This immediately got his attention, as it should, as it is a positive view with free fluid shown between the liver and the kidney (appearing black). He immediately ordered a CT angio and the patient was found to have a renal artery aneurysm rupture. He subsequently began to have more unstable vitals after back from CT, but thanks to Jim, the diagnosis was made quickly and made known – specialist admitted for repair – GREAT JOB Jim!
The other QAs of the month go to Dr. Zoe Howard and Dr. Don Schreiber. Although both are receiving this for different patients that presented in different ways, it was the same ultrasound application performed with the same image resulting in expeditious work up and admission for immediate intervention. One had a history of cancer and shortness of breath while the other had chest pain with known recent pericarditis diagnosis. Both were tachycardic with low BP, mentating well. The below image was seen and the cardiology specialist were called for a pericardial window: