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Re: Protocols for ER PelvicsFrom: Elison R Marshall (emdee2@juno.com)Tue Aug 25 06:50:36 1998
I agree totally. Do the easiest for the patient first and THEN if the question is not answered the abdominal scan can be done. Many times when ruling out ectopic I initially scan abdominally without a full bladder. With an anteverted uterus you can see the fundus very easily and verify an IUP or not. Essentially the exam is done in a few seconds. The question of an IUP has been answered. Full bladders for acute pelvic situations regretfully will take a long time before radiologists change their mind. Not long ago I participated in the ER with an OB/GYN doctor who just wanted to assurre the patient of her IUP. She had had a distended bladder which she could not empty. The doctor emptied her bladder, then asked if we could just do a TV exam for reassurance. I did that and after telerading the result, was told by the radiologist that it was an INADEQUATE exam, that it was she that had to dictate the report. She even wanted to read me the ACR protocols as if I didn't know them. I also do many OB exams for a group of OB/GYN doctors and we don't extend their bladders and take great pleasure in seeing them squirm. Very adequate sonography can be done without a distended bladder. This is a holdover IMO of static B scanning days. What do we do to rule out previa; we empty their bladder. In fact many times when doing a pelvic sono, if I could not see the ovaries I do a post void exam and am able to most times see the ovaries. Experience is a wonderful thing. Ellison Marshall, BSRT, RDMS
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