Introduction: Infective endocarditis (IE) is associated with high mortality (30%). Patients with structural cardiac disease or implanted hardware have higher risk for IE (23-47%). Diagnosis per the 2023 Duke–International Society for Cardiovascular Infectious Diseases criteria is by pathological confirmation or the major/minor criteria. Major criteria include ≥ 2 positive blood culture sets, echocardiography or computed tomography vegetation visualization, and surgical visualization. Septic emboli symptoms (which complicate 25% of IE cases) include neurological deficits or shortness of breath. Early intravenous antimicrobial therapy within one hour for patients who meet sepsis criteria is recommended per Infectious Diseases Society of America guidelines. Case report: A middle-aged male with recent IE and aortic valve prosthesis presented to the emergency department with altered mental status and hypoglycemia. He had right basilar lung rales but no heart murmur, leg swelling, or jugular venous distension. He met sepsis criteria with leukocytosis and hypothermia. Computed tomography head was performed due to his altered mental status and revealed a right parietal-occipital hypodense lesion concerning for an abscess with edema and mass effect. Given his history of IE and ill appearance, three blood culture sets were drawn and intravenous antibiotics initiated. The patient was admitted to the hospital with magnetic resonance imaging confirming brain abscess; and neurosurgery performed a craniotomy with brain abscess evacuation. Intravenous antibiotics were continued for four weeks for septic brain emboli from recent IE. Conclusion: Clinicians should keep a broad differential for altered mental status patients. Sepsis patients should have antimicrobials initiated within one hour. Expedited diagnosis with three sets of blood cultures, echocardiography, and surgical consult should be completed in patients with suspected infective endocarditis for improved patient outcomes. Finally, clinicians should evaluate for septic emboli symptoms such as neurological deficits or respiratory symptoms.

Point-of-care ultrasound (POCUS) is a dynamic imaging modality that can diagnose musculoskeletal and tendon injuries to facilitate appropriate orthopedic care and improve patient outcomes. This manuscript illustrates the value of dynamic POCUS to distinguish between complete and partial tendon injuries at the patient’s bedside, which is important for management and disposition planning in emergency department (ED) or clinic patients with acute trauma. In this case, a healthy 34-year-old male presented with acute left knee pain and swelling after a fall. He had a deformity superior to his patella and could not actively extend his left knee. Left knee X-ray was negative for fracture. POCUS demonstrated a disrupted left distal quadriceps tendon with anechoic fluid, tendon enlargement, and proximal tendon retraction. Importantly, a dynamic POCUS video cine loop revealed no contiguous tendon mobility with passive extension of the left knee (when movement is performed by the physician), confirming that this was a complete and not partial tendon tear. The patient was discharged in an extension knee brace. Outpatient magnetic resonance imaging confirmed the complete left quadriceps tendon rupture, and he underwent orthopedic surgery with good outcomes. Thus, early dynamic musculoskeletal POCUS confirmed a complete tendon injury, guiding expedited surgical treatment to prevent permanent damage and disability.

Over 350,000 patients experience out-of-hospital cardiac arrest annually in the United States. Patients presenting to the emergency department (ED) in cardiac arrest are critically ill and require emergent clinical decisions and treatment. Point-of-care ultrasound (POCUS) is useful as a rapid, bedside diagnostic imaging tool to help elucidate possible causes of cardiac arrest and guide management. Using a validated systematic approach such as the SHoC and CASA protocols, clinicians can safely perform POCUS with shortened pauses during pulse checks. POCUS is key in evaluating cardiac arrhythmias such as ventricular fibrillation (VF), which has higher survival rates with defibrillation, versus cardiac standstill, which has higher mortality per recent research studies. When performed by experienced users, POCUS also facilitates identification of reversible causes for improved cardiac arrest patient outcomes and can guide decisions in resuscitative efforts. In summary, this manuscript is a narrative review that illustrates identifiable POCUS findings and synthesizes them to guide potential emergent intervention in patients in cardiac arrest including: ventricular fibrillation, cardiac standstill, pericardial effusion, cardiac tamponade, right heart strain such as from acute pulmonary embolism, reduced cardiac function, wall motion abnormality, ruptured ventricular pseudoaneurysm, and aortic dissection.

Abdominal pain is a common presentation in the emergency department (ED). Ultrasound is the first-line diagnostic imaging modality for right upper quadrant pain. Point-of-care ultrasound (POCUS) is a focused examination that can be performed at the patient’s bedside to evaluate acute and emergent biliary pathology. The advantages of POCUS include avoiding the potential safety risks associated with transporting critically ill patients, no exposure to ionizing radiation, potentially reduced costs, and rapid diagnosis. This narrative review synthesizes key sonographic findings and techniques for emergent and non-emergent biliary diseases that physicians should recognize at first glance. We present significant and interesting images of cholelithiasis, acute cholecystitis, emphysematous gallbladder, choledocholithiasis or sludge, Mirizzi syndrome, post-operative biliary obstruction, gallbladder polyps, biliary neoplasms, and malignant-appearing lesions or masses. Finally, this review integrates POCUS into clinical pathways to guide decisions regarding additional abdominal imaging, such as computed tomography or radiology-performed ultrasound, and surgical consultation.