Ultrasound to the Rescue! – Dr Shannon

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A 19 year old male presents with an open right femur fracture after an MVC.  No complaints of CP, SOB.  Prelim read of the CXR is normal…

However, you’ve already consented the patient for the chest tube on the basis of your E-FAST!

E-Fast Right Lung

E-Fast Left Lung

You take a closer look at the CXR…

(click on image to enlarge)

… And also the CT C-spine…

(click on image to enlarge)

Because the patient is clinically stable and on O2, you go ahead and get the trauma CT, the patient accompanied by the Trauma service team.  An anterior coronal cut, and a more posterior coronal cut are shown.

(click on image to enlarge)

(click on image to enlarge)

How does this jive with your US?  With the CXR?  What is the significance of the “lung point” on E-FAST?

Forewarned is fore-armed, and the Trauma team puts in a right sided chest tube for his femur surgery which will require endotracheal intubation and positive pressure ventilation.  The tiny L-apical pneumo remains stable & then resolves during the subsequent hospital course.

(Many thanks to Dr Washington,  Dr Eng, and Dr Chew for this case!)



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