Cullen's sign. Lipase 1,781. Bruising in the skin around the umbilicus. This sign is named after Dr. Thomas Stephen Cullen, a Canadian gynecologist who first described it in the early 20th century. It is often associated with acute pancreatitis but can also be seen in other conditions that cause bleeding in the abdomen. Appearance: Cullen's sign is characterized by a blue or purple discoloration around the umbilicus. This discoloration results from the seepage of blood from the pancreas or other abdominal organs into the layers of the abdominal wall. Pathophysiology: The sign indicates intra-abdominal bleeding, which might be due to pancreatic necrosis, ectopic pregnancy, or other causes. In the context of acute pancreatitis, the release of pancreatic enzymes can lead to the digestion of blood vessels and subsequent bleeding. Clinical Significance: While it's a rare sign, its presence is a significant clinical finding. It suggests severe intra-abdominal pathology and often indicates a serious condition requiring urgent medical attention. Diagnosis and Context: It's essential to understand that Cullen's sign is not diagnostic on its own but should prompt further investigation. It's typically a late sign in acute pancreatitis and appears several days after the onset of other symptoms. In summary, Cullen's sign is a visual cue that can point towards serious underlying conditions, and its recognition is important in the diagnostic process. #cullensign #em #pancreatitis #cullen #clinical #image #emergencymedicine #peritonitis #IM #FM #ICU #surgery

Tick attached to skin in axilla for approximately 48 hours. #EM #ID #procedures #pathology #tick #tickremoval #ticks

Tick removed using fine suture looped in a half-hitch around the tick between the skin and tick's body. #EM #ID #procedures #pathology #tick #tickremoval #ticks

Removing a taser barb from a patient’s back. #TaserBarb #removal #clinical #video #foreignbody #forceps #trauma

17-year-old male s/p syncopal episode. #Brugada type 3 seen on 12 lead #EKG. Diagnosis confirmed by Pediatric #Cardiology. The patient received an AICD. #cardiology #ekg #electrocardiogram #diagnosis #em #peds #pediatrics

Traumatic lingual hematoma after a seizure. #trauma #airway #em #photo #diagnosis

Aortic dissection. #radiology #ctchest #diagnosis #radiologyassistant #em

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Weingart Assessment: LLS Score (WALLS) #algorithm #management #em #gibleed