo #Knee #Effusion

Shark Tail Appearance of Consolidated Lung on Pleural Effusion on POCUS

Dr. David Feller-Kopman @dfellerk

#Pleural #Effusion #pulmonary

Lung on Pleural Effusion ... dfellerk #Pleural #Effusion

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Clinical Management for Three Common Causes of Shock
HEMORRHAGIC SHOCK
• Ensure adequate ventilation and oxygenation.

Initiate judicious infusion ... of poor organ perfusion ... blood cell (PRBC) infusion ... kg, and titrate infusion ... • Begin PRBC infusion

Loculated pericardial effusion seen in apical 4-chamber on echocardiogram

Dr. J. Christian Fox @jchristianfox

#Pericardial #Effusion #Loculated #complex

Loculated pericardial effusion ... #Pericardial #Effusion

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Radiologists use many terms to describe areas of decreased density or lucencies within the lung, like

pneumatocele, emphysema ... with a thin wall Emphysema

Pleural #Fluid #Effusion

Cardiac MRI Demonstrating Electrical Alternans in Pericardial Effusion

Dr Prasad Jain @DrPrasadJain

#Pericardial #Effusion #Cardiac #MRI #Cine #CMRI

in Pericardial Effusion ... #Pericardial #Effusion

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Pericardial Effusion on EKG
• Electrical alternans
• Low voltage
• Sinus tachycardia (suggests possibility of

Pericardial Effusion ... #Pericardial #Effusion

Causes of Chronic Dyspnea - Differential Diagnosis Algorithm
Pericardial
• Effusion
• Cardiac Tamponade*
• Constriction
Myocardial
•

Pericardial • Effusion ... Abnormalities • Pleural Effusions

Hoover's Sign

Hoover’s sign refers to inward movement of the lower rib cage during inspiration- instead of

more specifically emphysema

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Cardiac Rupture with Pericardial Effusion

Apical 4 chamber. Note larger right sided pericardial effusion with significant compression

with Pericardial Effusion ... sided pericardial effusion ... #pericardial #effusion

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Large Pleural Effusion on Lung Ultrasound

That time when my ultrasound and surfing worlds suddenly collided

Dr. J.

Large Pleural Effusion ... jchristianfox #Pleural #Effusion

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Swinging Heart within a Large Pericardial Effusion on Cardiac MRI - Electrical Alternans Visualized

Prasad Jain, MD

Large Pericardial Effusion ... #Pericardial #Effusion

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Meigs Syndrome - Diagnosis and Management Summary
Triad:
1) Pleural effusion +
2) Ascites +
3) Benign Ovarian

Triad: 1) Pleural effusion ... Tumor R pleural effusion

Causes of Pleural Effusion - Differential Diagnosis Algorithm
Exudative Effusion:
- Pulmonary
•

Causes of Pleural Effusion ... Algorithm Exudative Effusion ... Transudative Effusion ... Normal #Pleural #Effusion

Malignant Pericardial Effusion causing Tamponade on POCUS

Parasternal long with some RV collapse explaining this cancer patient's

Malignant Pericardial Effusion ... #Pericardial #Effusion

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Brain Vascular Perfusion and Infarct Territories

By Dr. Eelco FM Wijdicks @EWijdicks

#Brain #Vascular #Perfusion #Infarct #Territories

Brain Vascular Perfusion ... Brain #Vascular #Perfusion

Differential diagnosis of Langerhans cell histiocytosis.
Nodular LCH:
- Sarcoidosis: perilymphatic distribution.
- Metastases: random distribution.
Cystic LCH:
- LAM: round

Centrilobular emphysema

Right pleural effusion with "spine sign" seen beautifully by using large footprint curvilinear transducer on lung

Right pleural effusion ... Lung #Pleural #Effusion

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Centrilobular emphysema

Cardiac Magnesium Infusion Protocol - Torsades de Pointes

#Magnesium #Infusion #Protocol #TorsadesDePointes #Management

Cardiac Magnesium Infusion ... #Magnesium #Infusion

Management of patients with known or suspected malignant pleural effusion (MPE) - An Official ATS/STS/STR Clinical

malignant pleural effusion ... Malignant #Pleural #Effusions

Causes of Pleural Effusions

Hydropneumothorax on Lung POCUS

HIV/AID(CD4<250) with cough, dyspnea.Left lung anterior mid. Left lung. Findings consistent with PNA.

Has pleural effusion ... hydropneumothorax #effusion

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Mechanical Cardiac Support Devices Compared
Cannula Size - Insertion Technique - Haemodynarnic Support
IABP:
• Afterload: Reduced
•

increase • Coronary perfusion ... Peripheral tissue perfusion ... Peripheral tissue perfusion ... Peripheral tissue perfusion ... Peripheral tissue perfusion

Chest Pain Diagnosis and Management Algorithm
STEMI:
- Hx: Pressure like CP, Radiation to arm/jaw, CAD risk

ingestion, HIV - PEX: crepitus

Cavities frequently arise within a mass or an area of consolidation as a result of necrosis.
We

associated pulmonary emphysema ... #Cavity #Cyst #Emphysema

Pericardial Clot on Echocardiogram

ST elevation of acute pericarditis was misdiagnosed as STEMI and thrombolysed with SK

hemorrhagic pericardial effusion ... #Pericardial #effusion

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Upper Lobe Lung Diseases - STAR CHASERS Mnemonic

S - Silicosis
T - Tuberculosis
A - Ankylosing Spondylitis
R -

ventilation to perfusion ... Centrilobular emphysema ... granulomatosis • Abnormal perfusion

Causes of Pericardial Effusion - Differential Diagnosis
Infectious:
• Viral: Enterovirus, Herpesvirus, Adenovirus, Parvovirus
• Bacterial: Mycobacterium

of Pericardial Effusion ... #Pericardial #Effusion

#pericardial #effusion

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Interventional bronchoscopic and surgical treatments for chronic obstructive pulmonary disease (COPD). Overview of various therapies used

with COPD and emphysema

Causes of Pleural Effusion - Differential Diagnosis Algorithm
Transudate - Hydrostatic
• Congestive heart failure
• Constrictive

Causes of Pleural Effusion ... 2LmUODZ #Pleural #Effusion

Dyspnea - Considerations with Malignancy
Directly Malignancy Related:
- Lymphangitic spread to lung
- Malignant pleural effusion

Malignant pleural effusion ... Malignant pericardial effusion

Differential Diagnosis for Hemolytic Anemia
Intrinsic Causes:
• Enzyme deficiencies ex. G6PD, pyruvate kinase
• Hemoglobinopathies

bites • IVIG infusion ... Hemoglobinuria • S/p IV infusion ... Rhogam • S/p IV infusion

Relevant Sonopathology of the Parasternal Long Axis (PLAX) - Point of Care Ultrasound
- Right Ventricular

- Pericardial Effusion

Hemothorax - Thoracic ultrasound in trauma
False positive for consolidated lung- organized clot in pleural space after

trauma #pulmonary #effusion

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Cough - Diagnostic Schema

Infectious: URTI, LRTI, Bacterial, Viral
Irritant/Exposure: Allergic, Post-infectious, Pneumonitis, ACEi, PTX, Foreign Body
Airway Disease:

Dz, Malignant effusion

Pleural effusion is not always visible as a meniscus in the costophrenic angle.
A subpulmonic effusion

Pleural effusion ... A subpulmonic effusion ... detect pleural effusion ... #CHF #Pleural #Effusion

A better approach to Torsades de Pointes - Algorithm and Magnesium Infusion Protocol

#TorsadesdePointes #Algorithm #Magnesium #Infusion

and Magnesium Infusion ... Algorithm #Magnesium #Infusion

Split Pleura Sign on Chest CT
• Contrast enhancement of the parietal and visceral pleura, separated

by an exudative effusion ... • DDx: Empyema ... , malignant effusions

Hepatopulmonary Syndrome - Diagnosis and Management Summary
A defect in arterial oxygenation due to a gas exchange

either due to a diffusion-perfusion ... and restricted diffusion ... radioactive lung perfusion

Pleural Effusions

Status Epilepticus
Continuous seizure activity > 5-10 min OR >= 2 seizures without full recovery
First line

(Phenytoin max infusion ... Fosphenytoin max infusion ... 0.5-10 mg/kg/hr infusion ... 1-15 mg/kg/hr infusion

possible pleural effusion

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Coronary Oxygen Balance

Myocardial Oxygen Demand <-> Coronary Artery Blood Flow <-> Oxygen Availability

#cardiac #oxygen #pathophysiology

anesthesiology #coronary #perfusion

High-Res Chest CT Patterns - Differential Diagnosis Framework
Reticular:
• Septal Thickening: Lymphangitic Carcinoma, Interstitial Edema, Alveolar

Attenuation: • Emphysema

Parapneumonic Empyema on Lung POCUS

Also note pleural effusion, air bronchograms, intraabdominal FF

Dr. Michael I. Prats @PratsEM

#Parapneumonic

Parapneumonic Empyema ... Also note pleural effusion ... Parapneumonic #Empyema ... ultrasound #complex #effusion

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Synovial Fluid Analysis:

Findings (COLOR TRANSPARENCY VISCOSITY WBC COUNT (PER MM3) PMN CELL COUNT (%) GRAM STAIN CULTURE PCR TEST CRYSTALS)

By Condition (Normal
Noninflammatory
Inflammatory:

Syonvial #Fluid #Effusion

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Small Bowel Infarction - Pathogenesis and Clinical Findings

Thankfully, bowel infarction in general is the rarest cause

reduced blood perfusion ... arteries, reduced perfusion ... If perfusion to

Inadequate tissue perfusion

Anxiety • Pleural Effusion

HHV8/KSHV-reIated diseases: From Cellular Proliferation to Hyperinflammation
Kaposi sarcoma (KS):
• Target organs: Ubiquitous (cutaneous and mucosal

splenomegaly, effusion ... Monotype Primary effusion ... Clinical features: Effusion

Lung ultrasound pathology in a COVID-19 positive patient
- Few B-lines (vertical white lines)
- Confluent

Small Tiny Pleural Effusions

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Algorithm - Approach to the differential diagnosis of the patient presenting with overt glomerular proteinuria. CMV

ear (unexplained effusions ... pain, pleural effusion

Chest Pain - Differential Diagnosis Framework

Cardiovascular Causes of Chest Pain:
• Myocardium:
- Myocarditis
- CAD/ACS
- Valvulopathy
- Myopericarditis

• Pleura: - Effusion

of intravenous infusion

Pink Puffer (Emphysema

Pulmonary Pathology and Associated Lung Ultrasound Findings
Pneumothorax:
- No lung sliding/barcode sign
- Lung point (hard

Possible small plural effusion ... Possible bilateral effusion

Tuberculous Pleural Effusions - Tests and Biomarkers
Age + fever + red blood cells + ADA -

Tuberculous Pleural Effusions ... Tuberculous #Pleural #Effusions

Dyspnea - Differential Diagnosis Framework

Cardiovascular Causes of Dyspnea:
• Myocardium:
- Heart failure
- CAD/ACS
- Valvulopathy
• Electrical:
-

• Pleura: - Effusion

Shock Classification Types - Pathophysiology Comparison

Obstructive Shock:
• Obstructive shock is characterized by a blockage in

massive pericardial effusion ... Tamponade: pericardial effusion

Assessment of Chest Tube Drains
Stepwise assessment of Chest Tube Function
TUBE POSITIONING
• Look at the CXR:

suction to large effusions ... Fr hemothorax/empyema ... drainage of an effusion

Focused Assessment with Sonography for HIV/TB - The FASH Exam

The main objective of the FASH exam

and pericardial effusions

Pulse and Poor Perfusion

Pediatric Elbow Injuries - Elbow Xrays

Check the fat pads on the lateral projection:
1. A displaced anterior

Not all joint effusions ... An effusion often

Knee Effusions - Arthrocentesis Interpretation

Inflammatory arthritis:
• Color: Yellow-> Green
• Clarity: Opaque
• Viscosity: Low

Knee Effusions - ... rav7ks #Knee #Effusions

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