Ultrasonography is increasingly used in medical education, but its impact on learning outcomes is unclear. Adding ultrasound may facilitate learning, but may also potentially overwhelm novice learners. Based upon the framework of cognitive load theory, this study seeks to evaluate the relationship between cognitive load associated with using ultrasound and learning outcomes. The use of ultrasound was hypothesized to facilitate learning in anatomy for 161 novice first-year medical students. Using linear regression analyses, the relationship between reported cognitive load on using ultrasound and learning outcomes as measured by anatomy laboratory examination scores four weeks after ultrasound-guided anatomy training was evaluated in consenting students. Second anatomy examination scores of students who were taught anatomy with ultrasound were compared with historical controls (those not taught with ultrasound). Ultrasound's perceived utility for learning was measured on a five-point scale. Cognitive load on using ultrasound was measured on a nine-point scale. Primary outcome was the laboratory examination score (60 questions). Learners found ultrasound useful for learning. Weighted factor score on "image interpretation" was negatively, but insignificantly, associated with examination scores [F (1,135) = 0.28, beta = -0.22; P = 0.61]. Weighted factor score on "basic knobology" was positively and insignificantly associated with scores; [F (1,138) = 0.27, beta = 0.42; P = 0.60]. Cohorts exposed to ultrasound had significantly higher scores than historical controls (82.4% ± SD 8.6% vs. 78.8% ± 8.5%, Cohen's d = 0.41, P < 0.001). Using ultrasound to teach anatomy does not negatively impact learning and may improve learning outcomes. Anat Sci Educ 10: 144-151. © 2016 American Association of Anatomists.

Pleural effusions are a common finding in many clinical settings and have important diagnostic and therapeutic implications.   They may be identified by physical exam, chest radiography, chest computerized tomography (CT) scans or point of care ultrasonography (POCUS).  The use of POCUS for the diagnosis and management of pleural effusions offers several advantages relevant to the practice of the general internist.  For the diagnosis of pleural effusion, POCUS has superior sensitivity and specificity when compared to chest radiography and physical exam.  Abnormal sonographic features of the pleural fluid and the adjacent pleura may suggest the presence of an exudative or malignant effusion. POCUS can be used to quickly estimate the size of a pleural effusion.  Lastly, the use of ultrasound guidance when performing a thoracentesis reduces the risk of pneumothorax and hemorrhage.

A previously healthy 71-year-old man presented with acute onset epigastric pain and was diagnosed with gallstone pancreatitis complicated by septic shock, acute kidney injury, and hypoxemic respiratory failure. Abdominal computed tomography (CT) scanning showed necrotizing pancreatitis. He was transferred to the intensive care unit (ICU) for mechanical ventilation, hemodynamic support, and further medical care. He did not require continuous pharmacological neuromuscular blockade or corticosteroids at any point. Due to clinical findings of abdominal compartment syndrome, the patient underwent decompressive laparotomy, followed by temporary maintenance of an open abdomen, on day 4 of admission. Laparotomy confirmed necrotizing gallstone pancreatitis, as well as an ischemic left colon necessitating resection. Multiple surgeries were required, including complete colectomy, creation of end-ileostomy, cholecystectomy, pancreatic debridement, abscess drainage, and finally wound closure on day 14 of admission.Despite discontinuation of sedation 1-week post admission, the patient exhibited profound generalized weakness including severe quadriparesis and ophthalmoplegia. The patient was consistently able to perform multistep tasks such as, "Tap your left index finger once, tap your right middle finger twice, and then tap with your left index finger again." The patient continued to demonstrate wakefulness through a tapping communications method developed in the ICU. Pupils were 3-4 mm with a sluggish light response. Bilateral C a n a d i a n J o u r n a l o f G e n e r a l I n t e r n a l M e d i c i n e 34V o l u m e 1 1 , I s s u e 1 , 2 0 1 6 Pseudo-Locked-In Syndrome and Apnea Due to Critical Illness Myopathy AbstractCritical Illness myopathy and polyneuropathy are common complications that occur in critically ill patients. Critical Illness myopathy and polyneuropathy are typically recognized in the ICU setting by the development of acquired weakness and failure to wean from ventilatory support. We report a case of a patient who developed severe critical illness myopathy that resulted in near-quadriplegia, apnea and ophthalmoplegia.

Critical Illness myopathy and polyneuropathy are common complications that occur in critically ill patients. Critical Illness myopathy and polyneuropathy are typically recognized in the ICU setting by the development of acquired weakness and failure to wean from ventilatory support. We report a case of a patient who developed severe critical illness myopathy that resulted in near-quadriplegia, apnea and ophthalmoplegia.