Bedside ultrasound is not yet the standard of care. But it will be.

I just read a Clinical Problem Solving case from the New England Journal of Medicine (NEJM). It was entitled “Stream of Consciousness“and it told the story of a 65-year-old man who was a patient at the Brigham and Women’s Hospital of Harvard Medical School, arguably one of the finest medical institutions in the world. These cases are presented in single paragraphs to a clinical expert physician who then comments about his or her thought processes and discusses how he or she would have handled the situation. In this narrative, the patient presented to a different hospital in New England with kidney failure and a gradual onset of confusion in the setting of very high blood pressure. He was then transferred to the Brigham and Women’s Hospital for further evaluation and treatment. He had lab tests of all color and stripe along with MRI and CT scans of his brain which showed some disconcerting spots. He had a lumbar puncture, and his high blood pressure was treated. Eventually, after 2 or 3 days in the hospital (I can’t tell from the narrative), an ultrasound was done which showed that his bladder had not been emptying properly, which had caused the kidney failure and probably the high blood pressure. A Foley catheter was placed which drained nearly 3 liters (!) of urine after which his blood pressure was much more easily controlled. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social medi...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Hospital-Based Medicine Neurology Source Type: blogs