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Classic Wenckebach-Block ( AV Block grade II Mobitz I)

60 years old male patient coming to ER due to recurrent vomiting after eating. Vitally was stable und laboratory investigations showed nothing valuable. So he was admitted to the Ward for further investigations. Gastroscopy was done which showed Achalasia. CVC was inserted to give Parenteral nutrition. Everything was ok but after 2 days started to complain of shortness of breath and tachypnea.

X-Ray after inserting CVC

X-Ray 2 days later

Ultrasound shows big pleural effusion so pleural catheter was inserted and that’s what came out

After laboratory investigation, it’s just Smofkabiven ( parenteral nutrition) in the Pleura. No bleeding and no Pneumothorax !
Smofkabiven Thorax !

X-Ray follow up 2 days later after pleural catheter insertion

50 year old patient with COPD exacerbation. Suddenly he had developed tachypnea and tachycardia up to 160/min SR with saturation drop to 75%. BGA showed PH of 7.1 and pco2 110, he was connected to NIV and treated with 100 mg prednisolone, 10 mg morphine, salbutamol/atrovent and adrenaline inhalation, 1 gm magnesium. Nevertheless BGA control was still worse with PH 6.9, pco2 150 mmHg. therefore he was intubated emergency. With V.a. tension pneumothorax, an X-ray was requested.

See Below.

Tension pneumothorax established.
Firstly a wide bore cannula was placed in second intercostal space midclavicular line. Then a thoracic drainage was inserted, the lung is re-inflated.

In case of COPD exacerbation please think about tension pneumothorax

This is how massive pulmonary embolism shows in Echo:
• RV wall hypokinesis
• RV dilatation

Ecg of a young patient with extensive pulmonary embolism
Its a rare sign to see ( S1Q3T3) :

Prominent S wave in lead I.
Large Q wave in lead III.
T wave inversion or flat T wave in lead III.

How could you see Pneumothorax with ultrasound ?
You can use linear ultrasound probe in midclavicular line with marker directed towards patient head (long axis view) or (short axis view) with marker directed towards shoulder.
As you see, this is parietal and visceral pleura sliding toward each others with shadows coming through know as comets tails. This is the normal finding of the pleura. You can see it clearer with short axis view

As a pathological result:
This a patient with pleural effusion, you can see that the parietal and visceral pleura away from each others with the gap in between full of fluids.

For more details please see this video